Social disparities in heart disease risk and survivor bias among autoworkers: an examination based on survival models and g-estimation
Published Date:Nov 21 2014
Source:Occup Environ Med. 2015; 72(2):138-144.
Air Pollutants, Occupational
European Continental Ancestry Group
Health Status Disparities
Healthy Worker Effect
Healthy Worker Survivor Effect
Pubmed Central ID:PMC4316942
Funding:R01 OH008927/OH/NIOSH CDC HHS/United States
To examine gender and racial disparities in ischaemic heart disease (IHD) mortality related to metalworking fluid exposures and in the healthy worker survivor effect.
A cohort of white and black men and women autoworkers in the USA was followed from 1941 to 1995 with quantitative exposure to respirable particulate matter from water-based metalworking fluids. Separate analyses used proportional hazards models and g-estimation.
The HR for IHD among black men was 3.29 (95% CI 1.49 to 7.31) in the highest category of cumulative synthetic fluid exposure. The HR for IHD among white women exposed to soluble fluid reached 2.44 (95% CI 0.96 to 6.22). However, no increased risk was observed among white men until we corrected for the healthy worker survivor effect. Results from g-estimation indicate that if white male cases exposed to soluble or synthetic fluid had been unexposed to that fluid type, then 1.59 and 1.20 years of life would have been saved on average, respectively.
We leveraged the strengths of two different analytic approaches to examine the IHD risks of metalworking fluids. All workers may have the same aetiological risk; however, black and female workers may experience more IHD from water-based metalworking fluid exposure because of a steeper exposure–response or weaker healthy worker survivor effect.
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