Collection and Use of Industry and Occupation Data III: Cancer surveillance findings among construction workers

Transcription

1 Collection and Use of Industry and Occupation Data III: Cancer surveillance findings among construction workers Geoffrey M. Calvert, MD, MPH, FACP National Institute for Occupational Safety and Health Centers for Disease Control and Prevention The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.

2 Outline I. Background II. Methods III. Preliminary Results IV. Discussion V. Next steps

3 Cancer and Construction Cancer = leading cause of death for those under 85 Multiple factors contribute to cancer Interaction of hereditary and environmental factors From 4% to 20% of cases may be related to occupation Construction workers are at increased risk Exposed to several potential carcinogens: Silica, asbestos, solvents, paints, diesel exhaust, wood dust, lead, PAHs, ETS, Types of cancer possibly linked to construction occupations: Mesothelioma (cancer of the pleura), lung, lip, leukemia (esp. chronic lymphocytic leukemia-cll), esophagus, larynx, bladder, stomach In UK, construction workers account for 50% of all cancer cases attributed to occupational exposures

4 Methods

5 Demographics Distribution of cancer cases among construction workers by age, sex and occupation Prostate cancer Mean age at diagnosis and % of cases diagnosed at distant stage by industry and occupation

6 Cancer Incidence Rates For total cancer and major cancer sites Numerator: construction workers with cancer of interest Denominator: construction labor force estimates Obtained from Census/BLS Current Population Survey Labor force = employed + unemployed from layoff + unemployed but looking for work Age-adjusted (directly adjusted) Females excluded Age restriction: 15 years 64 years Unreliable denominator data for those > 64 years

7 Cancer Incidence Rates Rates for entire time period: Rates for four 5-year time periods: , , , Rates for race/ethnic groups: white, black, Hispanic and Asian Mutually exclusive groups Rates for specific construction occupations

8 Cancer Incidence Rate Ratios (IRR) Numerator: age-adjusted incidence rate for construction workers Denominator: age-adjusted incidence rate for nonconstruction workers 95% confidence interval calculated

9 Case-control Analyses Cases: all individuals in CCR with cancer of interest Controls: individual with one of more of the following cancers: prostate, colon, brain, kidney, testis, bones and joints, thyroid Matched on: sex, race, 5-year age group, year of diagnosis (5-year groupings) Age restriction: or years Morbidity odds ratios (MOR), 95% confidence intervals calculated conditional logistic regression SAS version 9.1, proc phreg Separate analyses for occupations, morphologic subtype, and race/ethnicity

10 Preliminary Results

11 Construction Occupations in the CCR, (n=75,031) Laborers Carpenters Supervisors Managers/Administrators Electricians Painters Plumbers Operating Engineers Roofers Civil Engineers Brickmasons Structural Metal Workers Concrete Finishers

12 Number of CCR construction cases, (n=75,031) 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Total cases yrs 65 yrs Males Females

13 Rate per 100,000 workers Age-adjusted Rates of All Cancer* among Construction Workers and Other Workers in California, males aged 15-64, Construction workers Other workers *excluding non-melanoma skin cancers and in situ cases, except bladder cancer

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15 IRRs among Construction Workers vs. all Other Workers, Black Males Only, No increased IRRs observed for colon, bladder, prostate or lymphoma

16 Rate per 100,000 workers Age-adjusted Rates of Cancer of the Pleura/peritoneum* among Construction Workers and Other Workers in California, aged 15-64, Construction workers Other workers *Includes mesothelioma

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18 Rate per 100,000 workers Age-adjusted Rates of Lung Cancer among Construction Workers and Other Workers in California, males aged 15-64, Construction workers Other workers

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21 4.5 4 Smoking prevalence* MOR vs IRR findings, Lung Cancer in construction workers, % 45% 44% 34% 43% 33% 36% MOR age lt 95 years MOR age lt 65 years IRR age lt 65 years All Roofer Painter Laborer Plumber Carpenter Electrician Supervisor * Based on NHIS data collected in 1987, 1988, ; Lee et al Smoking prevalence rate for all US workers was 28%.

22 5 4.5 MOR s for NSCLC vs. SCL, Construction workers, age LT 65 years, Smoking prevalence* 58% 45% 44% 34% 43% 33% 36% NSCLC SCLC All Roofer Painter Laborer Plumber Carpenter Electrician Supervisor NSCLC= non-small cell lung cancer, SCL=small cell lung cancer * Based on NHIS data collected in 1987, 1988, ; Lee et al Smoking prevalence rate for all US workers was 28%.

23 Rate per 100,000 workers Age-adjusted Rates of Esophageal Cancer among Construction Workers and Other Workers in California, aged 15-64, Construction workers Other workers

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25 Prostate Cancer: Mean age at diagnosis and % diagnosed at distant stage by usual industry, California, Agriculture, Forestry, and Fisheries Mining Personal, Entertainment and Recreation Services Construction Business and Repair Services Manufacturing Wholesale & Retail Trade Transportation, Communications, & Other Public Utilities Public Administration Professional and Related Services Health Care Finance, Insurance, and Real Estate Mean age at diagnosis (years) Proportion diagnosed at distant stage

26 Prostate Cancer: Mean age at diagnosis and % diagnosed at distant stage by construction occupation, California, All Metal worker Painter Laborer Carpenter Roofer Electrician Brickmason Plumber Supervisor Engineer Mean age at diagnosis (years) Proportion diagnosed at distant stage

27 Discussion No other studies known to have reported lung cancer histology among roofers Nordic study did not suggest that etiological factors would be specific to one histologic subtype only. No other studies known that systematically explore cancer risk by both occupation and 4 race/ethnicity groups No other studies known that explore stage of prostate cancer at diagnosis by occupation

28 Using cancer registry data for occupational cancer surveillance Strengths Lots of cases Workers compared to other workers Potential to become a national system Detailed clinical data Limitations Incomplete I&O data Incomplete data on potential confounders (e.g., smoking) Occupational exposures inferred from usual I&O Research in progress, not all data gaps identified

29 Next Steps Continue to calculate incidence rates, IRRs and MORs By cancer and morphologic subtypes By race/ethnicity Calculate morbidity odds ratios by exposure tertiles Expand project to additional states Develop I&O training materials for cancer registrars

30 Acknowledgements California Cancer Registry Rosemary Cress Mark Allen Katrina Bauer Los Angeles Cancer Surveillance Program, University of Southern California Dennis Deapen NIOSH, CDC Sara Luckhaupt Soo-Jeong Lee Rui Shen SangWoo Tak Pam Schumacher Statistical Assistants

31 Extra slides

32 Industry Information on CCR cases, (n=2,989,888) Frequency Agriculture Construction Firefighter Health Care Other Industry Worker-uncoded Retired Housewife Military Non-worker Unemp/Unknown

33 Industry Information on CCR cases, (n=2,989,888) Percent Agriculture Construction Firefighter Health Care Other Industry Worker-uncoded Retired Housewife Military Non-worker Unemp/Unknown 16.55

34 MOR s for NSCLC vs. SCL, Construction workers, age LT 95 years, Smoking prevalence* 58% 45% 44% 34% 43% 33% 36% NSCLC SCLC All Roofer Painter Laborer Plumber Carpenter Electrician Supervisor NSCLC= non-small cell lung cancer, SCLC=small cell lung cancer * Based on NHIS data collected in 1987, 1988, ; Lee et al Smoking prevalence rate for all US workers was 28%.