May 2021 additions to NERDB

May 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 296 entries. Ordered by year in which the abstract is published

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Last new entries:

Stanganelli I, De Felici MB, Mandel VD, Caini S, Raimondi S, Corso F, Bellerba F, Quaglino P, Sanlorenzo M, Ribero S, Medri M, Farnetani F, Feliciani C, Pellacani G, Gandini S; IMI the Italian Melanoma Intergroup. The association between pesticide use and cutaneous melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2020 Apr;34(4):691-708. doi: 10.1111/jdv.15964. Epub 2019 Oct 28. PMID: 31541557.

The incidence of cutaneous melanoma (CM), the deadliest form of skin cancer, has gradually increased in the last decades among populations of European origin. Epidemiological studies suggested that farmers and agricultural workers are at an increased risk of CM because they were exposed to pesticides. However, little is known about the relationship between pesticides and CM. To investigate the association between exposure to pesticides and CM by systematically reviewing the literature. A secondary aim was to determine the categories of pesticides mainly involved in CM development. A systematic review of the literature was performed up to September 2018 using MEDLINE, Embase and Web of Science. Studies assessing CM risk in licensed pesticide applicators were considered. Strict criteria were established to select independent studies and risk estimates; random effect models, taking into account heterogeneity, were applied. A pooled risk estimate for CM was calculated for the use of each type of pesticide and type of exposure. Between-study and estimate heterogeneity was assessed and publication bias investigated.

A total of nine studies (two case-controls and seven cohorts) comprising 184,389 unique subjects were included. The summary relative risks for the categories ‘herbicides – ever exposure’, ‘insecticides – ever exposure’, ‘any pesticide – ever exposure’ and ‘any pesticide – high exposure’ resulted 1.85 [95% confidence interval (CI): 1.01, 3.36], 1.57 (95% CI: 0.58, 4.25), 1.31 (95% CI: 0.85, 2.04) and 2.17 (95% CI: 0.45, 10.36), respectively. Herbicides and insecticides had no between-study heterogeneity (I2 = 0%), while a significant heterogeneity (I2 > 50%) was detected for the high exposure to any pesticide. No indication for publication bias was found. Individuals exposed to herbicides are at an increased risk of CM. Future properly designed observational studies are required to confirm this finding.

Spraying pesticides- Picture by Erich Westendarp via Pixabay

Faruque MO, Boezen HM, Kromhout H, et al Airborne occupational exposures and the risk of developing respiratory symptoms and airway obstruction in the Lifelines Cohort Study Thorax Published Online First: 02 March 2021. doi: 10.1136/thoraxjnl-2020-216721.

To date, only a few studies have investigated the associations between occupational exposures and respiratory outcomes longitudinally in the general population. The researchers investigated the associations between occupational exposures and the development of respiratory symptoms and airway obstruction in the Lifelines Cohort Study. They included 35,739 occupationally active subjects with data on chronic cough, chronic phlegm, chronic bronchitis or airway obstruction at baseline and approximately 4.5 years follow-up. Exposures to biological dust, mineral dust, gases/fumes, pesticides, solvents and metals in the current job at baseline were estimated with the ALOHA+job-exposure matrix (JEM). Airway obstruction was defined as FEV1/FVC below the lower limit of normal. Logistic regression analysis adjusted for baseline covariates was used to investigate the associations.

At follow-up, 1888 (6.0%), 1495 (4.7%), 710 (2.5%) and 508 (4.5%) subjects had developed chronic cough, chronic phlegm, chronic bronchitis and airway obstruction, respectively. High exposure to biological dust was associated with a higher odds to develop chronic cough and chronic bronchitis. High exposure to pesticides was associated with a higher odds for the development of all respiratory symptoms and airway obstruction. In the multiple exposures analyses, only the association between pesticides exposure and respiratory symptoms remained. Subjects exposed to high pesticides had a higher odds to develop respiratory symptoms on average 4.5 years later. Control measures should be taken to reduce pesticides exposure among the working population to prevent respiratory symptoms and airway obstruction.

