December 2021 additions to NERDB

December 2021 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database on the NERDB page

On the website, we will publish regular updates on new disease-exposure combinations we added to the database. Currently, we have 324 entries. Ordered by year in which the abstract is published

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Last new entries:

Photo by Patrick Hendry on Unsplash

Montén, Adam MB BCh; Bryngelsson, Ing-Liss BSc; Fornander, Louise PhD; Wiebert, Pernilla PhD; Vihlborg, Per MD Occupational Quartz Exposure in a Population of Male Individuals—Association With Risk of Developing Atrial Fibrillation, Journal of Occupational and Environmental Medicine: June 2020 – Volume 62 – Issue 6 – p e267-e272

Occupational quartz exposure is a health risk, with an increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases. To evaluate this, a population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job-exposure matrix.

The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06–2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02–4.10). The main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m3 mean quartz dust) men aged 20 to 55 years.

Del Monaco A, Gwini SM, Kelly S, de Klerk N, Benke G, Dennekamp M, Fritschi L, Dimitriadis C, William Bill Musk A, Abramson MJ, Sim MR. Respiratory outcomes among refinery workers exposed to inspirable alumina dust: A longitudinal study in Western Australia. Am J Ind Med. 2020 Dec;63(12):1116-1123. doi: 10.1002/ajim.23182. Epub 2020 Sep 17. PMID: 32944994..

Information is scarce about the occupational health effects of exposure to alumina dust. This study examines the respiratory effects of respirable alumina dust exposure in alumina refineries.

An inception cohort study at three alumina refineries in Western Australia recruited 416 participants (351 males, 65 females) between 1995 and 2000 who were followed up annually until 2008 or until exit from the study. At each health interview, a respiratory questionnaire and lung function test was undertaken, measuring forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Participants provided job histories which were combined with air monitoring data to calculate cumulative exposure to respirable alumina dust (mg/m3 -years). Generalized estimating equations with Poisson distribution and mixed-effects models were used to examine the effects of alumina exposure.

The number of exposed participants was relatively small (n = 82, 19.7%). There was no association between alumina dust exposure and prevalence of cough, wheeze, or rhinitis. No associations were found between measures of lung function and tertiles of alumina exposure in the first two follow-ups, or the whole follow-up period, though there was a suggestive dose-response trend across exposed groups for the decline in absolute FEV1 (p for trend = .06). For the mean annual change in FEV1 and FVC based on the first three follow-ups, it was not possible to rule out an effect above a threshold level of exposure.

There is no evidence of an association between exposure to alumina and the reporting of respiratory symptoms, but some evidence for an effect on lung function.

Lindström I, Ryhänen AM, Jungewelter S, Suojalehto H, Suuronen K. Asthma onset after exposure to fluorinated hydrocarbons in the presence of combustion. Am J Ind Med. 2020 Nov;63(11):1054-1058. doi: 10.1002/ajim.23181. Epub 2020 Sep 12. PMID: 32918746.

Fluorinated hydrocarbons, which can thermally degrade into toxic hydrofluoric acid, are widely used as, for example, cooling agents in refrigerators and air conditioning systems and as medical aerosol propellants. Hydrofluoric acid is a known causative agent of irritant-induced asthma.

The authors report on two patients with asthma initiation shortly after exposure to fluorinated hydrocarbon-based cooling agents while welding or smoking cigarettes in a confined space. Both cases developed respiratory symptoms and headache and later demonstrated nonspecific bronchial hyperresponsiveness. In follow-up, asthma was persistent and responded poorly to asthma medication.

Exposure to the fluorinated hydrocarbons themselves is unlikely to have caused asthma due to their low toxicity. Instead, exposure to small amounts of hydrofluoric acid via the thermal degradation of the fluorinated hydrocarbons was considered the most likely cause of asthma onset. This is supported by the typical clinical picture of irritant-induced asthma and acute symptoms resembling hydrofluoric acid poisoning.

When fluorinated hydrocarbons are used in the presence of combustion, thermal degradation may lead to the formation of hydrofluoric acid. In confined spaces, this exposure may induce asthma via irritation. Welding, smoking, and other sources of combustion in confined spaces may be a risk in workplaces and other places in which fluorinated hydrocarbons are used.

Bertke SJ, Keil AP, Daniels RD. Lung Cancer Mortality and Styrene Exposure in the Reinforced-Plastics Boatbuilding Industry: Evaluation of Healthy Worker Survivor Bias. Am J Epidemiol. 2021 Sep 1;190(9):1784-1792. doi: 10.1093/aje/kwab108. PMID: 33847736; PMCID: PMC8628256..

The evidence for styrene’s being a human lung carcinogen has been inconclusive. Occupational cohorts within the reinforced-plastics industry are an ideal population in which to study this association because of their relatively high levels of exposure to styrene and lack of concomitant exposures to other known carcinogens. However, healthy worker survivor bias (HWSB), where healthier workers stay employed longer and thus have higher exposure potential, is a likely source of confounding bias for exposure-response associations, in part due to styrene’s acute effects.

Through December 31, 2016, we studied a cohort of 5,163 boat builders exposed to styrene in Washington State who were employed between 1959 and 1978; prior regression analyses had demonstrated little evidence for an exposure-response relationship between styrene exposure and lung cancer mortality.

Based on estimates of necessary components of HWSB, we found evidence for a potentially large HWSB. Using g-estimation of a structural nested model to account for HWSB, we estimated that 1 year of styrene exposure at more than 30 parts per million accelerated time to lung cancer death by 2.29 years (95% confidence interval: 1.53, 2.94).

Our results suggest possibly strong HWSB in our small cohort and indicate that large, influential studies of styrene-exposed workers may suffer from similar biases, warranting a reassessment of the evidence of long-term health effects of styrene exposure.

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