title: Myocardial infarction and occupational exposure to motor exhaust: a population-based case-control study in Sweden.
abstract: There is a well-established association between particulate urban air pollution and cardiovascular disease, but few studies have investigated the risk associated with occupational exposure to particles from motor exhaust. This study investigated the risk of myocardial infarction (MI) after occupational exposure to motor exhaust, using elemental carbon (EC) as a marker of exposure. A population-based case-control study of first-time non-lethal MI was conducted among Swedish citizens in ages 45-70 living in Stockholm County 1992-1994, including 1,643 cases and 2,235 controls. Working histories and data on potential confounders were collected by questionnaire and medical examination. The exposure to EC was assessed through a job-exposure matrix. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated by unconditional logistic regression. We investigated various exposure metrics: intensity, cumulative exposure and years since exposure. There was an exposure-response relation between the highest average exposure intensity during the work history and the risk of MI when adjusting for smoking and alcohol drinking (p for trend 0.034), with an OR of 1.30 (95% CI 0.99-1.71) in the highest tertile of exposure compared to the unexposed. An exposure-response pattern was observed in the analysis of years since exposure cessation among formerly exposed. Additional adjustments for markers of the metabolic syndrome reduced ORs and trends to non-significant levels, although this might be an over-adjustment since the metabolic syndrome may be part of the causal pathway. Occupational exposure to motor exhaust was associated with a moderately increased risk of MI.
authors: Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77, Stockholm, Sweden, Anna.Ilar@ki.se.
authors: Anna
authors: A
authors: Ilar
authors: Marie
authors: M
authors: Lewné
authors: Nils
authors: N
authors: Plato
authors: Johan
authors: J
authors: Hallqvist
authors: Magnus
authors: M
authors: Alderling
authors: Carolina
authors: C
authors: Bigert
authors: Christer
authors: C
authors: Hogstedt
authors: Per
authors: P
authors: Gustavsson
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D001335:Vehicle Emissions
chemical_list: D001335:Vehicle Emissions