Health Assessment Document for Diesel Emissions - NSCEP | US ...
Health Assessment Document for Diesel Emissions - NSCEP | US ...
Health Assessment Document for Diesel Emissions - NSCEP | US ...
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1 8.4.7. Steineck et al. (1990): Increased Risk ofUrothelial Cancer in Stockholm From 1985<br />
2 to 1987, After Exposure to Benzene and Exhausts<br />
3 This study was conducted to investigate the association between benzene, diesel, and<br />
4 petrol exhausts as well as some other industry-related chemicals and the risk ofurothelial cancer.<br />
5 Designed as a population-based case-control study, it was conducted among all men born<br />
6 between 1911 and 1945 and living in the County of Stockholm <strong>for</strong> all or part ofthe observation<br />
7 period (September 15, 1985, to November 30, 1987). All incident cases ofurothelial cancer and<br />
8 squamous-cell carcinoma of the lower urinary tract were contacted <strong>for</strong> jnclusion in the study.<br />
9 Controls were selected by stratified random sampling during the observation period from a<br />
1 0 computerized register <strong>for</strong> the population of Stockholm. A postal questionnaire was sent to study<br />
11 subjects at their homes to collect in<strong>for</strong>mation on occupational history. The questions on<br />
12 occupation included exposure to certain specified occupations/industries/chemicals and lists of<br />
13 all jobs held and duration in each job. An industrial hygienist, unaware of case-control status,<br />
14 classified subjects as being exposed or unexposed to 38 agents and groups of substances,.<br />
15 including 17 exposure categories with aromatic amines. Using all the exposure in<strong>for</strong>mation, the<br />
16 exposure period was defined and the annual dose was rated as low, moderate, or high based on<br />
17 the accumulated dose (exposure duration multiplied by intensity of exposure) during the course<br />
18 of 1 average year <strong>for</strong> the defined exposure period. Swedish and international data were used to<br />
19 classify subjects as exposed, based on air concentrations in the. work environment that were<br />
20 higher than-<strong>for</strong> the general public, or skin contact with liquids of low volatility. To allow <strong>for</strong><br />
21 latency, the authors ignored exposures after 1981. Data were gathered from 256 cases and 287<br />
22 controls. Controls were selected by stratified random sampling four times from the computerized<br />
23 register during the observation period ofthe population ofthe County of Stockholm. These<br />
24 subjects comprised 80% of eligible cases and 79% of eligible controls. Nine of the cases and<br />
25 16% of the controls refused to participate in. the study. The distribution ofurothelial cancers was<br />
26 as follows: 5 tumors in the renal pelvis, 243 in the urinary bladder, 5 in the ureter, none in the<br />
27 urethra, and 3 at multiple sites. Two cases who were exposed to a high annual dose of aromatic<br />
28 amines were omitted from all further analysis to eliminate their confounding effects. Crude<br />
29 relative risks were calculated <strong>for</strong> men classified as exposed or not exposed to several substances.<br />
30 TwentY:·five cases and 19 controls reported having been exposed to diesel exhaust, yielding an<br />
31 odds ratio of 1.7 (95% CI = 0.9, 3.3). The corresponding relative odds<strong>for</strong> petrol exhausts, based<br />
32 on 24 cases and 24 controls, were 1.0 (95% CI = 0.5, 1.9). Odds ratios were then calculated <strong>for</strong><br />
33 low, moderate, and high levels of the annual dose adjusted <strong>for</strong> smoking and year of birth. :For<br />
. 34 diesel exhausts, the odds ratio was 1.3 (95% CI = 0.6, 3.1) <strong>for</strong> low levels, 2.2 (95% CI = 0.7, 6.6)<br />
35 <strong>for</strong> moderate levels, and 2.9 (95% CI = 0.3, 30.0) <strong>for</strong> high levels, indicating a dose response.<br />
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