title: Mustard gas exposure and mortality among retired workers at a poisonous gas factory in Japan: a 57-year follow-up cohort study.
abstract: Mustard gas (MG) has been the most widely used chemical warfare agent in the past century. However, few but conflicting data exist on the effects of MG exposure on long-term mortality. We investigated MG-related mortality in retired workers at a poisonous gas factory.
  
  
  
  We assessed mortality rates among 2392 male and 1226 female workers, whose vital status could be determined through 31 December 2009, at a poisonous gas factory operating from 1929 to 1945 in Okuno-jima, Japan. The analysis employed standardised mortality ratios (SMRs) calculated using national and prefectural references and a Cox proportional hazard regression model. Applying the Kaplan-Meier method, we compared cumulative death rates in the study cohort stratified by an 'Okuno-jima MG Index' which represented the product of HRs derived for job category and length of service.
  
  
  
  Among male workers, we found significant excesses in mortality from upper respiratory tract cancer (SMR 3.06), liver cancer (1.67), lung cancer (2.01) and chronic bronchitis/emphysema (4.84) compared with the national population, as well as stomach cancer (1.20) versus the Hiroshima Prefecture population. When stratified into 3 subgroups by the Okuno-jima MG Index, those with a higher Okuno-jima MG Index had significantly higher cumulative rates of death from respiratory cancer and chronic bronchitis/emphysema.
  
  
  
  MG exposure significantly increases the long-term risk of death from respiratory cancer and chronic bronchitis/emphysema. The Okuno-jima MG Index may be a useful indicator for estimating cumulative MG exposure.
authors: Department of Molecular and Internal Medicine, Institute of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Kenichi
authors: K
authors: Mukaida
authors: Department of Molecular and Internal Medicine, Institute of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Noboru
authors: N
authors: Hattori
authors: Department of Molecular and Internal Medicine, Institute of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Hiroshi
authors: H
authors: Iwamoto
authors: Department of Respiratory Medicine, Mazda Hospital, Hiroshima, Japan.
authors: Yojiro
authors: Y
authors: Onari
authors: Tadanoumi Branch Hospital, Kure Kyosai Hospital, Takehara, Japan.
authors: Yoshifumi
authors: Y
authors: Nishimura
authors: Tadanoumi Branch Hospital, Kure Kyosai Hospital, Takehara, Japan.
authors: Keiichi
authors: K
authors: Kondoh
authors: Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Tomoyuki
authors: T
authors: Akita
authors: Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Junko
authors: J
authors: Tanaka
authors: Department of Molecular and Internal Medicine, Institute of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Nobuoki
authors: N
authors: Kohno
mesh_terms: D029481:Bronchitis, Chronic / Q000139:chemically induced / Q000401:mortality; D002423:Cause of Death; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D015331:Cohort Studies; D003644:Death Certificates; D004646:Emphysema / Q000139:chemically induced / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007221:Industry; D007564:Japan / Q000453:epidemiology; D008297:Male; D009151:Mustard Gas / Q000009:adverse effects*; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced* / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012179:Retirement
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas