American Journal of Epidemiology Advance Access originally published online on July 27, 2006
American Journal of Epidemiology 2006 164(5):405-420; doi:10.1093/aje/kwj252
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Meta-Analysis |
Meta-Analysis of Mortality and Cancer Incidence among Workers in the Synthetic Rubber-Producing Industry
1 Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
2 Division of Primary Care, School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom
3 MRC Institute for Environment and Health, Leicester, United Kingdom
4 Department of Health Sciences, School of Medicine, University of Leicester, Leicester, United Kingdom
5 Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
Correspondence to Dr. Alexander Sutton, Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester School of Medicine, 22–28 Princess Road West, Leicester LE1 6TP, United Kingdom (e-mail: ajs22{at}le.ac.uk).
Production of synthetic rubber involves exposure to several potentially harmful chemicals. The authors carried out a systematic review and meta-analysis of cohort studies of workers in the rubber-producing industry. Data were obtained from computerized literature searches of several databases from their inception through December 2003. The reference lists of identified articles were inspected for further relevant articles. The authors conducted random-effects meta-analyses of log standardized mortality ratios (SMRs)/standardized incidence ratios. Heterogeneity between study results was explored through subgroup analyses and meta-regression on cohort demographic factors and study quality indicators. The authors identified 36 published articles reporting information on 31 different cohort groups. The meta-SMR was 0.86 (95% confidence interval (CI): 0.82, 0.91) for all-cause mortality (28 cohorts) and 0.94 (95% CI: 0.89, 1.01) for all malignant neoplasms (27 cohorts). Heterogeneity was observed for these endpoints and for the majority of disease-specific outcomes. Statistically significant excesses were observed for diabetes (meta-SMR = 1.36, 95% CI: 1.17, 1.59) (five cohorts) and leukemia (meta-SMR = 1.21, 95% CI: 1.03, 1.43) (16 cohorts), the latter particularly for persons working exclusively in nontire manufacturing (meta-SMR = 1.70, 95% CI: 1.14, 2.54) (four cohorts). Excesses highlighted in previous narrative reviews were not substantiated. Interpretation of these results is complicated by substantial unexplainable heterogeneity; small excesses in specific mortality outcomes may have been disguised by the healthy worker effect.
chemical industry; meta-analysis; mortality; neoplasms; occupational exposure; review [publication type]; rubber
Abbreviations: CI, confidence interval; SIR, standardized incidence ratio; SMR, standardized mortality ratio
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