Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany

A critical review of the relationship between occupational exposure to diesel emissions and lung cancer risk

“…This study had the lowest response rate in controls among all pooled studies (response rate 41%) (Olsson et al 2011(Olsson et al , 2012. The main reason for this low response rate was probably the fact that the study base was part of a then ongoing study on lung cancer due to indoor radon exposure and the associated requirement to install a measuring instrument in the living room as well as in the bedroom for one year (Br€ uske-Hohlfeld et al 1997.…”

“…90% confidence intervals). As one of the authors (MM) was involved in a large-scale case-control study on DE exposure and lung cancer (Br€ uske-Hohlfeld et al 1997, the original data from this particular study were used to demonstrate some of the issues discussed in the section on case-control studies.…”

“…We also reviewed two studies conducted in the city of Turin (Richiardi et al 2006) and the Lombardy region of Italy (De Matteis et al 2012), three in France (Menvielle et al 2003;Wild et al 2012;Matrat et al 2015), one in Germany (Br€ uskeHohlfeld et al 1999), one in Stockholm, Sweden (Gustavsson et al 2000), and one study with two reports (one of which was restricted to nonsmokers) in Hong Kong, China (Tse et al 2009(Tse et al , 2011. Furthermore, a pooled analysis of case-control studies in Europe and Canada (Olsson et al 2011) included data from several of the aforementioned studies (Table 11): the German study with two study centers (Br€ uske-Hohlfeld et al 1999), the Italian study in the Lombardy region (EAGLE study) (De Matteis et al 2012), the study from Turin, Italy, which extended to a second study center in the Venetian region (Richiardi et al 2004(Richiardi et al , 2006, and the Swedish study in Stockholm (Gustavsson et al 2000). Additional populationbased case-control data involved in the pooled analysis came from the Liverpool and Warsaw centers of the INCO Copernicus project (Cassidy et al 2007) and, as a special case, from the Netherlands sub-cohort of the European Prospective Investigation into Cancer and Nutrition (Table 11).…”

“…In the analysis initially published, the figures provided were 412 and 226, respectively; however, a few individuals were categorized as non-exposed due to the data records showing that the vehicle was not powered by a diesel engine (Br€ uske-Hohlfeld et al 1997. Assuming that the SER is 0.64 for all controls "ever employed" as professional drivers, the actual number of exposed controls should be 367 instead of 234.…”

“…However, of the separate population-based case-control studies reviewed (Table 12), four did not consider any control for socio-economic variables (Lerchen et al 1987;Gustavsson et al 2000;Menvielle et al 2003;Villeneuve et al 2011). Seven studies published main risk estimates adjusted for socioeconomic variables (Br€ uske-Hohlfeld et al 1999;Richiardi et al 2006;Parent et al 2007;Pintos et al 2012;Tse et al 2011;Wild et al 2012), while only two of these studies reported both unadjusted and adjusted results. In the Italian study adjustment for socio-economic status reduced the risk estimate by about 9% to an OR of <1, as reported above (Richiardi et al 2006).…”