title: Epidemiologic challenges for studies of occupational exposure to engineered nanoparticles; a commentary.
abstract: OBJECTIVE
  Identify most likely health effects of occupational exposure to engineered nanoparticles (ENP). Recommend analytic approaches to address epidemiologic challenges.
  
  
  METHODS
  Review air pollution and occupational literature on health effects of fine particulate matter (PM). Provide example of mortality study of exposure to PM composed of metalworking fluid. Apply standard Cox models and g-estimation to adjust for potential healthy worker survival effect (HWSE).
  
  
  RESULTS
  In contrast with standard methods, g-estimation suggests that exposure to PM may cause chronic heart and lung disease; longer exposure reduces survival. HWSE appears stronger for chronic disease than for cancer.
  
  
  CONCLUSIONS
  We recommend hazard surveillance, short-term panel studies of biomarkers, and prospective cohort studies of cardiovascular and respiratory diseases. Building research capacity in g-estimation methods to reduce HWSE is necessary for future studies of chronic disease and ENP.
authors.affiliation: Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California 94720-7360, USA. eeisen@berkeley.edu
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Eisen
authors.forename: Sadie
authors.initials: S
authors.lastname: Costello
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chevrier
authors.forename: Sally
authors.initials: S
authors.lastname: Picciotto
mesh_terms: D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000453:epidemiology; D004785:Environmental Pollutants / Q000009:adverse effects; D016021:Epidemiologic Studies; D015989:Healthy Worker Effect; D006801:Humans; D053758:Nanoparticles / Q000009:adverse effects*; D009369:Neoplasms / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D052638:Particulate Matter / Q000009:adverse effects; D011084:Polycyclic Aromatic Hydrocarbons / Q000009:adverse effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D013223:Statistics as Topic
chemical_list: D015415:Biomarkers; D004785:Environmental Pollutants; D052638:Particulate Matter; D011084:Polycyclic Aromatic Hydrocarbons