Increased risk of cardiovascular disease (CVD) related to particulate matter (PM) in air pollution has become a major public health concern in the US and worldwide. However, while exposure to particles of combustion and crustal origin are prevalent in industrial work, in concentrations up to 2-3 orders of magnitude higher than those associated with CVD in the ambient environment, evidence regarding occupational-related heart disease risk associated with PM exposure is scant. We propose to examine CVD incidence and mortality in a cohort of approximately 75,000 workers exposed to PM2.5 of varying composition and concentration, who has been under intense observation for over a decade as part of the PI's ongoing studies at a major Aluminum Company. As a consequence of these ongoing studies, the investigators have in-hand and fully linked unparalleled information on individual social (e.g. income, education, savings) and behavior (e.g. smoking, BMI, cholesterol) risks, work exposure profiles including all physical, chemical and psycho-social factors of relevance (e.g. heat, noise, strain), complete health claims files since 1996, and NDI results through 2007. Availing this trove of data and our extensive experience working with it, as well as the full cooperation and support of the Company to study this critical problem, the following Specific Aims are proposed:
Aim 1 : Estimate the concentration of fine (PM2.5) and other particulate size fractions in each SEG in the workforce year by year for both PM and by chemical composition.
Aim 2 : In a cohort of active workers, followed historically and prospectively for up to 18 years, identify cases of CVD incidence derived from serial medical claims data, and estimate the relationship between PM2.5 exposure (both simple PM2.5 and by composition) and disease incidence utilizing selected exposure metrics- annual average each year, 95th percentile in each year, cumulative, and lagged.
Aim 3 : To address potential bias due to healthy worker survivor effects that can lead to underestimates of effects, apply the following approaches: extend follow-up of the cohort to mortality and model CVD mortality as end-points, rather than incidence, including inactive as well as active person-time;and applying nested structural models to estimate causal dose-response parameters for both incidence and mortality outcomes to handle time varying confounders that may also be intermediate variables on the causal pathway.

Public Health Relevance

Millions of American workers are exposed to fine particulate in the workplaces. Although there is accumulating evidence such exposures may cause cardiovascular disease, fine particulate has not generally been measured in the workplace, nor directly regulated or uncontrolled. Thus, cardiovascular risk remains unknown. This proposal aims to provide such information in a major industrial setting with broad relevance to the US working population.

Agency
National Institute of Health (NIH)
Institute
National Institute for Occupational Safety and Health (NIOSH)
Type
Research Project (R01)
Project #
5R01OH009939-02
Application #
8331207
Study Section
Safety and Occupational Health Study Section (SOH)
Program Officer
Childress, Adele M
Project Start
2011-09-01
Project End
2015-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
2
Fiscal Year
2012
Total Cost
$631,434
Indirect Cost
$68,240
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Pensa, Mellisa A; Galusha, Deron H; Cantley, Linda F (2018) Patterns of Opioid Prescribing and Predictors of Chronic Opioid Use in an Industrial Cohort, 2003 to 2013. J Occup Environ Med 60:457-461
Liu, Sa; Noth, Elizabeth; Eisen, Ellen et al. (2018) Respirator use and its impact on particulate matter exposure in aluminum manufacturing facilities. Scand J Work Environ Health 44:547-554
Rehkopf, David H; Modrek, Sepideh; Cantley, Linda F et al. (2017) Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence. Health Aff (Millwood) 36:258-265
Costello, Sadie; Neophytou, Andreas M; Brown, Daniel M et al. (2016) Incident Ischemic Heart Disease After Long-Term Occupational Exposure to Fine Particulate Matter: Accounting for 2 Forms of Survivor Bias. Am J Epidemiol 183:861-8
Brown, Daniel M; Petersen, Maya; Costello, Sadie et al. (2015) Occupational Exposure to PM2.5 and Incidence of Ischemic Heart Disease: Longitudinal Targeted Minimum Loss-based Estimation. Epidemiology 26:806-14
Liu, Sa; Noth, Elizabeth M; Dixon-Ernst, Christine et al. (2014) Particle Size Distribution in Aluminum Manufacturing Facilities. Environ Pollut (Tor) 3:79-88
Neophytou, Andreas M; Costello, Sadie; Brown, Daniel M et al. (2014) Marginal structural models in occupational epidemiology: application in a study of ischemic heart disease incidence and PM2.5 in the US aluminum industry. Am J Epidemiol 180:608-15
Noth, Elizabeth M; Dixon-Ernst, Christine; Liu, Sa et al. (2014) Development of a job-exposure matrix for exposure to total and fine particulate matter in the aluminum industry. J Expo Sci Environ Epidemiol 24:89-99
Costello, Sadie; Brown, Daniel M; Noth, Elizabeth M et al. (2014) Incident ischemic heart disease and recent occupational exposure to particulate matter in an aluminum cohort. J Expo Sci Environ Epidemiol 24:82-8
Picciotto, Sally; Brown, Daniel M; Chevrier, Jonathan et al. (2013) Healthy worker survivor bias: implications of truncating follow-up at employment termination. Occup Environ Med 70:736-42