Incidence and mortality from malignant mesothelioma 1982-2020 and relationship with asbestos exposure: the Australian Mesothelioma Registry.

OBJECTIVES: Malignant mesothelioma is an uncommon cancer associated with asbestos exposure, predominantly occupational. Asbestos has been banned in Australia since 2003 but mesothelioma has a long latency and incident cases continue to present. The Australian Mesothelioma Registry was incepted to collect systematic data about incidence and mortality alongside asbestos exposure. METHODS: Benefiting from the Australian national system of cancer notification, all incident cases of mesothelioma in all states and territories are fast-tracked and notified regularly. Notified patients are contacted asking for consent to collect exposure information, initially by postal questionnaire and subsequently by telephone interview. Age-standardised annual incidence rates and mortality rates were calculated. Asbestos exposure was categorised as occupational, non-occupational, neither or, both; and as low, or high, probability of exposure. RESULTS: Mesothelioma incidence appears to have peaked. The age-standardised incidence rates have declined steadily since the early 2000s (peaking in males at 5.9/100 000 and in all-persons at 3.2/100 000), driven by rates in males, who comprise the majority of diagnosed cases. Rates in women have remained fairly stable since that time. Age-standardised mortality rates have followed similar trends. Mesothelioma remains the most common in those aged over 80 years. Nearly all (94%) cases were linked with asbestos exposure (78% occupational in men; 6.8% in women). CONCLUSIONS: With effective control of occupational asbestos use, the decline in age-standardised incidence and death rates has occurred. Incidence rates among women, in whom occupational asbestos exposure is rarely detectable, remain unchanged, pointing to the role of household and /or environmental asbestos exposure.

Cancer incidence in agricultural workers: Findings from an international consortium of agricultural cohort studies (AGRICOH).

BACKGROUND: Agricultural work can expose workers to potentially hazardous agents including known and suspected carcinogens. This study aimed to evaluate cancer incidence in male and female agricultural workers in an international consortium, AGRICOH, relative to their respective general populations. METHODS: The analysis included eight cohorts that were linked to their respective cancer registries: France (AGRICAN: n = 128,101), the US (AHS: n = 51,165, MESA: n = 2,177), Norway (CNAP: n = 43,834), Australia (2 cohorts combined, Australian Pesticide Exposed Workers: n = 12,215 and Victorian Grain Farmers: n = 919), Republic of Korea (KMCC: n = 8,432), and Denmark (SUS: n = 1,899). For various cancer sites and all cancers combined, standardized incidence ratios (SIR) and 95% confidence intervals (CIs) were calculated for each cohort using national or regional rates as reference rates and were combined by random-effects meta-analysis. RESULTS: During nearly 2,800,000 person-years, a total of 23,188 cancers were observed. Elevated risks were observed for melanoma of the skin (number of cohorts = 3, meta-SIR = 1.18, CI: 1.01-1.38) and multiple myeloma (n = 4, meta-SIR = 1.27, CI: 1.04-1.54) in women and prostate cancer (n = 6, meta-SIR = 1.06, CI: 1.01-1.12), compared to the general population. In contrast, a deficit was observed for the incidence of several cancers, including cancers of the bladder, breast (female), colorectum, esophagus, larynx, lung, and pancreas and all cancers combined (n = 7, meta-SIR for all cancers combined = 0.83, 95% CI: 0.77-0.90). The direction of risk was largely consistent across cohorts although we observed large between-cohort variations in SIR for cancers of the liver and lung in men and women, and stomach, colorectum, and skin in men. CONCLUSION: The results suggest that agricultural workers have a lower risk of various cancers and an elevated risk of prostate cancer, multiple myeloma (female), and melanoma of skin (female) compared to the general population. Those differences and the between-cohort variations may be due to underlying differences in risk factors and warrant further investigation of agricultural exposures.

Gender differences in respiratory health outcomes among farming cohorts around the globe: findings from the AGRICOH consortium.

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

The impact of sustained hot weather on risk of acute work-related injury in Melbourne, Australia.

It has been reported that weather-related high ambient temperature is associated with an increased risk of work-related injury. Understanding this relationship is important because work-related injuries are a major public health problem, and because projected climate changes will potentially expose workers to hot days, including consecutive hot days, more often. The aim of this study was to quantify the impact of exposure to sustained periods of hot weather on work-related injury risk for workers in Melbourne, Australia. A time-stratified case crossover study design was utilised to examine the association between two and three consecutive days and two and three consecutive nights of hot weather and the risk of work-related injury, using definitions of hot weather ranging from the 60th to the 95th percentile of daily maximum and minimum temperatures for the Melbourne metropolitan area, 2002-2012. Workers' compensation claim data was used to identify cases of acute work-related injury. Overall, two and three consecutive days of hot weather were associated with an increased risk of injury, with this effect becoming apparent at a daily maximum temperature of 27.6 °C (70th percentile). Three consecutive days of high but not extreme temperatures were associated with the strongest effect, with a 15% increased risk of injury (odds ratio 1.15, 95% confidence interval 1.01-1.30) observed when daily maximum temperature was ≥33.3 °C (90th percentile) for three consecutive days, compared to when it was not. At a threshold of 35.5 °C (95th percentile), there was no significant association between temperature and injury for either two or three consecutive days of heat. These findings suggest that warnings to minimise harm to workers from hot weather should be given, and prevention protocol initiated, when consecutive warm days of temperatures lower than extreme heat temperatures are forecast, and well before the upper ranges of ambient daytime temperatures are reached.

Association between high ambient temperature and acute work-related injury: a case-crossover analysis using workers' compensation claims data.

Objectives The aim of this study was to investigate the association between high ambient temperature and acute work-related injury, expanding on previous research in this area. Specifically we examined the relationship between both daytime and overnight temperatures and injury risk and disentangled physically demanding occupational exposures from exposure to outdoor working conditions. Methods A time-stratified case-crossover study design was used to examine the association between ambient temperatures and acute work-related injuries in Melbourne, Australia, 2002-2012, using workers' compensation claims to identify work-related injuries. The relationship was assessed for both daily maximum and daily minimum temperatures using conditional logistic regression. Results Significant positive associations between temperature and acute work-related injury were seen for younger workers (<25 years), with the odds of injury increasing by 1% for each 1 °C increase in daily minimum temperature, and by 0.8% for each 1 °C increase in daily maximum temperature. Statistically significant associations were also observed between daily maximum temperature and risk of injury for workers employed in the highest strength occupations and for male workers, and between daily minimum temperature and injury for all cases combined, female workers, workers aged 25-35 and ≥55 years, "light" and "limited" physical demand groups, and "in vehicle or cab" and "regulated indoor climate" workplace exposure groups. Conclusions Young workers, male workers and workers engaged in heavy physical work are at increased risk of injury on hot days, and a wider range of worker subgroups are vulnerable to injury following a warm night. In light of climate change projections, this information is important for informing injury prevention strategies.

Use of antiseptic hand rubs in the health and community services industry: an Australian population-based survey.

BACKGROUND: The use of antiseptic hand rubs (AHRs), rather than washing with soap and water, is considered to be the gold standard for reducing the frequency of nosocomial infections, as well as being less damaging to the hands than washing with soap and water, but little is known at a population level about usage patterns for AHRs. OBJECTIVES: To describe AHR use patterns among workers in the health and community services industry in Australia. METHODS: Using data from a population-based survey of Australian workers, we focused on health and community services workers' exposure to chemicals at work, including the use of AHRs. Data regarding the frequency of hand-washing were also collected. RESULTS: Nine hundred and fifty-six health and community service workers participated in the Australian National Hazard Exposure Worker Surveillance survey. Of these, 11% reported using AHRs, and 31% reported hand-washing >20 times per shift. According to an adjusted logistic regression model, professional workers [adjusted odds ratio (aOR) 2.29, 95% confidence interval (CI): 1.40-3.72] and frequent hand washers (aOR 3.08, 95%CI: 1.92-4.93) were more likely to use AHRs. CONCLUSIONS: AHR use by health and community service workers was generally lower than expected. AHR use was most likely to be reported by professionals and frequent hand washers, suggesting that AHRs are used as an adjunct to conventional hand-washing.

Comparison of data sets for surveillance of work-related injury in Victoria, Australia.

OBJECTIVE: To investigate differences and similarities between three sources of work-related injury information: workers compensation claims, emergency department (ED) presentation data and hospital admissions data. METHODS: This population-based, retrospective descriptive analysis of non-fatal, work-related injuries of workforce participants in Victoria, Australia, has compared data from workers compensation claims and ED presentation and hospital admission data sets for the period 2004-2011. Work-related injury case frequency and rate were compared across study years according to gender, age, geographical location and injury type. Injury rates were expressed as cases per million hours worked. RESULTS: Rates of hospital admissions for treatment of work-related injury increased over the study period, compared with decreasing rates of injury in compensation claims and ED data. The highest rate of injuries to younger workers was captured in ED data. There was greater capture of musculoskeletal injuries by workers' compensation data, and of open wound and burn injury by the ED data. Broad similarities were noted for temporal trends according to gender, for the distribution of cases across older age groups and for rates of fracture injuries. CONCLUSIONS: These study findings inform use of workers' compensation, ED presentation and hospital admission data sets as sources of information for surveillance of work-related injuries in countries where these types of data are routinely collected. Choice of data source for investigation of work-related injury should take into consideration the population and injury types of interest.

