1
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Fendler J, Guihenneuc C, Ancelet S. Bayesian identification and estimation of radon-related increased hazard rates of cancer death in the updated French cohort of uranium miners (1946-2014). Int Arch Occup Environ Health 2024; 97:941-958. [PMID: 39269483 DOI: 10.1007/s00420-024-02098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE A recent update of the French cohort of uranium miners added seven years of follow-up data. We use these new data to look for new possible radon-related increased risks and refine the estimation of the potential association between cumulative radon exposure and four cancer sites: lung cancer, kidney cancer, brain and central nervous system (CNS) cancer and leukemia (excluding chronic lymphocytic leukemia, which is not radiation-induced). METHODS Several parametric survival models are proposed, fitted and compared under the Bayesian paradigm, to perform new and original exposure-risk analyses. In line with recent UNSCEAR recommendations, we consider time-related effect modifiers and exposure rate as potential effect modifying factors. We use Bayesian model selection criteria to identify radon-related increased hazard rates. RESULTS Under the assumption of a linear exposure-risk relationship, we found a substantial evidence for a strictly positive effect of cumulative radon exposure on the hazard rate of death by lung cancer among French uranium miners. Given the current available data under the assumptions of a linear or log-linear exposure-risk relationship, it is not possible to conclude in favour of the absence or the existence of a strictly positive effect of chronic exposure to radon on the hazard rate of death by kidney cancer. Regarding death by brain and CNS cancer, there is a substantial evidence for the absence of radon-related effect. Finally, under the assumption of a log-linear exposure-risk relationship, a small positive radon-related effect appears when looking at the risk of death by leukemia (excluding CLL). CONCLUSION This study investigates the existence of radon-related increased risk of death by lung cancer, kidney cancer, brain and CNS cancer and leukemia under a Bayesian framework and assumptions of linear and log-linear exposure-risk relationships. If there is no doubt in the interpretation of the results for lung cancer and brain and CNS cancer, the conclusion is less clear-cut in the case of kidney cancer and leukemia (excluding CLL). A future update of the French cohort, increasing the follow-up time for miners, may help to reach a clearer conclusion for these two cancer sites.
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Affiliation(s)
- Julie Fendler
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-Aux-Roses, France.
| | | | - Sophie Ancelet
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-Aux-Roses, France
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2
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Kreuzer M, Deffner V, Sommer M, Fenske N. Updated risk models for lung cancer due to radon exposure in the German Wismut cohort of uranium miners, 1946-2018. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:415-425. [PMID: 37695330 PMCID: PMC10628028 DOI: 10.1007/s00411-023-01043-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
UNSCEAR recently recommended that future research on the lung cancer risk at low radon exposures or exposure rates should focus on more contemporary uranium miners. For this purpose, risk models in the German Wismut cohort of uranium miners were updated extending the follow-up period by 5 years to 1946-2018. The full cohort (n = 58,972) and specifically the 1960 + sub-cohort of miners first hired in 1960 or later (n = 26,764) were analyzed. The 1960 + sub-cohort is characterized by low protracted radon exposure of high quality of measurements. Internal Poisson regression was used to estimate the excess relative risk (ERR) for lung cancer per cumulative radon exposure in Working Level Months (WLM). Applying the BEIR VI exposure-age-concentration model, the ERR/100 WLM was 2.50 (95% confidence interval (CI) 0.81; 4.18) and 6.92 (95% CI < 0; 16.59) among miners with attained age < 55 years, time since exposure 5-14 years, and annual exposure rates < 0.5 WL in the full (n = 4329 lung cancer deaths) and in the 1960 + sub-cohort (n = 663 lung cancer deaths), respectively. Both ERR/WLM decreased with older attained ages, increasing time since exposure, and higher exposure rates. Findings of the 1960 + sub-cohort are in line with those from large pooled studies, and ERR/WLM are about two times higher than in the full Wismut cohort. Notably, 20-30 years after closure of the Wismut mines in 1990, the estimated fraction of lung cancer deaths attributable to occupational radon exposure is still 26% in the full Wismut cohort and 19% in the 1960 + sub-cohort, respectively. This demonstrates the need for radiation protection against radon.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
| | - V Deffner
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - M Sommer
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - N Fenske
- Federal Office for Radiation Protection, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
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3
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Innes GK, Bhondoekhan F, Lau B, Gross AL, Ng DK, Abraham AG. The Measurement Error Elephant in the Room: Challenges and Solutions to Measurement Error in Epidemiology. Epidemiol Rev 2022; 43:94-105. [PMID: 34664648 PMCID: PMC9005058 DOI: 10.1093/epirev/mxab011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022] Open
Abstract
Measurement error, although ubiquitous, is uncommonly acknowledged and rarely assessed or corrected in epidemiologic studies. This review offers a straightforward guide to common problems caused by measurement error in research studies and a review of several accessible bias-correction methods for epidemiologists and data analysts. Although most correction methods require criterion validation including a gold standard, there are also ways to evaluate the impact of measurement error and potentially correct for it without such data. Technical difficulty ranges from simple algebra to more complex algorithms that require expertise, fine tuning, and computational power. However, at all skill levels, software packages and methods are available and can be used to understand the threat to inferences that arises from imperfect measurements.
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Affiliation(s)
| | | | | | | | | | - Alison G Abraham
- Correspondence to Dr. Alison G. Abraham, Department of Epidemiology, University of Colorado, Anschutz Medical Campus, 1635 Aurora Ct, Aurora, CO 80045 (e-mail: )
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4
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Ass’ad NA, Shore X, Myers O, Camacho AR, Jacquez Q, Pollard C, Cook LS, Leng S, Page K, Sood A, Zychowski KE. VCAM-1 Is Upregulated in Uranium Miners Compared to Other Miners. Life (Basel) 2021; 11:1223. [PMID: 34833099 PMCID: PMC8621685 DOI: 10.3390/life11111223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
The United States has a rich history of mining including uranium (U)-mining, coal mining, and other metal mining. Cardiovascular diseases (CVD) are largely understudied in miners and recent literature suggests that when compared to non-U miners, U-miners are more likely to report CVD. However, the molecular basis for this phenomenon is currently unknown. In this pilot study, a New Mexico (NM)-based occupational cohort of current and former miners (n = 44) were recruited via a mobile screening clinic for miners. Serum- and endothelial-based endpoints were used to assess circulating inflammatory potential relevant to CVD. Non-U miners reported significantly fewer pack years of smoking than U-miners. Circulating biomarkers of interest revealed that U-miners had significantly greater serum amyloid A (SAA), soluble intercellular adhesion molecule 1 (ICAM-1, ng/mL), soluble vascular cell adhesion molecule 1 (VCAM-1, ng/mL), and VCAM-1 mRNA expression, as determined by the serum cumulative inflammatory potential (SCIP) assay, an endothelial-based assay. Even after adjusting for various covariates, including age, multivariable analysis determined that U-miners had significantly upregulated VCAM-1 mRNA. In conclusion, VCAM-1 may be an important biomarker and possible contributor of CVD in U-miners. Further research to explore this mechanism may be warranted.
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Affiliation(s)
- Nour A. Ass’ad
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (N.A.A.); (L.S.C.); (S.L.); (K.P.); (A.S.)
| | - Xin Shore
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (X.S.); (O.M.)
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (X.S.); (O.M.)
| | - Alexandra R. Camacho
- College of Nursing, University of New Mexico-Health Sciences Center, Albuquerque, NM 87131, USA; (A.R.C.); (Q.J.)
| | - Quiteria Jacquez
- College of Nursing, University of New Mexico-Health Sciences Center, Albuquerque, NM 87131, USA; (A.R.C.); (Q.J.)
| | - Charles Pollard
- Miners’ Colfax Medical Center, 203 Hospital Drive, Raton, NM 87740, USA;
| | - Linda S. Cook
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (N.A.A.); (L.S.C.); (S.L.); (K.P.); (A.S.)
- Department of Epidemiology, School of Public Health, University of Colorado-Anschutz, Arora, CO 80045, USA
| | - Shuguang Leng
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (N.A.A.); (L.S.C.); (S.L.); (K.P.); (A.S.)
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (N.A.A.); (L.S.C.); (S.L.); (K.P.); (A.S.)
| | - Akshay Sood
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (N.A.A.); (L.S.C.); (S.L.); (K.P.); (A.S.)
- Miners’ Colfax Medical Center, 203 Hospital Drive, Raton, NM 87740, USA;
| | - Katherine E. Zychowski
- College of Nursing, University of New Mexico-Health Sciences Center, Albuquerque, NM 87131, USA; (A.R.C.); (Q.J.)
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5
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Abstract
Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.
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Affiliation(s)
- D Laurier
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | | | - E Rage
- Institute for Radiological Protection and Nuclear Safety, 92262 Fontenay aux Roses Cedex, France; e-mail:
| | - L Tomasek
- National Radiation Protection Institute, Czech Republic
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6
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Yi L, Cui J, Hu N, Li L, Chen Y, Mu H, Yin J, Wei S, Gong Y, Wei Y, Liu B, Ding D. iTRAQ-Based Proteomic Profiling of Potential Biomarkers in Rat Serum for Uranium Tailing Suspension Intratracheal Instillation. J Proteome Res 2020; 20:995-1004. [PMID: 33151695 DOI: 10.1021/acs.jproteome.0c00766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Protection against low-dose ionizing radiation is of great significance. Uranium tailings are formed as a byproduct of uranium mining and a potential risk to organisms. In this study, we identified potential biomarkers associated with exposure to low-dose radiation from uranium tailings. We established a Wistar rat model of low dose rate irradiation by intratracheal instillation of a uranium tailing suspension. We observed pathological changes in the liver, lung, and kidney tissues of the rats. Using isobaric tags for relative and absolute quantification, we screened 17 common differentially expressed proteins in three dose groups. We chose alpha-1 antiproteinase (Serpina1), keratin 17 (Krt17), and aldehyde dehydrogenase (Aldh3a1) for further investigation. Our data showed that expression of Serpina1, Krt17, and Aldh3a1 had changed after the intratracheal instillation in rats, which may be potential biomarkers for uranium tailing low-dose irradiation. However, the underlying mechanisms require further investigation.
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Affiliation(s)
- Lan Yi
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Jian Cui
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Nan Hu
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China
| | - Linwei Li
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Yonglin Chen
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Hongxiang Mu
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Jie Yin
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Shuang Wei
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Yaqi Gong
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Yuanyun Wei
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Bang Liu
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China.,Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, P. R. China.,Hengyang Medical College, Institute of Cytology and Genetics, University of South China, Hengyang 421001, Hunan Province, P. R. China
| | - Dexin Ding
- The Hengyang Key Laboratory of Cellular Stress Biology, Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, P. R. China
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7
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Burstyn I. Occupational epidemiologist's quest to tame measurement error in exposure. GLOBAL EPIDEMIOLOGY 2020. [DOI: 10.1016/j.gloepi.2020.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Belloni M, Laurent O, Guihenneuc C, Ancelet S. Bayesian Profile Regression to Deal With Multiple Highly Correlated Exposures and a Censored Survival Outcome. First Application in Ionizing Radiation Epidemiology. Front Public Health 2020; 8:557006. [PMID: 33194957 PMCID: PMC7652768 DOI: 10.3389/fpubh.2020.557006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/21/2020] [Indexed: 12/31/2022] Open
Abstract
As multifactorial and chronic diseases, cancers are among these pathologies for which the exposome concept is essential to gain more insight into the associated etiology and, ultimately, lead to better primary prevention strategies for public health. Indeed, cancers result from the combined influence of many genetic, environmental and behavioral stressors that may occur simultaneously and interact. It is thus important to properly account for multifactorial exposure patterns when estimating specific cancer risks at individual or population level. Nevertheless, the risk factors, especially environmental, are still too often considered in isolation in epidemiological studies. Moreover, major statistical difficulties occur when exposures to several factors are highly correlated due, for instance, to common sources shared by several pollutants. Suitable statistical methods must then be used to deal with these multicollinearity issues. In this work, we focused on the specific problem of estimating a disease risk from highly correlated environmental exposure covariates and a censored survival outcome. We extended Bayesian profile regression mixture (PRM) models to this context by assuming an instantaneous excess hazard ratio disease sub-model. The proposed hierarchical model incorporates an underlying truncated Dirichlet process mixture as an attribution sub-model. A specific adaptive Metropolis-Within-Gibbs algorithm-including label switching moves-was implemented to infer the model. This allows simultaneously clustering individuals with similar risks and similar exposure characteristics and estimating the associated risk for each group. Our Bayesian PRM model was applied to the estimation of the risk of death by lung cancer in a cohort of French uranium miners who were chronically and occupationally exposed to multiple and correlated sources of ionizing radiation. Several groups of uranium miners with high risk and low risk of death by lung cancer were identified and characterized by specific exposure profiles. Interestingly, our case study illustrates a limit of MCMC algorithms to fit full Bayesian PRM models even if the updating schemes for the cluster labels incorporate label-switching moves. Then, although this paper shows that Bayesian PRM models are promising tools for exposome research, it also opens new avenues for methodological research in this class of probabilistic models.
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Affiliation(s)
- Marion Belloni
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
| | - Olivier Laurent
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
| | - Chantal Guihenneuc
- Université de Paris, Unité de Recherche “Biostatistique, Traitement et Modélisation des données biologiques” BioSTM - UR 7537, Paris, France
| | - Sophie Ancelet
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
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9
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Behney AC. Ignoring uncertainty in predictor variables leads to false confidence in results: a case study of duck habitat use. Ecosphere 2020. [DOI: 10.1002/ecs2.3273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Adam C. Behney
- Avian Research Section Colorado Parks and Wildlife 317 W Prospect Road Fort Collins Colorado80526USA
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10
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Belloni M, Guihenneuc C, Rage E, Ancelet S. A Bayesian hierarchical approach to account for left-censored and missing radiation doses prone to classical measurement error when analyzing lung cancer mortality due to γ-ray exposure in the French cohort of uranium miners. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:423-437. [PMID: 32567014 DOI: 10.1007/s00411-020-00859-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Epidemiological data on cohorts of occupationally exposed uranium miners are currently used to assess health risks associated with chronic exposure to low doses of ionizing radiation. Nevertheless, exposure uncertainty is ubiquitous and questions the validity of statistical inference in these cohorts. This paper highlights the flexibility and relevance of the Bayesian hierarchical approach to account for both missing and left-censored (i.e. only known to be lower than a fixed detection limit) radiation doses that are prone to measurement error, when estimating radiation-related risks. Up to the authors' knowledge, this is the first time these three sources of uncertainty are dealt with simultaneously in radiation epidemiology. To illustrate the issue, this paper focuses on the specific problem of accounting for these three sources of uncertainty when estimating the association between occupational exposure to low levels of γ-radiation and lung cancer mortality in the post-55 sub-cohort of French uranium miners. The impact of these three sources of dose uncertainty is of marginal importance when estimating the risk of death by lung cancer among French uranium miners. The corrected excess hazard ratio (EHR) is 0.81 per 100 mSv (95% credible interval: [0.28; 1.75]). Interestingly, even if the 95% credible interval of the corrected EHR is wider than the uncorrected one, a statistically significant positive association remains between γ-ray exposure and the risk of death by lung cancer, after accounting for dose uncertainty. Sensitivity analyses show that the results obtained are robust to different assumptions. Because of its flexible and modular nature, the Bayesian hierarchical models proposed in this work could be easily extended to account for high proportions of missing and left-censored dose values or exposure data, prone to more complex patterns of measurement error.
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Affiliation(s)
- M Belloni
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France.
| | - C Guihenneuc
- UR 7537, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - E Rage
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - S Ancelet
- PSE-SANTE/SESANE/LEPID, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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11
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Little MP, Patel A, Hamada N, Albert P. Analysis of Cataract in Relationship to Occupational Radiation Dose Accounting for Dosimetric Uncertainties in a Cohort of U.S. Radiologic Technologists. Radiat Res 2020; 194:153-161. [PMID: 32845990 PMCID: PMC10656143 DOI: 10.1667/rr15529.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/07/2020] [Indexed: 11/19/2023]
Abstract
Cataract is one of the major morbidities in the U.S. population and it has long been appreciated that high and acutely delivered radiation doses of 1 Gy or more can induce cataract. Some more recent studies, in particular those of the U.S. Radiologic Technologists, have suggested that cataract may be induced by much lower, chronically delivered doses of ionizing radiation. It is well recognized that dosimetric measurement error can substantially alter the shape of the radiation dose-response relationship and thus, the derived study risk estimates, and can also inflate the variance of the estimates. In the current study, we evaluate the impact of uncertainties in eye-lens absorbed doses on the estimated risk of cataract in the U.S. Radiologic Technologists' Monte Carlo Dosimetry System, using both absolute and relative risk models. Among 11,345 cases we show that the inflation in the standard error for the excess relative risk (ERR) is generally modest, at most approximately 20% of the unadjusted standard error, depending on the model used for the baseline risk. The largest adjustment results from use of relative risk models, so that the ERR/Gy and its 95% confidence intervals change from 1.085 (0.645, 1.525) to 1.085 (0.558, 1.612) after adjustment. However, the inflation in the standard error of the excess absolute risk (EAR) coefficient is generally minimal, at most approximately 0.04% of the standard error.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892-9778, USA
| | - Ankur Patel
- Radiation Epidemiology Branch, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892-9778, USA
- Biostatistics Branch, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892-9778, USA
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
| | - Paul Albert
- Biostatistics Branch, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20892-9778, USA
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12
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Rage E, Richardson DB, Demers PA, Do M, Fenske N, Kreuzer M, Samet J, Wiggins C, Schubauer-Berigan MK, Kelly-Reif K, Tomasek L, Zablotska LB, Laurier D. PUMA - pooled uranium miners analysis: cohort profile. Occup Environ Med 2020; 77:194-200. [PMID: 32005674 PMCID: PMC8663280 DOI: 10.1136/oemed-2019-105981] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/02/2019] [Accepted: 12/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Epidemiological studies of underground miners have provided clear evidence that inhalation of radon decay products causes lung cancer. Moreover, these studies have served as a quantitative basis for estimation of radon-associated excess lung cancer risk. However, questions remain regarding the effects of exposure to the low levels of radon decay products typically encountered in contemporary occupational and environmental settings on the risk of lung cancer and other diseases, and on the modifiers of these associations. These issues are of central importance for estimation of risks associated with residential and occupational radon exposures. METHODS The Pooled Uranium Miner Analysis (PUMA) assembles information on cohorts of uranium miners in North America and Europe. Data available include individual annual estimates of exposure to radon decay products, demographic and employment history information on each worker and information on vital status, date of death and cause of death. Some, but not all, cohorts also have individual information on cigarette smoking, external gamma radiation exposure and non-radiological occupational exposures. RESULTS The PUMA study represents the largest study of uranium miners conducted to date, encompassing 124 507 miners, 4.51 million person-years at risk and 54 462 deaths, including 7825 deaths due to lung cancer. Planned research topics include analyses of associations between radon exposure and mortality due to lung cancer, cancers other than lung, non-malignant disease, modifiers of these associations and characterisation of overall relative mortality excesses and lifetime risks. CONCLUSION PUMA provides opportunities to evaluate new research questions and to conduct analyses to assess potential health risks associated with uranium mining that have greater statistical power than can be achieved with any single cohort.
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Affiliation(s)
- Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
| | | | | | - Minh Do
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | | | - Charles Wiggins
- University of New Mexico, Albuquerque, New Mexico, USA
- New Mexico Tumor Registry, Albuquerque, New Mexico, USA
| | - Mary K Schubauer-Berigan
- International Agency for Research on Cancer, Lyon, France
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | | | - Lydia B Zablotska
- University of California, San Francisco, San Francisco, California, USA
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, Fontenay-aux-Roses, France
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Schöllnberger H, Kaiser JC, Eidemüller M, Zablotska LB. Radio-biologically motivated modeling of radiation risks of mortality from ischemic heart diseases in the Canadian fluoroscopy cohort study. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:63-78. [PMID: 31781840 DOI: 10.1007/s00411-019-00819-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Recent analyses of the Canadian fluoroscopy cohort study reported significantly increased radiation risks of mortality from ischemic heart diseases (IHD) with a linear dose-response adjusted for dose fractionation. This cohort includes 63,707 tuberculosis patients from Canada who were exposed to low-to-moderate dose fractionated X-rays in 1930s-1950s and were followed-up for death from non-cancer causes during 1950-1987. In the current analysis, we scrutinized the assumption of linearity by analyzing a series of radio-biologically motivated nonlinear dose-response models to get a better understanding of the impact of radiation damage on IHD. The models were weighted according to their quality of fit and were then mathematically superposed applying the multi-model inference (MMI) technique. Our results indicated an essentially linear dose-response relationship for IHD mortality at low and medium doses and a supra-linear relationship at higher doses (> 1.5 Gy). At 5 Gy, the estimated radiation risks were fivefold higher compared to the linear no-threshold (LNT) model. This is the largest study of patients exposed to fractionated low-to-moderate doses of radiation. Our analyses confirm previously reported significantly increased radiation risks of IHD from doses similar to those from diagnostic radiation procedures.
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Affiliation(s)
- Helmut Schöllnberger
- Department of Radiation Sciences, Institute of Radiation Medicine, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
- Division UR-Environmental Radioactivity, Federal Office for Radiation Protection, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Jan Christian Kaiser
- Department of Radiation Sciences, Institute of Radiation Medicine, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Markus Eidemüller
- Department of Radiation Sciences, Institute of Radiation Medicine, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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Aßenmacher M, Kaiser JC, Zaballa I, Gasparrini A, Küchenhoff H. Exposure-lag-response associations between lung cancer mortality and radon exposure in German uranium miners. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2019; 58:321-336. [PMID: 31218403 DOI: 10.1007/s00411-019-00800-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/05/2019] [Indexed: 06/09/2023]
Abstract
Exposure-lag-response associations shed light on the duration of pathogenesis for radiation-induced diseases. To investigate such relations for lung cancer mortality in the German uranium miners of the Wismut company, we apply distributed lag non-linear models (DLNMs) which offer a flexible description of the lagged risk response to protracted radon exposure. Exposure-lag functions are implemented with B-Splines in Cox models of proportional hazards. The DLNM approach yielded good agreement of exposure-lag-response surfaces for the German cohort and for the previously studied cohort of American Colorado miners. For both cohorts, a minimum lag of about 2 year for the onset of risk after first exposure explained the data well, but possibly with large uncertainty. Risk estimates from DLNMs were directly compared with estimates from both standard radio-epidemiological models and biologically based mechanistic models. For age > 45 year, all models predict decreasing estimates of the Excess Relative Risk (ERR). However, at younger age, marked differences appear as DLNMs exhibit ERR peaks, which are not detected by the other models. After comparing exposure-responses for biological processes in mechanistic risk models with exposure-responses for hazard ratios in DLNMs, we propose a typical period of 15 year for radon-related lung carcinogenesis. The period covers the onset of radiation-induced inflammation of lung tissue until cancer death. The DLNM framework provides a view on age-risk patterns supplemental to the standard radio-epidemiological approach and to biologically based modeling.
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Affiliation(s)
- Matthias Aßenmacher
- Department of Statistics, Ludwig-Maximilians-Universität, 80539, Munich, Germany.
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum München, 85764, Oberschleißheim, Germany
| | | | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Helmut Küchenhoff
- Department of Statistics, Ludwig-Maximilians-Universität, 80539, Munich, Germany
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Ferri GM, Intranuovo G, Cavone D, Corrado V, Birtolo F, Tricase P, Fuso R, Vilardi V, Sumerano M, L'abbate N, Vimercati L. Estimates of the Lung Cancer Cases Attributable to Radon in Municipalities of Two Apulia Provinces (Italy) and Assessment of Main Exposure Determinants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061294. [PMID: 29925825 PMCID: PMC6025095 DOI: 10.3390/ijerph15061294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/31/2018] [Accepted: 06/15/2018] [Indexed: 11/18/2022]
Abstract
Indoor radon exposure is responsible for increased incidence of lung cancer in communities. Building construction characteristics, materials, and environmental determinants are associated with increased radon concentration at specific sites. In this study, routine data related to radon measurements available from the Apulia (Italy) Regional Environmental Protection Agency (ARPA) were combined with building and ground characteristics data. An algorithm was created based on the experience of miners and it was able to produce estimates of lung cancer cases attributable to radon in different municipalities with the combined data. In the province of Lecce, the sites with a higher risk of lung cancer are Campi Salentina and Minervino, with 1.18 WLM (working level months) and 1.38 WLM, respectively, corresponding to lung cancer incidence rates of 3.34 and 3.89 per 10 × 103 inhabitants. The sites in the province of Bari with higher risks of lung cancer are Gravina di Puglia and Locorotondo, measuring 1.89 WLM and 1.22 WLM, respectively, which correspond to an incidence rate of lung cancer of 5.36 and 3.44 per 10 × 103 inhabitants. The main determinants of radon exposure are whether the buildings were built between 1999 and 2001, were one-room buildings with porous masonry, and were built on soil consisting of pelvis, clayey sand, gravel and conglomerates, calcarenites, and permeable lithotypes.
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Affiliation(s)
- Giovanni Maria Ferri
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Graziana Intranuovo
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Domenica Cavone
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Vincenzo Corrado
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Francesco Birtolo
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Paolo Tricase
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Raffaele Fuso
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Valeria Vilardi
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Marilena Sumerano
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Nicola L'abbate
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
| | - Luigi Vimercati
- Unit of Occupational Medicine, Regional University Hospital "Policlinico-Giovanni XXIII", Section "B. Ramazzini", Interdisciplinary Department of Medicine, University of Bari, Piazza G, Cesare, 11, 70124 Bari, Italy.
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Hoffmann S, Guihenneuc C, Ancelet S. A cautionary comment on the generation of Berkson error in epidemiological studies. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:189-193. [PMID: 29546458 DOI: 10.1007/s00411-018-0737-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
Exposure measurement error can be seen as one of the most important sources of uncertainty in studies in epidemiology. When the aim is to assess the effects of measurement error on statistical inference or to compare the performance of several methods for measurement error correction, it is indispensable to be able to generate different types of measurement error. This paper compares two approaches for the generation of Berkson error, which have recently been applied in radiation epidemiology, in their ability to generate exposure data that satisfy the properties of the Berkson model. In particular, it is shown that the use of one of the methods produces results that are not in accordance with two important properties of Berkson error.
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Affiliation(s)
- Sabine Hoffmann
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, 92262, Fontenay-aux-Roses, France.
| | | | - Sophie Ancelet
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, 92262, Fontenay-aux-Roses, France
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Ren J, Hao Y, Gao R, Zhang Y, Ran Y, Liu J, Dai X, Xiong W, Su Y, Li R. Effect of a novel polyethylene glycol compound on lung lavage in dogs after the inhalation of depleted uranium dust. Int J Radiat Biol 2018; 94:462-471. [DOI: 10.1080/09553002.2018.1446228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jiong Ren
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yuhui Hao
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Rui Gao
- Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Ying Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yonghong Ran
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Jing Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Xiaotian Dai
- Department of Respiratory Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei Xiong
- Department of Respiratory Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yongping Su
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Rong Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
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Rage E, Caër-Lorho S, Laurier D. Low radon exposure and mortality among Jouac uranium miners: an update of the French cohort (1946-2007). JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:92-108. [PMID: 28925920 DOI: 10.1088/1361-6498/aa8d97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
After the extension of the French cohort of uranium miners with the inclusion of workers employed in the Jouac mines, this article seeks to describe the new Jouac cohort and to estimate mortality risks, as well as to quantify their relation to radon exposure in this extended cohort. The Jouac cohort includes 458 miners hired by the Société des Mines de Jouac between 1957 and 2001. There is no measurement of radon exposure before 1978 and so no data were available. Consequently, only the post-1977 Jouac cohort (n = 314) has been included in the French cohort, creating an extended cohort of 5400 French uranium miners followed up from 1946 to 2007. Mortality analyses computed the standardised mortality ratios (SMRs). Excess relative risks (ERRs) were assessed using Poisson regression models. No evidence of a significant excess risk of overall mortality (n = 66, SMR = 0.93; 95% CI = 0.72-1.19) or any specific mortality was observed in the Jouac cohort. In the extended cohort, overall mortality did not increase, but a significant excess of deaths was observed for all cancers (SMR = 1.11, 95% CI = 1.03-1.19), lung cancer (SMR = 1.32, 95% CI = 1.14-1.51), and kidney cancer (SMR = 1.58, 95% CI = 1.01-2.35). Cumulative exposure to radon was 3.9 working level month (WLM) and 35.1 WLM in the post-1977 Jouac and extended cohorts, respectively. Cumulative radon exposure was significantly associated with an excess risk of death from lung cancer (ERR/100 WLM = 0.73, 95% CI = 0.32-1.33) and from cerebrovascular diseases (ERR/100 WLM = 0.42 95% CI = 0.04-1.04). In conclusion, the Jouac cohort is still a young cohort and its inclusion leads to slight modifications compared to previous analyses of the French cohort. The already known relation between radon exposure and lung cancer death as well as the excess risk of death from cerebrovascular diseases persisted in the extended cohort.
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Affiliation(s)
- Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, SESANE, LEPID, Fontenay-aux-Roses, France
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Hoffmann S, Laurier D, Rage E, Guihenneuc C, Ancelet S. Shared and unshared exposure measurement error in occupational cohort studies and their effects on statistical inference in proportional hazards models. PLoS One 2018; 13:e0190792. [PMID: 29408862 PMCID: PMC5800563 DOI: 10.1371/journal.pone.0190792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022] Open
Abstract
Exposure measurement error represents one of the most important sources of uncertainty in epidemiology. When exposure uncertainty is not or only poorly accounted for, it can lead to biased risk estimates and a distortion of the shape of the exposure-response relationship. In occupational cohort studies, the time-dependent nature of exposure and changes in the method of exposure assessment may create complex error structures. When a method of group-level exposure assessment is used, individual worker practices and the imprecision of the instrument used to measure the average exposure for a group of workers may give rise to errors that are shared between workers, within workers or both. In contrast to unshared measurement error, the effects of shared errors remain largely unknown. Moreover, exposure uncertainty and magnitude of exposure are typically highest for the earliest years of exposure. We conduct a simulation study based on exposure data of the French cohort of uranium miners to compare the effects of shared and unshared exposure uncertainty on risk estimation and on the shape of the exposure-response curve in proportional hazards models. Our results indicate that uncertainty components shared within workers cause more bias in risk estimation and a more severe attenuation of the exposure-response relationship than unshared exposure uncertainty or exposure uncertainty shared between individuals. These findings underline the importance of careful characterisation and modeling of exposure uncertainty in observational studies.
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Affiliation(s)
- Sabine Hoffmann
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
- * E-mail:
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Estelle Rage
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | | | - Sophie Ancelet
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
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Kreuzer M, Sobotzki C, Schnelzer M, Fenske N. Factors Modifying the Radon-Related Lung Cancer Risk at Low Exposures and Exposure Rates among German Uranium Miners. