The asbestos-asbestosis exposure-response relationship: a cohort study of the general working population

• Main Authors: Inge Brosbøl Iversen (Author), Jesper Medom Vestergaard (Author), Johan Ohlander (Author), Susan Peters (Author), Elisabeth Bendstrup (Author), Jens Peter E Bonde (Author), Vivi Schlünssen (Author), Jakob H Bønløkke (Author), Finn Rasmussen (Author), Zara A Stokholm (Author), Michael B Andersen (Author), Hans Kromhout (Author), Henrik A Kolstad (Author)
• Format: Book
• Published: Nordic Association of Occupational Safety and Health (NOROSH), 2024-07-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0355-3140; 1795-990X; 10.5271/sjweh.4153
• Keywords: occupational exposure; exposure; asbestos; cohort study; asbestosis; register study; working population; occupational exposure; job exposure matrix; exposure-response; interstitial lung disease; Public aspects of medicine; RA1-1270
• Source: Scandinavian Journal of Work, Environment & Health, Vol 50, Iss 5, Pp 372-379 (2024)

OBJECTIVES: The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure-response relationship for asbestosis in a general working population setting. We examined the exposure-response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population. METHODS: We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure-response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders. RESULTS: The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15- -1.22]. The IRR was 1.94 (95% CI 1.53-2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population. CONCLUSIONS: This study found exposure-response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.