Occupational exposure to solvents and gender-related risk of systemic sclerosis: a metaanalysis of case-control studies.
OBJECTIVE
In 2001 a metaanalysis reported an excess risk of systemic sclerosis (SSc) related to solvents exposure. The magnitude of risk varied among studies and sources of heterogeneity have not been investigated due to a lack of statistical power. We conducted a new metaanalysis to identify features associated with the magnitude of SSc risk in patients exposed to solvents.


METHODS
We searched 4 databases (Medline, Pascal, Pascal Biomed, Francis). Inclusion criteria were: case-control study, occupational exposure to solvents (OES) assessed by questionnaire and summarized to "any solvent" or "any organic solvent," SSc defined by the American College of Rheumatology or the consultant's criteria. The quality of studies within this metaanalysis was scored according to the Newcastle-Ottawa scale. Odds ratios (OR) were adjusted for the "publication bias" and validated by a sensitivity analysis. Subgroup analyses investigated the effect of gender, quality of studies, and the type of controls.


RESULTS
Among 11 studies (1291 patients and 3435 controls), 9 involved a majority of women (76.2 to 100%), while 2 involved men only. The risk of SSc associated with OES was variable among studies (p for heterogeneity = 0.01) and overrepresentation of higher OR values in smaller studies (p = 0.003) suggested "publication bias." SSc was associated with OES (OR 2.4; 95% CI 1.7-3.4; p < 0.0001), including after adjusting for bias (OR 1.8; 95% CI 1.2-2.5; p = 0.002). The relative risk was higher (p = 0.03) in men (OR 3.0; 95% CI 1.9-4.6; p < 0.0001) than in women (OR 1.8; 95% CI 1.5-2.1; p < 0.0001).


CONCLUSIONS
Whereas SSc affects women predominantly, among subjects with occupational exposure to solvents, men are at higher risk than women for the disease.
Kettaneh
Adrien
A
Department of Internal Medicine, Hopital Saint-Antoine, Assistance Publique/Hopitaux de Paris, France. adrien.kettaneh@sat.ap-hop-paris.fr
Al Moufti
Oubaida
O
Tiev
Kiet P
KP
Chayet
Catherine
C
Tolédano
Cécile
C
Fabre
Bénédicte
B
Fardet
Laurence
L
Cabane
Jean
J
D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D017594:Publication Bias; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000139:chemically induced* / Q000503:physiopathology; D012727:Sex Characteristics; D012997:Solvents / Q000009:adverse effects*
D012997:Solvents