Michael K. Odutola et al. 2021 A systematic review and meta-analysis of occupational exposures and risk of follicular lymphoma, Environmental Research Available online 17 February 2021, 110887

The etiology of follicular lymphoma (FL), a common non-Hodgkin lymphoma subtype, is largely unknown. The researchers performed a systematic review and meta-analysis of observational studies examining the relationship between occupational exposures and FL risk. They searched Ovid MEDLINE, Ovid EMBASE, and Web of Science for eligible observational studies examining job titles or occupational exposures prior to 1 January 2020. We performed a narrative synthesis and used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95%CI) for exposures reported by three or more studies.

Fifty-seven studies were eligible. Ten cohort and 36 case-control studies quantified FL risk in relation to any exposure to one or more occupational groups or agents. Eight cohort and 19 case-control studies examined dose-response relationships. We found evidence of a positive association with increasing plasma concentration of dichlorodiphenyldichloroethylene (DDE; meta-RR=1.51, 95%CI=0.99, 2.31; I2=0.0%) and polychlorinated biphenyls (PCBs; meta-RR=1.47, 95%CI=0.97, 2.24; I2=8.6%). We observed a positive association with exposure to any solvent (meta-RR=1.16, 95%CI=1.00, 1.34; I2=0.0%) and chlorinated solvents (meta-RR=1.35, 95%CI=1.09, 1.68; I2=0.0%). Single studies reported a significant positive dose-response association for exposure to any pesticide, hexachlorobenzene, any organophosphate, diazinon, metolachlor, carbaryl, lindane, trichloroethylene, oils/greases, and extremely low-frequency magnetic fields. Job title-only analyses suggested an increased risk for medical doctors and spray painters, and decreased risk for bakers and teachers. Overall, studies demonstrated a low risk of bias, but most studies examined small numbers of exposed cases.

The researchers conclude that current evidence indicates a positive association between FL and occupational exposure to DDE, PCBs, any solvent and chlorinated solvents. Our findings may help guide policies and practices on the safe use of solvents and inform models of lymphomagenesis. Future studies with larger sample sizes and comprehensive quantitative exposure measures may elucidate other avoidable carcinogenic exposures.

Liu K, Mu M, Fang K, Qian Y, Xue S, Hu W, Ye M. Occupational exposure to silica and risk of heart disease: a systematic review with meta-analysis. BMJ Open. 2020 Jan 7;10(1):e029653. doi: 10.1136/bmjopen-2019-029653. PMID: 31915156; PMCID: PMC6955526.

A systematic review and meta-analysis were performed to search for evidence of the relationship between occupational silica exposure and heart disease. This was because there is growing evidence suggesting a relationship between occupational silica exposure and heart disease; however, the link between them is less clear. PubMed, ScienceDirect, Springer and EMBASE were searched for articles published between 1 January 1995 and 20 June 2019. Articles that investigated the effects of occupational silica exposure on the risk of heart disease were considered. The researchers included cohort studies, including prospective, retrospective and retroprospective studies. They extracted data using a piloted data collection form and conducted random-effects meta-analysis and exposure-response analysis. The meta-relative risk (meta-RR), a measure of the average ratio of heart disease rates in those with and without silica exposure, was used as an inverse variance-weighted average of relative risks from the individual studies. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used for study quality assessment.

Twenty cohort studies were included. They calculated the risk of heart diseases such as pulmonary heart disease, ischaemic heart disease and others. The results suggest a significant increase in the risk of overall heart disease (meta-RR=1.08, 95% CI 1.03 to 1.13). Stronger evidence of association with pulmonary heart disease was found in the risk estimate of both categories of heart disease (meta-RR=1.24, 95% CI 1.08 to 1.43) and in the exposure-response analysis (meta-RR=1.39, 95% CI 1.19 to 1.62). Our subgroup analyses also revealed that the statistical heterogeneity among studies could be attributed mainly to the diversity in reference group, occupation and study quality score. The researchers concluded that silica-exposed workers are at an increased risk for overall heart disease, especially pulmonary heart disease. Further research is needed to better clarify the relationship between occupational silica exposure and ischaemic heart disease.

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