title: Causes of death among lead smelters in relation to the glucose-6-phosphate dehydrogenase polymorphism.
abstract: OBJECTIVE
  To assess, by updating a follow-up mortality study of a lead smelters cohort in Sardinia, Italy, the adverse health effects following occupational lead exposure in relation to the glucose-6-phosphate dehydrogenase (G6PD) polymorphism.
  
  
  METHODS
  The 1973-2003 mortality of 1017 male lead smelters were followed-up, divided into two subcohorts according to the G6PD phenotype: whether G6PD deficient (G6PD-) or wild-type (wtG6PD). Deaths observed in the overall cohort and the two subcohorts were compared with those expected, on the basis of the age-, sex- and calendar year-specific mortality in the general male population of the island. Directly standardised mortality rates (sr) in the two subcohorts were also compared.
  
  
  RESULTS
  Cardiovascular mortality was strongly reduced among production and maintenance workers, which is most related to the healthy worker effect. However, the sr for cardiovascular diseases was substantially lower among the G6PD- subcohort (5.0x10(-4)) than among the wtG6PD subcohort (33.6x10(-4); chi2 = 1.10; p = NS). Neoplasms of the haemopoietic system exceeded the expectation in the G6PD- subcohort (SMR = 388; 95% CI 111 to 1108). No other cancer sites showed any excess in the overall cohort or in the two subcohorts. No death from haemolytic anaemia occurred in the G6PD- subcohort.
  
  
  CONCLUSIONS
  With due consideration of the limited statistical power of our study, previous results suggesting that in workplaces where exposure is under careful control, expressing the G6PD- phenotype does not convey increased susceptibility to lead toxicity are confirmed. The observed excess risk of haematopoietic malignancies seems to have most likely resulted from chance.
authors.affiliation: Department of Public Health, Occupational Health Section, University of Cagliari, Cagliari, Italy. coccop@pacs.unica.it
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cocco
authors.forename: Domenica
authors.initials: D
authors.lastname: Fadda
authors.forename: Sergio
authors.initials: S
authors.lastname: Atzeri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Avataneo
authors.forename: Michele
authors.initials: M
authors.lastname: Meloni
authors.forename: Costantino
authors.initials: C
authors.lastname: Flore
mesh_terms: D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007854:Lead / Q000633:toxicity*; D008297:Male; D008669:Metallurgy; D009784:Occupational Diseases / Q000235:genetics* / Q000401:mortality; D016273:Occupational Exposure / Q000009:adverse effects*; D011110:Polymorphism, Genetic / Q000235:genetics*
chemical_list: D007854:Lead; D005954:Glucosephosphate Dehydrogenase