title: Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.
abstract: BACKGROUND
  Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer. In contrast, public health interventions are typically based on regulating radon concentration rather than workers' cumulative exposure. Estimating the effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker survivor bias.
  
  
  METHODS
  Workers in the Colorado Plateau Uranium Miners cohort (n = 4,134) entered the study between 1950 and 1964 and were followed for lung cancer mortality through 2005. We use the parametric g-formula to compare the observed lung cancer mortality to the potential lung cancer mortality had each of 3 policies to limit monthly radon exposure been in place throughout follow-up.
  
  
  RESULTS
  There were 617 lung cancer deaths over 135,275 person-years of follow-up. With no intervention on radon exposure, estimated lung cancer mortality by age 90 was 16%. Lung cancer mortality was reduced for all interventions considered, and larger reductions in lung cancer mortality were seen for interventions with lower monthly radon exposure limits. The most stringent guideline, the Mine Safety and Health Administration standard of 0.33 working-level months, reduced lung cancer mortality from 16% to 10% (risk ratio = 0.67 [95% confidence interval = 0.61 to 0.73]).
  
  
  CONCLUSIONS
  This work illustrates the utility of the parametric g-formula for estimating the effects of policies regarding occupational exposures, particularly in situations vulnerable to the healthy worker survivor bias.
authors.affiliation: From the aDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; and bDivision of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH.
authors.forename: Jessie K
authors.initials: JK
authors.lastname: Edwards
authors.forename: Leah J
authors.initials: LJ
authors.lastname: McGrath
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Buckley
authors.forename: Mary K
authors.initials: MK
authors.lastname: Schubauer-Berigan
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: David B
authors.initials: DB
authors.lastname: Richardson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000396:Air Pollutants, Radioactive / Q000633:toxicity*; D002423:Cause of Death; D003120:Colorado / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008906:Mining; D009381:Neoplasms, Radiation-Induced / Q000401:mortality*; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D011886:Radon / Q000633:toxicity*; D018570:Risk Assessment
chemical_list: D000396:Air Pollutants, Radioactive; D011886:Radon