Chemical control measures for dermal exposure in Australian workplaces.

OBJECTIVE: To investigate the relationships between occupational, workplace, and demographic factors and the provision of multilevel exposure protection systems. METHODS: Respondents reporting dermal chemical exposure at work were asked about protective measures provided to them in the workplace, which we classified as personal protection or awareness measures. An ordered logistic model was used to investigate the odds of workers reporting that both, either or neither, types of exposure control measures were provided in their workplaces. RESULTS: Larger workplace size and permanent and fixed-term employment were associated with exposure protection systems incorporating both hazard awareness and personal protective measures. CONCLUSION: Our results indicate that employment in small workplaces, nonpermanent and self-employed workers may be important intervention targets for improving workers' exposure protection. WHAT THIS PAPER ADDS: Chemical exposures in workplaces are an important occupational health and safety problem; however, there is little published information available about the provision of basic exposure controls to workers with dermal chemical exposures across industrial sectors. Using data from a large community-based survey,we found that workers in small workplaces and workers with less secure employment arrangements were more likely than others to report less comprehensive exposure control mitigation strategies. Small workplaces, temporary and casual workers, and industrial sectors in which these employment situations are common are likely to be worthwhile targets for efforts to improve exposure management systems for workers with dermal exposure to chemicals.

Dermal exposure associated with occupational end use of pesticides and the role of protective measures.

BACKGROUND: Occupational end users of pesticides may experience bodily absorption of the pesticide products they use, risking possible health effects. The purpose of this paper is to provide a guide for researchers, practitioners, and policy makers working in the field of agricultural health or other areas where occupational end use of pesticides and exposure issues are of interest. METHODS: This paper characterizes the health effects of pesticide exposure, jobs associated with pesticide use, pesticide-related tasks, absorption of pesticides through the skin, and the use of personal protective equipment (PPE) for reducing exposure. CONCLUSIONS: Although international and national efforts to reduce pesticide exposure through regulatory means should continue, it is difficult in the agricultural sector to implement engineering or system controls. It is clear that use of PPE does reduce dermal pesticide exposure but compliance among the majority of occupationally exposed pesticide end users appears to be poor. More research is needed on higher-order controls to reduce pesticide exposure and to understand the reasons for poor compliance with PPE and identify effective training methods.

Gender differences in the relationship between shiftwork and work injury: examining the influence of dependent children.

OBJECTIVE: To examine the relationship between shiftwork and work injury among men and women, taking into account the presence of dependent children. METHODS: An analysis of respondents to the 2009-2010 Multipurpose Household Survey (n = 6927 women and 7340 men). Logistic regression models examined the work injury risk, adjusting for various covariates. RESULTS: The risk of work injury associated with shiftwork was higher for women than for men. Nevertheless, gender differences were present only among respondents with dependent children. Shiftworking women with children also had a greater risk of work injury than shiftworking women without children. CONCLUSIONS: This previously noted elevated risk of injury associated with shiftwork among women compared with that in men may be a product of increased household responsibilities or other factors particular to female shiftworkers with dependent children.

OccIDEAS: An Innovative Tool to Assess Past Asbestos Exposure in the Australian Mesothelioma Registry.

Malignant mesothelioma is an uncommon but rapidly fatal disease for which the principal aetiological agent is exposure to asbestos. Mesothelioma is of particular significance in Australia where asbestos use was very widespread from the 1950s until the 1980s. Exposure to asbestos includes occupational exposure associated with working with asbestos or in workplaces where asbestos is used and also 'take-home' exposure of family members of asbestos exposed workers. Asbestos exposure may also be non-occupational, occurring as a consequence of using asbestos products in non-occupational contexts and passive exposure is also possible, such as exposure to asbestos products in the built environment or proximity to an environmental source of exposure, for example an asbestos production plant. The extremely long latency period for this disease makes exposure assessment problematic in the context of a mesothelioma registry. OccIDEAS, a recently developed online tool for retrospective exposure assessment, has been adapted for use in the Australian Mesothelioma Registry (AMR) to enable systematic retrospective exposure assessment of consenting cases. Twelve occupational questionnaire modules and one non-occupational module have been developed for the AMR, which form the basis of structured interviews using OccIDEAS, which also stores collected data and provides a framework for generating metrics of exposure.

