Social disparities in heart disease risk and survivor bias among autoworkers: an examination based on survival models and g-estimation

Details

• Alternative Title:
  Occup Environ Med
• Personal Author:
  Costello, Sadie ; Picciotto, Sally ; Rehkopf, David H ; Eisen, Ellen A
• Description:
  Objectives
  
  To examine gender and racial disparities in ischaemic heart disease (IHD) mortality related to metalworking fluid exposures and in the healthy worker survivor effect.
  
  Methods
  
  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.
  
  Results
  
  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.
  
  Conclusions
  
  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.
  
  
• Subjects:
  Aged Air Pollutants, Occupational Automobiles Bias (Epidemiology) Black Or African American Female Health Status Disparities Healthy Worker Effect Humans Male Manufacturing Industry Metals Middle Aged Models, Statistical Myocardial Ischemia Occupational Diseases Occupational Exposure Occupations Particulate Matter Risk Factors Sex Factors Survival Rate White

  More +
• Source:
  Occup Environ Med. 2015; 72(2):138-144.
• Pubmed ID:
  25415971
• Pubmed Central ID:
  PMC4316942
• Document Type:
  Journal Article
• Funding:
  R01 OH008927/OH/NIOSH CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  72
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e8d7354b19108f0c9a4ab341a91494aa18fb797d5351190aa72e449b50bd39ce
• Download URL:
  https://stacks.cdc.gov/view/cdc/32270/cdc_32270_DS1.pdf
• File Type:
  [PDF - 566.29 KB ]