Pathway Analysis for Healthy Worker Survivor Bias in a Cohort of Actively Employed Aluminum Fabrication Workers

Details

• Personal Author:
  Brown DM ; Costello S ; Cullen MR ; Eisen EA ; Hammond SK
• Description:
  Healthy worker survivor bias arises when there is a time-varying confounder on the causal pathway. In a cohort of 8290 actively employed aluminum fabrication workers followed from 1998 to 2009, we conducted a pathway analysis for PM2.5 exposure and incident ischemic heart disease (IHD) focused on two risk factors potentially on the causal pathway: incident hypertension and diabetes. For bias to occur, the three necessary associations are A) prior exposure and the risk factors, B) the risk factors and subsequent exposure, and C) the risk factors and outcome. There were 449 cases of IHD, 2402 cases of hypertension and 859 cases of diabetes. Modeled as a continuous variable (mg/m3), prior PM2.5 predicted hypertension (adjusted odds ratio (OR): 1.04 (95% confidence Interval (CI): 1.01, 1.06)) but not diabetes. Hypertension diagnosis was associated with a 0.01 mg/m3 reduction (standard error 0.006) and diabetes diagnosis was associated with a 0.02 mg/m3 (standard error 0.01) reduction in subsequent PM2.5 exposure. Hypertension and diabetes were both strong risk factors for incident IHD: the OR for hypertension was 1.96 (CI: 1.60, 2.40) and for diabetes was 2.60 (CI: 2.02, 3.26). Evidence suggests that hypertension, but not diabetes, may be on the causal pathway between PM2.5 exposure and IHD. There is modest evidence that hypertension may also be a confounder, thus g-methods are needed to reduce healthy worker survivor bias. In addition, both risk factors predicted leaving work before the age of 60 (censoring) with an OR of 1.36 (CI: 1.19, 1.94) and 1.30 (CI: 1.07, 1.57), for hypertension and diabetes, respectively. To address this potential selection bias, we will need to incorporate censoring weights in all future analyses of PM2.5 exposure and IHD. [Description provided by NIOSH]
• Subjects:
  Aluminum Compounds Blood Cardiovascular Diseases Cardiovascular System Dust Hematologic Diseases Metals Metal Workers Morbidity Occupational Health Particulate Matter Risk Assessment Risk Factors Safety

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• Keywords:
  Aluminum Industry Blood Sugar Disorders Exposure Assessment Health Effects Heart Disease Hypertension Metal Dusts Metal Industry Workers Morbidity Rates Particulate Dust Risk Factors

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• ISSN:
  0002-9262
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Abstract or Summary
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  177
• NIOSHTIC Number:
  nn:20053721
• Citation:
  Am J Epidemiol 2013 Jun; 177(Suppl 11):S75
• CAS Registry Number:
  Aluminum (CAS RN 7429-90-5)
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of California, Berkeley
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  American Journal of Epidemiology
• Supplement:
  11
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:00ce42869376e820d86f3ad4b7a0a6aef1888e000f798186fa1c02541ff4674d199617bdf3ff4fda68b7ca808d7cec898e43beaa03b5421f7621bccc231ab6fd
• Download URL:
  https://stacks.cdc.gov/view/cdc/216433/cdc_216433_DS1.pdf
• File Type:
  [PDF - 61.62 KB ]