Estimation of the diesel exhaust exposures of railroad workers: I. Current exposures

Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry

OBJECTIVES

Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario.

METHODS

Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure.

RESULTS

In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins.

CONCLUSIONS

This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.

A critical review of the relationship between occupational exposure to diesel emissions and lung cancer risk

In 2012, a working group of the International Agency for Research on Cancer classified diesel exhaust (DE) as a human carcinogen (Group 1). This decision was primarily based on the findings of the Diesel Exhaust in Miners Study (DEMS). The disparity between the results of various methodological approaches applied to the DEMS led to several critical commentaries. An expert panel was subsequently set up by the Health Effects Institute to evaluate the DEMS results, together with a large study in the trucking industry. The panel concluded that both studies provided a useful basis for quantitative risk assessments (QRAs) of DE exposure. However, the results of both studies were non-definitive as the studies suffer from several methodological shortcomings. We conducted a critical review of the studies used by the International Agency for Research on Cancer (IARC) working group to evaluate the relationship between DE and lung cancer. The aim was to assess whether the available studies support the statement of a causal relationship and, secondarily if they could be used for QRA. Our review highlights several methodological flaws in the studies, amongst them overadjustment bias, selection bias, and confounding bias. The conclusion from our review is that the currently published studies provide little evidence for a definite causal link between DE exposure and lung cancer risk. Based on two studies in miners, the DEMS and the German Potash Miners study, QRA may be conducted. However, the DEMS data should be reanalyzed in advance to avoid bias that affects the presently published risk estimates.

Rating locomotive crew diesel emission exposure profiles using statistics and Bayesian Decision Analysis

For more than 20 years CSX Transportation (CSXT) has collected exposure measurements from locomotive engineers and conductors who are potentially exposed to diesel emissions. The database included measurements for elemental and total carbon, polycyclic aromatic hydrocarbons, aromatics, aldehydes, carbon monoxide, and nitrogen dioxide. This database was statistically analyzed and summarized, and the resulting statistics and exposure profiles were compared to relevant occupational exposure limits (OELs) using both parametric and non-parametric descriptive and compliance statistics. Exposure ratings, using the American Industrial Health Association (AIHA) exposure categorization scheme, were determined using both the compliance statistics and Bayesian Decision Analysis (BDA). The statistical analysis of the elemental carbon data (a marker for diesel particulate) strongly suggests that the majority of levels in the cabs of the lead locomotives (n = 156) were less than the California guideline of 0.020 mg/m(3). The sample 95th percentile was roughly half the guideline; resulting in an AIHA exposure rating of category 2/3 (determined using BDA). The elemental carbon (EC) levels in the trailing locomotives tended to be greater than those in the lead locomotive; however, locomotive crews rarely ride in the trailing locomotive. Lead locomotive EC levels were similar to those reported by other investigators studying locomotive crew exposures and to levels measured in urban areas. Lastly, both the EC sample mean and 95%UCL were less than the Environmental Protection Agency (EPA) reference concentration of 0.005 mg/m(3). With the exception of nitrogen dioxide, the overwhelming majority of the measurements for total carbon, polycyclic aromatic hydrocarbons, aromatics, aldehydes, and combustion gases in the cabs of CSXT locomotives were either non-detects or considerably less than the working OELs for the years represented in the database. When compared to the previous American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) of 3 ppm the nitrogen dioxide exposure profile merits an exposure rating of AIHA exposure category 1. However, using the newly adopted TLV of 0.2 ppm the exposure profile receives an exposure rating of category 4. Further evaluation is recommended to determine the current status of nitrogen dioxide exposures. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: additional text on OELs, methods, results, and additional figures and tables.].

A retrospective assessment of occupational exposure to elemental carbon in the U.S. trucking industry

BACKGROUND

Despite considerable epidemiologic evidence about the health effects of chronic exposure to vehicle exhaust, efforts at defining the extent of risk have been limited by the lack of historical exposure measurements suitable for use in epidemiologic studies and for risk assessment.

OBJECTIVES

We sought to reconstruct exposure to elemental carbon (EC), a marker of diesel and other vehicle exhaust exposure, in a large national cohort of U.S. trucking industry workers.

METHODS

We identified the predictors of measured exposures based on a statistical model and used this information to extrapolate exposures across the cohort nationally. These estimates were adjusted for changes in work-related conditions over time based on a previous exposure assessment of this industry, and for changes in background levels based on a trend analysis of historical air pollution data, to derive monthly estimates of EC exposure for each job and trucking terminal combination between 1971 and 2000.

RESULTS

Occupational exposure to EC declined substantially over time, and we found significant variability in estimated exposures both within and across job groups, trucking terminals, and regions of the United States. Average estimated EC exposures during a typical work shift ranged from < 1 μg/m³ in the lowest exposed category in the 1990s to > 40 μg/m³ for workers in the highest exposed jobs in the 1970s.

CONCLUSIONS

Our results provide a framework for understanding changes over time in exposure to EC in the U.S. trucking industry. Our assessment should minimize exposure misclassification by capturing variation among terminals and across U.S. regions, and changes over time.

