Mortality among uranium miners in North America and Europe: the Pooled Uranium Miners Analysis (PUMA)

Richardson, David B.; Rage, Estelle; Demers, Paul A.; T, M; DeBono, Nathan L; Fenske, Nora; Deffner,; Kreuzer, Michaela; Samet, Jonathan M.; Wiggins, Charles L.; Schubauer‐Berigan, Mary K.; Kelly‐Reif, Kaitlin; Tomášek, Ladislav; Zablotska, Lydia B.; Laurier, Dominique

doi:10.1093/ije/dyaa195

Cited by 26 publications

(20 citation statements)

References 43 publications

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“…These are among the largest and most informative cohorts of uranium miners in the world. 19 A first article analyzed causes of death in regard to national mortality rates, 20 and analyses of the association between cumulative exposure to radon progeny and mortality are ongoing. Here, we report on the results of an analysis of miners first employed in 1960 or later, thereby excluding miners employed during the periods of highest exposure and focusing on those miners who tend to have higher-quality assessments of radon progeny exposures that occurred at lower exposure rates.…”

Section: Introductionmentioning

confidence: 99%

Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later

Richardson

Rage²,

Demers

et al. 2022

Environ Health Perspect

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Background: Despite reductions in exposure for workers and the general public, radon remains a leading cause of lung cancer. Prior studies of underground miners depended heavily upon information on deaths among miners employed in the early years of mine operations when exposures were high and tended to be poorly estimated. Objectives: To strengthen the basis for radiation protection, we report on the follow-up of workers employed in the later periods of mine operations for whom we have more accurate exposure information and for whom exposures tended to be accrued at intensities that are more comparable to contemporary settings. Methods: We conducted a pooled analysis of cohort studies of lung cancer mortality among 57,873 male uranium miners in Canada, Czech Republic, France, Germany, and the United States, who were first employed in 1960 or later (thereby excluding miners employed during the periods of highest exposure and focusing on miners who tend to have higher quality assessments of radon progeny exposures). We derived estimates of excess relative rate per 100 working level months (ERR/100 WLM) for mortality from lung cancer. Results: The analysis included person-years of observation and 1,217 deaths due to lung cancer. The relative rate of lung cancer increased in a linear fashion with cumulative exposure to radon progeny (ERR/100 ; 95% CI: 0.89, 1.88). The association was modified by attained age, age at exposure, and annual exposure rate; for attained ages , the ERR/100 WLM was 8.38 (95% CI: 3.30, 18.99) among miners who were exposed at of age and at annual exposure rates of working levels. This association decreased with older attained ages, younger ages at exposure, and higher exposure rates. Discussion: Estimates of association between radon progeny exposure and lung cancer mortality among relatively contemporary miners are coherent with estimates used to inform current protection guidelines. https://doi.org/10.1289/EHP10669

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Section: Introductionmentioning

confidence: 99%

Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later

Richardson

Rage²,

Demers

et al. 2022

Environ Health Perspect

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“…Pooled SMR analyses presented in Table 7 suggest an elevation of lung cancer among female uranium processing workers above the general population (SMR ¼ 1.34; 95% CI: 0.87, 1.81) compared to no increased rate in males (SMR¼ 1.04; 95% CI: 0.95, 1.12), though not statistically significant. On the other hand, studies of uranium miners typically show statistically significant increases in SMRs/SIRs for lung cancer compared to the general population in males, for example, (Richardson et al 2020), although the difference in lung cancer risk between this pooled analysis and uranium miners is likely due to the differences in exposures between the two cohorts. Specific or sex-adjusted dose-response analyses may aid in further elucidation of any differences in lung cancer risk among females and males.…”

Section: Strengths and Limitations Of The Pooled Studies Of Us And Canadian Workersmentioning

confidence: 66%

Cohort profile: four early uranium processing facilities in the US and Canada

Golden

Milder

Ellis

et al. 2021

International Journal of Radiation Biology

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Purpose: Pooling of individual-level data for workers involved in uranium refining and processing (excluding enrichment) may provide valuable insights into risks from occupational uranium and external ionizing radiation exposures. Methods: Data were pooled for workers from four uranium processing facilities (Fernald, Mallinckrodt and Middlesex from the U.S.; and Port Hope, Canada). Employment began as early as the 1930s and follow-up was as late as 2017. Workers were exposed to high concentrations of uranium, radium, and their decay products, as well as gamma radiation and ambient radon decay products. Exposure and outcome data were harmonized using similar definitions and dose reconstruction methods. Standardized mortality ratios (SMR) were estimated. Results: In total, 560 deaths from lung cancer, 503 non-malignant respiratory diseases, 67 renal diseases, 1,596 ischemic heart diseases, and 101 dementia and Alzheimer's disease (AD) were detected in the pooled cohort of over 12,400 workers ($1,300 females). Mean cumulative doses were 45 millisievert for whole-body external ionizing radiation exposure and 172 milligray for lung dose from radon decay products. Only SMR for dementia and AD among males was statistically significant (SMR=1.29; 95% confidence interval: 1.04, 1.54). Conclusions: This is the largest study to date to examine long-term health risks of uranium processing workers.

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“…The NMRD SMRs among this cohort are higher than in other uranium miner studies. In the largest pooled study of uranium miners, the Pooled Uranium Miners Analysis (PUMA), investigators analyzed SMRs for silicosis and COPD using data from seven cohorts, including Colorado Plateau 26 . The PUMA SMR for COPD was 0.98 (95% CI: 0.93, 1.02), and 13.56 (95% CI: 12.64, 14.52) for silicosis 26 .…”

Section: Discussionmentioning

confidence: 99%

“…In the largest pooled study of uranium miners, the Pooled Uranium Miners Analysis (PUMA), investigators analyzed SMRs for silicosis and COPD using data from seven cohorts, including Colorado Plateau 26 . The PUMA SMR for COPD was 0.98 (95% CI: 0.93, 1.02), and 13.56 (95% CI: 12.64, 14.52) for silicosis 26 . Unlike PUMA, we observed a large excess COPD mortality, although this excess was driven entirely by smokers.…”

Section: Discussionmentioning

confidence: 99%

Nonmalignant respiratory disease mortality in male Colorado Plateau uranium miners, 1960–2016

Kelly‐Reif

Bertke

Daniels

et al. 2022

American J Industrial Med

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Background: To evaluate trends of nonmalignant respiratory disease (NMRD) mortality among US underground uranium miners on the Colorado Plateau, and to estimate the exposure-response association between cumulative radon progeny exposure and NMRD subtype mortality.Methods: Standardized mortality ratios (SMRs) and excess relative rates per 100 working level months (excess relative rate [ERR]/100 WLM) were estimated in a cohort of 4021 male underground uranium miners who were followed from 1960 through 2016. Results:We observed elevated SMRs for all NMRD subtypes. Silicosis had the largest SMR (n = 52, SMR = 41.4; 95% confidence interval [CI]: 30.9, 54.3), followed by other pneumoconiosis (n = 49, SMR = 39.6; 95% CI: 29.6, 52.3) and idiopathic pulmonary fibrosis (IPF) (n = 64, SMR = 4.77; 95% CI 3.67, 6.09). SMRs for silicosis increased with duration of employment; SMRs for IPF increased with duration of employment and calendar period. There was a positive association between cumulative radon exposure and silicosis with evidence of modification by smoking (ERR/100 WLM ≥10 pack-years = 0.78; 95% CI: 0.05, 24.6 and ERR/100 WLM <10 pack-years = 0.01; 95% CI: −0.03, 0.52), as well as a small positive association between radon and IPF (ERR/100 WLM = 0.06, 95% CI: 0.00, 0.24); these associations were driven by workers with prior employment in hard rock mining.Conclusions: Uranium mining workers had excess NMRD mortality compared with the general population; this excess persisted throughout follow-up. Exposureresponse analyses indicated a positive association between radon exposure and IPF and silicosis, but these analyses have limitations due to outcome misclassification and missing information on occupational co-exposures such as silica dust.

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Mortality among uranium miners in North America and Europe: the Pooled Uranium Miners Analysis (PUMA)

Cited by 26 publications

References 43 publications

Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later

Lung Cancer and Radon: Pooled Analysis of Uranium Miners Hired in 1960 or Later

Cohort profile: four early uranium processing facilities in the US and Canada

Nonmalignant respiratory disease mortality in male Colorado Plateau uranium miners, 1960–2016

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