title: Occupational exposure to asbestos is associated with increased mortality in men recruited for a population-based study in Germany.
abstract: OBJECTIVE
  Occupational exposure to asbestos is associated with increased mortality which, however, has not been thoroughly validated in a general population. We have aimed at exploring whether this association may be confirmed within a population-based setting after adjustment for confounders. Furthermore, the impact of tobacco consumption on the association between occupational exposure to asbestos and mortality is assessed.
  
  
  METHODS
  We used data from 2072 (224 exposed) male participants of the Study of Health in Pomerania. Information on exposure to asbestos is based on a selfreport. Median follow-up time was 11.3 years. All-cause mortality and cause-specific mortality of exposed and non-exposed men were compared using mortality rate ratios, Kaplan-Meier analyses and multivariable Cox regression.
  
  
  RESULTS
  During the follow-up, 52 (23.2%) exposed and 320 (17.3%) non-exposed participants deceased. Exposed subjects had increased hazard ratios (HR) for all-cause mortality (HR=1.48, 95% CI: 1.1-2), benign lung disease mortality (HR=3, 95% CI: 1.18- 7.62) and stomach cancer mortality (HR=4.59, 95% CI: 1.53-13.76). The duration of exposure (per 10 years) was associated with all-cause (HR=1.21, 95% CI: 1.07-1.36) and benign lung disease mortality (HR=1.68, 95% CI: 1.26-2.22). Smokers occupationally exposed to asbestos had the highest risk for all-cause (HR=3.70, 95% CI: 2.19-6.27) and cancer mortality (HR=4.56, 95% CI: 1.99-10.48) as compared to non-asbestos exposed non-smokers.
  
  
  CONCLUSIONS
  Our results confirm associations of occupational exposure to asbestos with all-cause, benign lung disease, and stomach cancer mortality and underline the impact of joint effects of asbestos and smoking on mortality.
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute for Community Medicine). reppkatja@gmail.com.
authors.forename: Katja
authors.initials: K
authors.lastname: Repp
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute for Community Medicine).
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorbeer
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute for Community Medicine).
authors.forename: Till
authors.initials: T
authors.lastname: Ittermann
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases).
authors.forename: Sven
authors.initials: S
authors.lastname: Gläser
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute of Epidemiology and Social Medicine).
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute for Community Medicine).
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.affiliation: Ernst Moritz Arndt University of Greifswald, Greifswald, Germany (Institute for Community Medicine).
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
mesh_terms: D000328:Adult; D000368:Aged; D001194:Asbestos / Q000009:adverse effects* / Q000032:analysis; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D011159:Population Surveillance; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D001194:Asbestos
keywords: asbestos; cancer; epidemiology; mortality; occupational exposure to asbestos; population based