Mortality among workers employed in the titanium dioxide production industry in Europe.
OBJECTIVE
To assess the risk of lung cancer mortality related to occupational exposure to titanium dioxide (TiO2).


METHODS
A mortality follow-up study of 15,017 workers (14,331 men) employed in 11 factories producing TiO2 in Europe. Exposure to TiO2 dust was reconstructed for each occupational title; exposure estimates were linked with the occupational history. Observed mortality was compared with national rates, and internal comparisons were based on multivariate Cox regression analysis.


RESULTS
The cohort contributed 371,067 person-years of observation (3.3% were lost to follow-up and 0.7% emigrated). 2652 cohort members died during the follow-up, yielding standardized mortality ratios (SMRs) of 0.87 (95% confidence interval [CI] 0.83-0.90) among men and 0.58 (95% CI 0.40-0.82) among women. Among men, the SMR of lung cancer was significantly increased (1.23, 95% CI 1.10-1.38); however, mortality from lung cancer did not increase with duration of employment or estimated cumulative exposure to TiO2 dust. Data on smoking were available for over one third of cohort members. In three countries, the prevalence of smokers was higher among cohort members compared to the national populations.


CONCLUSIONS
The results of the study do not suggest a carcinogenic effect of TiO2 dust on the human lung.
International Agency for Research on Cancer, Lyon, France.
Paolo
P
Boffetta
Anne
A
Soutar
John W
JW
Cherrie
Fredrik
F
Granath
Aage
A
Andersen
Ahti
A
Anttila
Maria
M
Blettner
Valerie
V
Gaborieau
Stefanie J
SJ
Klug
Sverre
S
Langard
Daniele
D
Luce
Franco
F
Merletti
Brian
B
Miller
Dario
D
Mirabelli
Eero
E
Pukkala
Hans-Olov
HO
Adami
Elisabete
E
Weiderpass
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004396:Coloring Agents / Q000009:adverse effects*; D004391:Dust; D005060:Europe; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D007587:Job Description; D008175:Lung Neoplasms / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012907:Smoking; D014025:Titanium / Q000009:adverse effects*
D004396:Coloring Agents; D004391:Dust; C009495:titanium dioxide; D014025:Titanium