Cancer incidence, mortality, and blood lead levels among workers exposed to inorganic lead.

PURPOSE: We aimed to measure mortality and cancer incidence in a cohort of lead-exposed workers by using blood lead levels to assess exposure. METHODS: The cohort comprised male lead workers. Subjects were matched to cancer and death registries. Observed death and cancer incidence rates were compared with population rates to obtain standardized mortality ratios (SMR) and standardized incidence ratios (SIR). RESULTS: There were 4114 male subjects with average follow-up time of 16.2 years, and 406 deaths were observed. There were significant results for overall death (SMR, 111; 95% confidence interval [95% CI], 101-123), digestive system deaths (SMR, 167; 95% CI, 110-250), and deaths from external causes (SMR, 135; 95% CI, 105-174). A total of 228 subjects had cancer, with an overall SIR of 83 (95% CI, 73-95); liver cancer SIR of 217 (95% CI, 103-454) and esophageal cancer SIR of 240 (95% CI, 129-447). The latter was seven-fold greater (SIR 755; 95% CI, 314-1813) among those with a blood lead level result above 30 µg/dL compared with population rates. No other increases in cancers were observed. CONCLUSIONS: Overall mortality was elevated. Although incidence rates of overall cancer were low, further studies and analysis are required to investigate any biologically plausible associations between inorganic lead and liver or esophageal cancer.

Provision of control measures for exposure of the hands to wet-working conditions in Australian workplaces.

OBJECTIVE: To analyze the occupational and demographic characteristics for workers participating in the Australian National Hazard Exposure Worker Surveillance (NHEWS) Survey, who reported the provision of various types of workplace control measures for exposure of the hands to wet-working conditions, and to identify the barriers for the provision of controls. METHODS: Computer-assisted telephone interviews were conducted with 4500 workers in 2008. Workers were asked about the types of control measures provided to them in the workplace for exposure of the hands to liquids. RESULTS: Workplace size was the strongest predictor for the provision of control measures. Compared to workplaces with fewer than five employees, workers in workplaces with 200 or more employees were more likely to report provision of gloves, barrier creams and moisturizers, labeling and warning, and ongoing training and education about skin care. CONCLUSION: Smaller workplaces have poorer access to control measures to mitigate exposure to wet work.

Causes of death and incidence of cancer in a cohort of Australian pesticide-exposed workers.

PURPOSE: To determine the rates of mortality and of cancer incidence in a cohort of pesticide-exposed Australian workers. METHODS: The study cohort was assembled using records of former government occupational health surveillance programs. The cohort was then linked to the Australian national registries of cancer and mortality and analyzed in comparison with the general Australian population. RESULTS: Consistent with a healthy worker effect, we found no overall excesses in mortality or incident cancer. Non-injury-related causes of death were less than expected; however, non-intentional poisoning and suicide mortality were significantly elevated. All types of suicide were elevated, and firearm suicide deaths were significantly in excess. The suicides by poisoning were predominantly associated with pesticides, although other published research suggests this pattern is more often associated with developing countries. CONCLUSIONS: This study did not find evidence of a relationship between occupational pesticide exposure and cancer or non-injury-related mortality. However, accidental poisoning and intentional self-harm warrant further investigation.

Relationship between cardiopulmonary mortality and cancer risk and quantitative exposure to polycyclic aromatic hydrocarbons, fluorides, and dust in two prebake aluminum smelters.

OBJECTIVES: We examined the risk of mortality and cancer incidence with quantitative exposure to benzene-soluble fraction (BSF), benzo(a)pyrene (BaP), fluoride, and inhalable dust in two Australian prebake smelters. METHODS: A total of 4,316 male smelter workers were linked to mortality and cancer incidence registries and followed from 1983 through 2002 (mean follow-up: 15.9 years, maximum: 20 years). Internal comparisons using Poisson regression were undertaken based on quantitative exposure levels. RESULTS: Smoking-adjusted, monotonic relationships were observed between respiratory cancer and cumulative inhalable dust exposure (trend p = 0.1), cumulative fluoride exposure (p = 0.1), and cumulative BaP exposure (p = 0.2). The exposure-response trends were stronger when examined across the exposed categories (BaP p = 0.1; inhalable dust p = 0.04). A monotonic, but not statistically significant trend was observed between cumulative BaP exposure and stomach cancer (n = 14). Bladder cancer was not associated with BaP or BSF exposure. No other cancer and no mortality outcomes were associated with these smelter exposures. CONCLUSIONS: The carcinogenicity of Söderberg smelter exposures is well established; in these prebake smelters we observed an association between smelter exposures and respiratory cancer, but not bladder cancer. The exploratory finding for stomach cancer needs confirmation. These results are preliminary due to the young cohort and short follow-up time.

All cause mortality and incidence of cancer in workers in bauxite mines and alumina refineries.

Bauxite is a reddish clay that is refined to produce alumina, which is then reduced to aluminium. There have been studies examining the health of workers in aluminium smelters, but not workers in bauxite mining and alumina refining. A cohort of employees of 1 large aluminium company since 1983 was assembled (n = 6,485, 5,828 men). Deaths and incident cancers to 2002 were ascertained by linkage to national and state cancer and death registries. SIRs and SMRs were calculated compared to national rates standardizing for calendar year, sex and 5-year age group. The mortality from all causes (SMR 0.68, 95% CI: 0.60-0.77), and from circulatory and respiratory diseases, all cancers combined and injury in the male cohort were lower than in the Australian male population and were similar across work groups and with duration of employment. The only significant increased mortality risk was from pleural mesothelioma. The incidence of all cancers combined was similar to the Australian rate. The cohort had a lower risk of incident lymphohaematopoietic cancer (SIR 0.50, 95% CI: 0.31-0.88) and a higher risk of melanoma (SIR 1.30, 95% CI: 1.00-1.69) although no dose-responses were seen. There was also an increased risk of mesothelioma (SIR 3.49, 95% CI: 1.82-6.71), which was associated with exposures outside the aluminium industry. This study is the first to examine cancer and mortality amongst workers in bauxite mines and alumina refineries and found little evidence for increased cancer incidence or mortality in these workers.

Comparison of first, last, and longest-held jobs as surrogates for all jobs in estimating cumulative exposure in cross-sectional studies of work-related asthma.

BACKGROUND: Previous occupational studies have used exposure in most recent job as a surrogate for all jobs or "total work history" exposure. This method may not be valid for diseases in which disability brought on by one job may influence later work history, such as asthma. We investigated different surrogates for total work history for the outcome of asthma symptoms. METHODS: In a cross-sectional study, we quantitatively compared three exposure surrogates (last job, first job, and longest-held job) with the total cumulative work exposure (all jobs) in a cohort of 1778 aluminium industry workers. The chemical exposures we compared were total fluoride dust, inspirable dust, and sulfur dioxide with the respiratory symptoms of wheeze, chest tightness, and rhinitis. RESULTS: When extrapolated over time, all surrogates quantitatively overestimated the gold standard "all jobs" for all three exposures investigated. For the symptom of wheeze, last job was found to be the worst surrogate for all jobs for the three exposure types investigated. Prevalence ratios for fluoride exposure and the symptom of occupational wheeze were last job 1.07 (95% confidence interval, 0.92-1.26), longest job 1.10 (0.94-1.30), first job 1.14 (0.97-1.35), and all jobs 1.27 (1.05-1.53). CONCLUSIONS: Although last job has been found to be a satisfactory surrogate for all jobs in cancer studies, we do not recommend the use of this metric in studies of chronic diseases where development of disability may occur with early exposure. We found that both first job and longest job held were better metrics in studies where the adverse health effect may influence the job history of subject.

Methodological issues in linking study participants to Australian cancer registries using different methods: lessons from a cohort study.

OBJECTIVE: To compare results of concurrent linkage of records from the same occupational cohort to cancer registries at both a State and national level. Methodological issues affecting the record registry linkage process will be explored in cases of discordant results between the State and national cancer linkages. METHODS: The number of incident invasive cancers in an occupational cohort of more than 11,000 workers was determined by linkage to the National Cancer Statistics Clearing House (NCSCH) in 2003. The results were then compared with linkages by the cancer registries of Victoria and Western Australia in 2004, and also with a previous NCSCH linkage in 1998. RESULTS: Our analyses show an under-ascertainment of confirmed cancer cases by the NCSCH of about 13% (26/205) in Victoria and 11% (32/297) in Western Australia. In addition, 14 cases (5%) identified in a previous NCSCH record linkage in 1998 were not matched in 2003. CONCLUSIONS: These findings strongly indicate that record linkage to the State cancer registries was essential to maximise the ascertainment of cancer cases in our cohort. We attribute the discordant linkage results to differences in the quality of the record linkage process by the cancer registries. IMPLICATIONS: The record linkage methods of the national and State cancer registries need further standardisation. At present it is advisable to perform cancer record linkages through the State registries in addition to or instead of the NCSCH.