The diesel exhaust in miners study: I. Overview of the exposure assessment process

This report provides an overview of the exposure assessment process for an epidemiologic study that investigated mortality, with a special focus on lung cancer, associated with diesel exhaust (DE) exposure among miners. Details of several components are provided in four other reports. A major challenge for this study was the development of quantitative estimates of historical exposures to DE. There is no single standard method for assessing the totality of DE, so respirable elemental carbon (REC), a component of DE, was selected as the primary surrogate in this study. Air monitoring surveys at seven of the eight study mining facilities were conducted between 1998 and 2001 and provided reference personal REC exposure levels and measurements for other agents and DE components in the mining environment. (The eighth facility had closed permanently prior to the surveys.) Exposure estimates were developed for mining facility/department/job/year combinations. A hierarchical grouping strategy was developed for assigning exposure levels to underground jobs [based on job titles, on the amount of time spent in various areas of the underground mine, and on similar carbon monoxide (CO, another DE component) concentrations] and to surface jobs (based on the use of, or proximity to, diesel-powered equipment). Time trends in air concentrations for underground jobs were estimated from mining facility-specific prediction models using diesel equipment horsepower, total air flow rates exhausted from the underground mines, and, because there were no historical REC measurements, historical measurements of CO. Exposures to potentially confounding agents, i.e. respirable dust, silica, radon, asbestos, and non-diesel sources of polycyclic aromatic hydrocarbons, also were assessed. Accuracy and reliability of the estimated REC exposures levels were evaluated by comparison with several smaller datasets and by development of alternative time trend models. During 1998-2001, the average measured REC exposure level by facility ranged from 40 to 384 μg m⁻³ for the underground workers and from 2 to 6 μg m⁻³ for the surface workers. For one prevalent underground job, 'miner operator', the maximum annual REC exposure estimate by facility ranged up to 685% greater than the corresponding 1998-2001 value. A comparison of the historical CO estimates from the time trend models with 1976-1977 CO measurements not used in the modeling found an overall median relative difference of 29%. Other comparisons showed similar levels of agreement. The assessment process indicated large differences in REC exposure levels over time and across the underground operations. Method evaluations indicated that the final estimates were consistent with those from alternative time trend models and demonstrated moderate to high agreement with external data.

Lung cancer and diesel exhaust: a critical review of the occupational epidemiology literature

The diesel exhaust (DE)-lung cancer hypothesis is evaluated. Diesel power became common after World War II, exposure was to traditional diesel exhaust (TDE) before 1988. In the next, 20 years, emissions were modified to new-technology diesel exhaust (NTDE) containing 1% of pre-1988 levels of diesel particulate matter (DPM). Nearly all pre-1990 studies were cohorts with primarily pre-diesel exposures. This review focuses on the proportion of cases with >20 years since initial DE exposure; strength of association; biological gradients; roles of chance, bias, and confounding; and consistency in 13 diesel studies. Five studies had adequate latency, six had a minority of workers with >20 years' latency, and in two studies most workers had inadequate latency. This pattern suggests too few relevant studies for evaluating the DE-lung cancer hypothesis. The 16 highest exposure categories showed 7 with probable associations (relative risk [RR] > 1.5), 7 with improbable or no associations (RRs < 1.2), and 2 with possible associations (RRs 1.2-1.5). This random pattern with many weak RRs does not support the DE-lung cancer hypothesis. Ten of 34 exposure-response (E-R) analyses showed positive trends and 24 had indeterminate or negative trends. This small number of positive biological gradients does not support causality. Weight of evidence suggests 70% of studies are indeterminate, whereas 30% are positive or negative, indicating a lack of consistency. To support a traditional diesel exhaust-lung cancer hypothesis requires more studies with longer follow-up and quantitative E-R analyses.

Estimation and validation of biomarker-based exposures for historical ammonium perfluorooctanoate

Ammonium perfluorooctanoate (APFO) exposures were estimated for use in an occupational mortality study using detailed work histories of cohort members and an exposure reconstruction model developed from occupational information and serum PFO(-) data collected in 2004 as part of a cross-sectional health survey. Measured serum PFO(-) levels of the health survey participants were linked with the job title held by the individuals at the time of sampling. The median, range, and distribution of serum levels were calculated to determine the typical exposure intensity for each job title. High variability was observed in the serum levels of workers within the same job titles. In addition, working in many "APFO-use" jobs did not result in higher exposure than working in "no APFO-use" jobs. Each job title was then assigned to one of three relative APFO job exposure categories (low, medium, or high). Participants' length of time in their job was examined in relation to their serum PFO(-) level and found unlikely to contribute to misclassification of job titles within exposure categories. The mean of the serum PFO(-) measurements for each job exposure category served as the mean intensity factor. Subsequently, the job exposure categories were applied to all historical job titles of the mortality cohort based on their correspondence with job titles represented in the health survey. The resulting job exposure matrix was validated with additional historical blood data collected between 1979 through 2002 from voluntary participants in a separate biomonitoring program. The validation analyses showed general agreement between estimated and measured exposure, reflecting the within-job-title variability observed in measured serum levels used to classify job exposure.

Occupational exposure to diesel engine exhaust: a literature review

Diesel exhaust (DE) is classified as a probable human carcinogen. Aims were to describe the major occupational uses of diesel engines and give an overview of personal DE exposure levels and determinants of exposure as reported in the published literature. Measurements representative of personal DE exposure were abstracted from the literature for the following agents: elemental carbon (EC), particulate matter (PM), carbon monoxide (CO), nitrogen oxide (NO), and nitrogen dioxide (NO(2)). Information on determinants of exposure was abstracted. In total, 3528 EC, 4166 PM, 581 CO, 322 NO, and 1404 NO(2) measurements were abstracted. From the 10,001 measurements, 32% represented exposure from on-road vehicles and 68% from off-road vehicles (30% mining, 15% railroad, and 22% others). Highest levels were reported for enclosed underground work sites in which heavy equipment is used: mining, mine maintenance, and construction (EC: 27-658 microg/m(3)). Intermediate exposure levels were generally reported for above-ground (semi-) enclosed areas in which smaller equipment was run: mechanics in a shop, emergency workers in fire stations, distribution workers at a dock, and workers loading/unloading inside a ferry (generally: EC<50 microg/m(3)). Lowest levels were reported for enclosed areas separated from the source, such as drivers and train crew, or outside, such as surface mining, parking attendants, vehicle testers, utility service workers, surface construction and airline ground personnel (EC<25 microg/m(3)). The other agents showed a similar pattern. Determinants of exposure reported for enclosed situations were ventilation and exhaust after treatment devices. Reported DE exposure levels were highest for underground mining and construction, intermediate for working in above-ground (semi-) enclosed areas and lowest for working outside or separated from the source. The presented data can be used as a basis for assessing occupational exposure in population-based epidemiological studies and guide future exposure assessment efforts for industrial hygiene and epidemiological studies.

Predicting changes in PM exposure over time at U.S. trucking terminals using structural equation modeling techniques

This study analyzes the temporal variability of occupational and environmental exposures to fine particulate matter in the U.S. trucking industry and tests the predictive ability of a novel multilayer statistical approach to occupational exposure modeling using structural equation modeling (SEM) techniques. For these purposes, elemental carbon mass in PM<1 microm at six U.S. trucking terminals were measured twice during the same season up to 2 years apart, observing concentrations in the indoor loading dock (median EC: period 1 = 0.65 microg/m(3); period 2 = 0.94 microg/m(3)) and outdoor background location (median EC: period 1 = 0.46 microg/m(3); period 2 = 0.67 microg/m(3)), as well as in the truck cabs of local drivers while on the road (median EC: period 1 = 1.09 microg/m(3); period 2 = 1.07 microg/m(3)). There was a general trend toward higher exposures during the second sampling trips; however, these differences were statistically significant in only a few cases and were largely attributable to changes in weather patterns (wind speed, precipitation, etc.). Once accounting for systematic prediction errors in background concentrations, the SEM approach provided a strong fit for work-related exposures in this occupational setting.

Acrolein environmental levels and potential for human exposure

This article provides environmental information on acrolein including environmental fate, potential for human exposure, analytical methods, and a listing of regulations and advisories. Acrolein may be released to the environment in emissions and effluents from its manufacturing and use facilities, in emissions from combustion processes (including cigarette smoking and combustion of petrochemical fuels), from direct application to water and waste water as a slimicide and aquatic herbicide, as a photooxidation product of various hydrocarbon pollutants found in air (including propylene and 1,3-butadiene), and from land disposal of some organic waste materials. Acrolein is a reactive compound and is unstable in the environment. The general population may be exposed to acrolein through inhalation of contaminated air and through ingestion of certain foods. Important sources of acrolein exposure are via inhalation of tobacco smoke and environmental tobacco smoke and via the overheating of fats contained in all living matter. There is potential for exposure to acrolein in many occupational settings as the result of its varied uses and its formation during the combustion and pyrolysis of materials such as wood, petrochemical fuels, and plastics.

Tracking personal exposure to particulate diesel exhaust in a diesel freight terminal using organic tracer analysis

Personal exposure to particle-phase molecular markers was measured at a trucking terminal in St Louis, MO, as part of a larger epidemiologic project aimed at assessing carbonaceous fine particulate matter (PM) exposure in this occupational setting. The integration of parallel personal exposure, ambient worksite area and ambient urban background (St Louis Supersite) measurements provided a unique opportunity to track the work-related exposure to carbonaceous fine PM in a freight terminal. The data were used to test the proposed personal exposure model in this occupational setting: To accurately assess the impact of PM emission sources, particularly motor vehicle exhaust, and organic elemental carbon (OCEC) analysis and nonpolar organic molecular marker analysis by thermal desorption-gas chromatography/mass spectrometry (TD-GCMS) were conducted on all of the PM samples. EC has been used as a tracer for diesel exhaust in urban areas, however, the emission profile for diesel exhaust is dependent upon the operating conditions of the vehicle and can vary considerably within a fleet. Hopanes, steranes, polycyclic aromatic hydrocarbons and alkanes were measured by TD-GCMS. Hopanes are source-specific organic molecular markers for lubricating oil present in motor vehicle exhaust. The concentrations of OC, EC and the organic tracers were averaged to obtain average profiles to assess differences in the personal, worksite area and urban background samples, and were also correlated individually by sample time to evaluate the exposure model presented above. Finally, a chemical mass balance model was used to apportion the motor vehicle and cigarette-smoke components of the measured OC and EC for the average personal exposure, worksite area and urban background samples.

A case-control study relating railroad worker mortality to diesel exhaust exposure using a threshold regression model

A case-control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan-Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality.

Chronic obstructive pulmonary disease mortality in railroad workers

BACKGROUND

There is little information describing the risk of non-malignant respiratory disease and occupational exposure to diesel exhaust.

METHODS

US railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II. In a retrospective cohort study we examined the association of chronic obstructive pulmonary disease (COPD) mortality with years of work in diesel-exposed jobs. To examine the possible confounding effects of smoking, multiple imputation was used to model smoking history. A Cox proportional hazards model was used to estimate an incidence rate ratio, adjusted for age, calendar year, and length of follow-up after leaving work (to reduce bias due to a healthy worker survivor effect).

RESULTS

Workers in jobs with diesel exhaust exposure had an increased risk of COPD mortality relative to those in unexposed jobs. Workers hired after the introduction of diesel locomotives had a 2.5% increase in COPD mortality risk for each additional year of work in a diesel-exposed job. This risk was only slightly attenuated after adjustment for imputed smoking history.

CONCLUSIONS

These results support an association between occupational exposure to diesel exhaust and COPD mortality.

A Reevaluation of the Literature Regarding the Health Assessment of Diesel Engine Exhaust

While the International Agency for Research on Cancer (IARC) classified diesel exhaust (DE) as a"probable"carcinogen in 1989 based primarily on"sufficient"animal data, other investigators have since concluded that the lung tumors found in the rat studies were a result of particle overloading. Subsequent health risk assessments of DE have not used the rat cancer data. The U.S. Environmental Protection Agency (EPA), in developing its 2002 Health Assessment Document (HAD) for DE, primarily considered the epidemiology studies of railroad workers and truck drivers to develop health risk assessments of DE. However, both sets of epidemiology studies have serious weaknesses that make them unsuitable for cancer risk assessment. Major shortcomings were the lack of contemporaneous measurements of exposures to DE, difficulties with exposure history reconstruction, and adequately accounting for other exposures such as gasoline exhaust and cigarette smoke. To compound these problems, there was not, and there is still not, a specific exposure marker for DE. Interestingly, in the underground mining industry, where diesel exposures are much higher than observed in railroad workers and truck drivers, there was no increase in lung cancer. These problems and concerns led the U.S. EPA to conclude that while DE was a"likely"carcinogen, a unit risk value or range of risk cannot be calculated from existing data and that the risk could be zero. In addition, the DE emissions have changed and continue to change with the implementation of new emission control technologies. The HAD recognized this fact and noted that further studies are needed to assess new diesel engine emissions. Recent chemical characterization studies on low-emitting diesel engines with catalyzed particulate filters have shown emissions rates for several chemicals of concern that are even lower than comparable compressed natural gas (CNG)-fueled engines. With lower emissions, better fire safety, and improved cost-effectiveness of new low-emitting diesels compared to CNG, current efforts to restrict use of low-emitting diesels seems misguided.

Historical estimation of diesel exhaust exposure in a cohort study of U.S. railroad workers and lung cancer

We have previously shown an elevated risk of lung cancer mortality in diesel exhaust exposed railroad workers. To reduce exposure misclassification, we obtained extensive historical information on diesel locomotives used by each railroad. Starting in 1945, we calculated the rate each railroad converted from steam to diesel, creating annual railroad-specific weighting factors for the probability of diesel exposure. We also estimated the average annual exposure intensity based on emission factors. The U.S. Railroad Retirement Board provided railroad assignment and work histories for 52,812 workers hired between 1939-1949, for whom we ascertained mortality from 1959-1996. Among workers hired after 1945, as diesel locomotives were introduced, the relative risk of lung cancer for any exposure was 1.77 (95% CI = 1.50-2.09), and there was evidence of an exposure-response relationship with exposure duration. Exposed workers hired before 1945 had a relative risk of 1.30 (95% CI = 1.19-1.43) for any exposure and there was no evidence of a dose response with duration. There was no evidence of increasing risk using estimated measures of intensity although the overall lung cancer risk remained elevated. In conclusion, although precise historical estimates of exposure are not available, weighting factors helped better define the exposure-response relationship of diesel exhaust with lung cancer mortality.

A critical assessment of studies on the carcinogenic potential of diesel exhaust

After decades of research involving numerous epidemiologic studies and extensive investigations in laboratory animals, a causal relationship between diesel exhaust (DE) exposure and lung cancer has not been conclusively demonstrated. Epidemiologic studies of the transportation industry (trucking, busing, and railroad) show a small elevation in lung cancer incidence (relative risks [RRs] generally below 1.5), but a dose response for DE is lacking. The studies are also limited by a lack of quantitative concurrent exposure data and inadequate or lack of controls for potential confounders, particularly tobacco smoking. Furthermore, prior to dieselization, similar elevations in lung cancer incidence have been reported for truck drivers, and in-cab diesel particulate matter (DPM) exposures of truck drivers were comparable to ambient highway exposures. Taken together, these findings suggest that an unidentified occupational agent or lifestyle factor might be responsible for the low elevations in lung cancer reported in the transportation studies. In contrast, underground miners, many of whom experience the highest occupational DPM exposures, generally do not show elevations in lung cancer. Laboratory studies must be interpreted with caution with respect to predicting the carcinogenic potential of DE in humans. Tumors observed in rats following lifetime chronic inhalation of very high levels of DPM may be attributed to species-specific overload mechanisms that lack relevance to humans. Increased tumor incidence was not observed in other species (hamsters or mice) exposed to DPM at very high levels or in rats exposed at lower levels (</=2000 mug/m3). Although DPM contains mutagens, mutagenicity studies in which cells were exposed to concentrated extracts of DPM also have limited application to human risk assessment, because such extracts can be obtained from DPM only by using strong organic solvents, agitation, and heat. Most studies have shown that whole DPM itself is not mutagenic because the adsorbed organic compounds are minimally bioavailable in aqueous-based fluids. In the past two decades, dramatic changes in diesel engine technology (e.g., low-sulfur fuel and exhaust after-treatment) have resulted in >99% reduction in DPM and other quantitative and qualitative changes in the chemical and physical characteristics of diesel exhaust. Thus, the current database, which is focused almost entirely on the potential health effects of traditional diesel exhaust (TDE), has only limited utility in assessing the potential health risks of new-technology diesel exhaust (NTDE). To overcome some of the limitations of the historical epidemiologic database on TDE and to gain further insights into the potential health effects of NTDE, new studies are underway and more studies are planned.

Occupational exposure to diesel exhausts and risk for lung cancer in a population-based case–control study in Italy

BACKGROUND

We studied the effect of exposure to diesel exhausts on lung cancer risk in a population-based case-control study in the city of Turin, Italy.

PATIENTS AND METHODS

Information on occupational histories of 595 incident lung cancer cases diagnosed in 1991-1992 and 845 population controls was obtained. During the interviews, diesel job-specific modules (D-JSMs) were administered whenever subjects had worked in occupations included in the following nine categories: railroad workers, miners, professional drivers and transport conductors, heavy-machine operators, mechanics and testers, filling station attendants, motor-vehicle park attendants, transport equipment operators, and occupations carried out in/near urban roads. All D-JSMs were evaluated for probability, intensity and frequency of exposure.

RESULTS

The odds ratio for ever exposure to diesel exhausts was 1.04 (95% confidence interval 0.79-1.37), after adjusting for age, sex, smoking and having worked in occupations entailing exposure to known lung carcinogens. No association was found with intensity, probability and duration of exposure.

CONCLUSIONS

Although misclassification of the exposure may have contributed to the negative results, we did not find an association between occupational exposure to diesel exhausts and lung cancer risk.

Smoking imputation and lung cancer in railroad workers exposed to diesel exhaust

BACKGROUND

An association between diesel exhaust exposure and lung cancer mortality in a large retrospective cohort study of US railroad workers has previously been reported. However, specific information regarding cigarette smoking was unavailable.

METHODS

Birth cohort, age, job, and cause of death specific smoking histories from a companion case-control study were used to impute smoking behavior for 39,388 railroad workers who died 1959-1996. Mortality analyses incorporated the effect of smoking on lung cancer risk.

RESULTS

The smoking adjusted relative risk of lung cancer in railroad workers exposed to diesel exhaust compared to unexposed workers was 1.22 (95% CI = 1.12-1.32), and unadjusted for smoking the relative risk was 1.35 (95% CI = 1.24-1.46).

CONCLUSIONS

These analyses illustrate the use of imputation in record-based occupational health studies to assess potential confounding due to smoking. In this cohort, small differences in smoking behavior between diesel exposed and unexposed workers did not explain the elevated lung cancer risk.

Chronic obstructive pulmonary disease mortality in diesel-exposed railroad workers

Diesel exhaust is a mixture of combustion gases and ultrafine particles coated with organic compounds. There is concern whether exposure can result in or worsen obstructive airway diseases, but there is only limited information to assess this risk. U.S. railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II, and by 1959, 95% of the locomotives were diesel. We conducted a case-control study of railroad worker deaths between 1981 and 1982 using U.S. Railroad Retirement Board job records and next-of-kin smoking, residential, and vitamin use histories. There were 536 cases with chronic obstructive pulmonary disease (COPD) and 1,525 controls with causes of death not related to diesel exhaust or fine particle exposure. After adjustment for age, race, smoking, U.S. Census region of death, vitamin use, and total years off work, engineers and conductors with diesel-exhaust exposure from operating trains had an increased risk of COPD mortality. The odds of COPD mortality increased with years of work in these jobs, and those who had worked >/= 16 years as an engineer or conductor after 1959 had an odds ratio of 1.61 (95% confidence interval, 1.12-2.30) . These results suggest that diesel-exhaust exposure contributed to COPD mortality in these workers. Further study is needed to assess whether this risk is observed after exposure to exhaust from later-generation diesel engines with modern emission controls.

Exposure of trucking company workers to particulate matter during the winter

This study analyzed the workplace area concentrations and the personal exposure concentrations to fine particulate (PM2.5), elemental carbon (EC), and organic carbon (OC) measured during the winter period in trucking companies. The averaged personal exposure concentrations at breathing zones of workers are much greater than those of the microenvironment concentrations. The highest difference between the area (microenvironment) and personal exposure concentrations was in the PM2.5 concentrations followed by the OC concentrations. The area concentrations of PM2.5, EC, and OC at a large terminal were higher than those at a small one. The highest area concentrations of PM2.5, EC, and OC were observed in the shop areas followed by pick-up and delivery (P&D) areas. The area concentrations and personal exposure to PM2.5, EC, and OC in the shop and P&D areas which are highly affected by diesel engine exhaust emissions were much higher than those in the docks which are significantly affected by liquefied petroleum gas (LPG) engine exhaust emissions. The highest EC fraction to the total carbon (EC + OC) concentrations was observed in the shops, while the lowest one was identified in the offices. The personal exposure of the smoking workers to PM2.5 and OC was much higher than that of the non-smoking workers. However, the smoking might not significantly contribute to the personal exposure to EC. There were significant correlations between the PM2.5 and OC concentrations in both the area and personal exposure concentrations. However, significant correlations between the PM2.5 and EC concentrations and between the OC and EC concentrations were not identified.

Carcinogenicity studies of diesel engine exhausts in laboratory animals: a review of past studies and a discussion of future research needs

Diesel engines play a vital role in world economy, especially in transportation. Exhaust from traditional diesel engines using high-sulfur fuel contains high concentrations of respirable carbonaceous particles with absorbed organic compounds. Recognition that some of these compounds are mutagenic has raised concern for the cancer-causing potential of diesel exhaust exposure. Extensive research addressing this issue has been conducted during the last three decades. This critical review is offered to facilitate an updated assessment of the carcinogenicity of diesel exhaust and to provide a rationale for future animal research of new diesel technology. Life-span bioassays in rats, mice, and Syrian hamsters demonstrated that chronic inhalation of high concentrations of diesel exhaust caused lung tumors in rats but not in mice or Syrian hamsters. In 1989, the International Agency for Research on Cancer (IARC) characterized the rat findings as "sufficient evidence of animal carcinogenicity," and, with "limited" evidence from epidemiological studies, classified diesel exhaust Category 2A, a "probable human carcinogen." Subsequent research has shown that similar chronic high concentration exposure to particulate matter generally considered innocuous (such as carbon black and titanium dioxide) also caused lung tumors in rats. Thus, in 2002, the U.S. Environmental Protection Agency (EPA) concluded that the findings in the rats should not be used to characterize the cancer hazard or quantify the cancer risk of diesel exhaust. Concurrent with the conduct of the health effects studies, progressively more stringent standards have been promulgated for diesel exhaust particles and NOx. Engine manufacturers have responded with new technology diesel (improved engines, fuel injection, fuels, lubricants, and exhaust treatments) to meet the standards. This review concludes with an outline of research to evaluate the health effects of the new technology, research that is consistent with recommendations included in the U.S. EPA 2002 health assessment document. When this research has been completed, it will be appropriate for IARC to evaluate the potential cancer hazard of the new technology diesel.

Correlation between suspended particles in the environmental air and causes of disease among inhabitants: cross-sectional studies using the vital statistics and air pollution data in Japan

To identify the diseases that correlate with suspended particle concentration in the ambient air, a cross-sectional epidemiological study was conducted using the annual vital statistics and air pollution estimates of 1881 points throughout Japan. The concentration of suspended particulate matters (SPMs) 10 microm or less in diameter were hypothetically converted to PM(2.5) values (converted PM(2.5) or cPM(2.5)) by using a conversion factor obtained from 25 estimates in Japan. Among various causes of death, a significant correlation was observed between both the SPM and cPM(2.5) (SPM/cPM(2.5)) levels and the age-adjusted death rates of ischemic heart disease or hypertensive heart disease in both genders. Correlation was noted with pneumonia, asthma, chronic bronchitis/emphysema, or lung cancer only in females. Unexpectedly, breast, endometrial, and ovarian cancer also showed significant increases in mortality rates related to the SPM/cPM(2.5) level, suggesting a role for suspended particles in the ambient air with or without gaseous component as a possible endocrine-disrupting, estrogenic agent. Multivariate regression analysis of confounding factors, smoking rate, population density, and hormone-related factors revealed consistent significance of SPM/cPM(2.5) in these diseases.

Lung cancer in railroad workers exposed to diesel exhaust

Diesel exhaust has been suspected to be a lung carcinogen. The assessment of this lung cancer risk has been limited by lack of studies of exposed workers followed for many years. In this study, we assessed lung cancer mortality in 54,973 U.S. railroad workers between 1959 and 1996 (38 years). By 1959, the U.S. railroad industry had largely converted from coal-fired to diesel-powered locomotives. We obtained work histories from the U.S. Railroad Retirement Board, and ascertained mortality using Railroad Retirement Board, Social Security, and Health Care Financing Administration records. Cause of death was obtained from the National Death Index and death certificates. There were 43,593 total deaths including 4,351 lung cancer deaths. Adjusting for a healthy worker survivor effect and age, railroad workers in jobs associated with operating trains had a relative risk of lung cancer mortality of 1.40 (95% confidence interval, 1.30-1.51). Lung cancer mortality did not increase with increasing years of work in these jobs. Lung cancer mortality was elevated in jobs associated with work on trains powered by diesel locomotives. Although a contribution from exposure to coal combustion products before 1959 cannot be excluded, these results suggest that exposure to diesel exhaust contributed to lung cancer mortality in this cohort. Key words: diesel exhaust, lung cancer, occupational exposure.

Airborne concentrations of benzene due to diesel locomotive exhaust in a roundhouse

Concentrations of airborne benzene due to diesel exhaust from a locomotive were measured during a worst-case exposure scenario in a roundhouse. To understand the upper bound human health risk due to benzene, an electromotive diesel and a General Electric four-cycle turbo locomotive were allowed to run for four 30-min intervals during an 8-h workshift in a roundhouse. Full-shift and 1-h airborne concentrations of benzene were measured in the breathing zone of surrogate locomotive repairmen over the 8-h workshift on 2 consecutive days. In addition, carbon monoxide was measured continuously; elemental carbon (surrogate for diesel exhaust) was sampled with full-shift area samples; and nitrogen dioxide/nitric oxide was sampled using full-shift and 15-min (nitrogen dioxide only) area samples. Peak concentrations of carbon monoxide ranged from 22.5 to 93 ppm. The average concentration of elemental carbon for each day of the roundhouse study was 0.0543 and 0.0552 microg/m(3 )for an 8-h workshift. These were considered "worst-case" conditions since the work environment was intolerably irritating to the eyes, nose, and throat. Short-term nitrogen dioxide concentrations ranged from 0.81 to 2.63 ppm during the diesel emission events with the doors closed. One-hour airborne benzene concentrations ranged from 0.001 to 0.015 ppm with 45% of the measurements below the detection limit of 0.002-0.004 ppm. Results indicated that the 8-h time-weighted average for benzene in the roundhouse was approximately 100-fold less than the current threshold limit value (TLV) of 0.5 ppm. These data are consistent with other studies, which have indicated that benzene concentrations due to diesel emissions, even in a confined environment, are quite low.

Diesel exhaust exposure and lung cancer: adjustment for the effect of smoking in a retrospective cohort study

BACKGROUND

The extent that cigarette smoking may confound the relationship between diesel exhaust exposure and lung cancer was assessed in a retrospective cohort study of 55,395 U.S. railroad workers followed from 1959 to 1976.

METHODS

The relative risk (RR) of lung cancer due to diesel exhaust was indirectly adjusted using job-specific smoking data from a case-control study of railroad workers who died between 1981-1982 and from a survey of 514 living workers from an active railroad in 1982. Adjustment factors were developed based on the distribution of job-specific smoking rates.

RESULTS

The unadjusted RR for lung cancer was 1.58 (95% CI = 1.14-2. 20) for workers aged 40-44 in 1959, who experienced the longest possible duration of exposure, and the smoking adjusted RR was 1.44 (1.01-2.05).

CONCLUSIONS

After considering differences in smoking rates between workers exposed and unexposed to diesel exhaust in a relatively large blue-collar cohort, there were still elevated risks of lung cancer in workers in jobs with diesel exhaust exposure.

Diesel exhaust and lung cancer mortality in potash mining

BACKGROUND

Findings from experimental studies on rodents and from epidemiological studies suggest that diesel exhaust may cause lung cancer. There is evidence that in several occupations, e.g., truck drivers and railway workers, the risk of lung cancer increases with duration of employment, and exposure to diesel exhaust provides the most likely explanation for these elevations of risk.

METHODS

We investigated the association between lung cancer mortality and exposure to diesel exhaust in a cohort study. The cohort comprised 5, 536 male potash miners who were followed from 1970 to 1994. Exposure was assessed from concentration measurements of the total carbon (i. e., elemental and organic carbon in total) in personal dust samples. The concentration values were multiplied by years of exposure to give a quantitative exposure measure. The concentration levels ranged from 0.12 to 0.39 mg/m(3) total carbon in fine dust. Work histories and smoking habit data were obtained from medical company records. Causes of death were ascertained from death certificates.

RESULTS

During the follow-up period, 424 deaths were recorded, including 133 of cancer, 38 of lung cancer. The relative risk of lung cancer between two groups with high and low exposure was 2.2 (95% confidence interval 0.8-6.0). With Cox regression, we found a lung cancer relative risk 1.7 (0.5-5.8) after twenty years of exposure. Extensive scrutiny proved smoking not to be a confounder in this study.

CONCLUSIONS

The principal finding of the study is a doubling of relative lung cancer risk after twenty years of exposure in the workplaces with highest exposure. However, the observed elevation is nonsignificant even at a 90% level. Further follow-up is intended to enhance the study power.

Lung cancer mortality and diesel exhaust: reanalysis of a retrospective cohort study of U.S. railroad workers

A retrospective cohort study of 55,407 U.S. railroad workers has been called the most definitive study linking exposure to diesel exhaust (DE) with lung cancer in humans. However, reanalysis of data from this study suggests caution in interpreting this study as demonstrating such a link. Although workers who rode trains had a significantly elevated lung cancer mortality relative to clerks and signalmen (who were assumed to be unexposed), shop workers did not, despite convincing evidence that these workers had the highest exposures to DE. Mortality from heart disease and cirrhosis of the liver were also significantly elevated among train riders, which suggests that these workers had a substantially different lifestyle from other workers, and raises the possibility that their elevated lung cancer mortality may be related to lifestyle rather than to DE exposure. Smoking information was not available for this cohort. A positive, monotone dose-response trend in lung cancer mortality with increasing duration of exposure found by the original investigators was not present when age was controlled more carefully and years of exposure quantified more accurately. Instead, a negative dose-response trend for lung cancer was seen among exposed workers based on either duration of exposure or quantitative measures of cumulative exposure. Similar negative trends were seen with several broad categories of mortality, including all causes. These negative trends are possibly a result of incomplete follow-up that was most severe among workers with the longest tenures. A sizable fraction of deaths occurring during the last 4 years of follow-up evidently were not identified, and there is evidence that follow-up in earlier years was also incomplete. At the very least, problems with the follow-up should be rectified before any conclusions are drawn about the carcinogenicity of DE in this cohort.

1-Nitropyrene as a marker for the mutagenicity of diesel exhaust-derived particulate matter in workplace atmospheres

The use of 1-nitropyrene (1-NP) as a marker for the occupational exposure to diesel exhaust (DE) mutagens was investigated in workplace atmospheres contaminated with DE from a variety of emission sources, such as power supplies, forklifts, trucks, caterpillar vehicles, trains, ships' engines, and vehicles in city traffic. Total suspended particulate matter was collected by area sampling. The 1-NP content of acetone extracts of these samples as determined by gas chromatography-high resolution mass spectrometry varied from 0.080 to 17 micrograms/g acetone extractable matter, corresponding to air concentrations of 0.012 to 1.2 ng/m3. A sample collected in a rural area contained 0.0017 ng/m3 1-NP. The mutagenicity of the extracts was tested in the Salmonella typhimurium strains TA98 and TA1538, using the microsuspension assay with and without metabolic activation by an exogeneous metabolizing system (rat liver S9-fraction). In addition, the S. typhimurium strains YG1021 and YG1024 were used because of their high sensitivity towards the mutagenicity of nitro polycyclic aromatic hydrocarbons. When plotting the mutagenic potency of the air sample extracts as determined in the absence of liver S9 versus the particle-associated 1-NP level, a relatively high correlation (r = 0.80-0.91) was observed in all of the S. typhimurium strains. High correlations (r = 0.80-0.93) were also observed when plotting the results of mutagenicity testing after activation by S9 versus the outcome of chemical analysis. These results show that the 1-NP content of workplace air samples is associated with their mutagenic potency, suggesting that 1-NP may be used as a marker for occupational exposure to DE-derived particle-associated mutagens.

A perspective on the potential development of environmentally acceptable light-duty diesel vehicles

Between 1979 and 1985, an international technical focus was placed upon potential human health effects associated with exposure to diesel emissions. A substantial data base was developed on the composition of diesel emissions; the fate of these emissions in the atmosphere; and the effects of whole particles and their chemical constituents on microorganisms, cells, and animals. Since that time, a number of significant developments have been made in diesel engine technology that require a new look at the future acceptability of introducing significant numbers of light-duty diesel automobiles into the European and American markets. Significant engineering improvements have been made in engine design, catalysts, and traps. As a result, particle emissions and particle associated organic emissions have been reduced by about 10 and 30 times, respectively, during the past 10 years. Research studies to help assess the environmental acceptability of these fuel-efficient engines include the development of an emissions data base for current and advanced diesel engines, the effect of diesel emissions on urban ozone formation and atmospheric particle concentrations, the effect of fuel composition, e.g., lower sulfur and additives on emissions, animal inhalation toxicology studies, and fundamental molecular biology studies.

Statistical model for prediction of retrospective exposure to ethylene oxide in an occupational mortality study

Since direct measures of individual exposure seldom exist for the entire period of an occupational mortality study, retrospective exposure estimates are necessary. This is often done in a subjective manner involving a consensus of opinion from a panel of epidemiologists and industrial hygienists. An alternative method utilizing a statistical model provides a more objective procedure for retrospective exposure assessment. The development of a weighted multiple regression model is presented for estimation of exposure levels to ethylene oxide (ETO) for inclusion in a cohort mortality study of workers in the sterilization industry. Three steps in development of the model are described: (1) data acquisition and assessment, (2) model building, and (3) evaluation of the model. The final model explained a remarkable 85% of the variability in 205 average measurements of ETO levels. Exposure factors included in the model were exposure category, product type, size of the sterilization unit, selected engineering controls, days after sterilization, and calendar year. The model was evaluated in two ways: against a set of measurement data not used to develop the model and a panel of 11 industrial hygienists representing the sterilization industry. The model predicted ETO exposures within 1.1 ppm of the validation data set with a standard deviation of 3.7 ppm. The arithmetic and geometric means of the 46 measurements in the validation data set were 4.6 and 2.2 ppm, respectively. The model also outperformed the panel of industrial hygienists relative to the validation data in terms of both bias and precision.

Combustion of diesel fuel from a toxicological perspective. II. Toxicity

Epidemiological data and results of toxicity studies in experimental animals indicate the possible health risk of diesel exhaust exposure. Acute effects of this exposure include odor, eye irritations, lung function decrements, cardiovascular symptoms, and some non-specific effects. Most of these effects are reported among persons highly exposed to diesel exhaust. Lung function decrements are reported as chronic effects. Another chronic effect that has been studied extensively among occupationally exposed persons in lung cancer. In addition to lung cancer, but at a less frequent rate, an enhanced incidence of bladder cancer is reported. The carcinogenic action of diesel exhaust exposure is ascribed to effects of the soot particles, particle-associated organics, and/or gas phase compounds. Direct effects of the particle load may include retardation of lung clearance, inflammation, and increased cell proliferation. These effects were all demonstrated in rodents. The particles may also prolong the residence time of particulate organics or induce the generation of reactive oxygen species. These compounds are known to react with macromolecules, causing lipid peroxidation, DNA damage, and/or activation of other genotoxic substances such as polycyclic aromatic hydrocarbons (PAHs). However, these results have not yet been confirmed in mammals in vivo. A direct interaction of particles with lung tissue is also suggested as a cause of cancer but a mechanism for this interaction has not yet been proposed. Organics associated with the particles are known to contain genotoxic properties attributable to PAHs and their derivatives. A number of these compounds are also identified as carcinogens in animal studies. However, it is not clear whether parent PAHs, their nitro-, oxy-, alkylated, or heterocyclic derivatives, or possibly other compounds are principally responsible for inducing tumors in the lungs of animals after diesel exhaust exposure. Furthermore, the mechanism of the bioavailability of these organics is not completely understood. The effects of gas phase constituents on the carcinogenic properties of the particles and/or particle-associated organics either have not been investigated or the findings have been inconclusive.

Exposure to diesel exhaust in the trucking industry and possible relationships with lung cancer

We previously reported that long-term truck drivers and mechanics in the Teamsters Union had higher lung cancer risks than Teamsters outside the trucking industry. We now summarize results from an industrial hygiene survey of current exposures to diesel exhaust in the trucking industry, and relate these to our prior results pertaining to lung cancer risk.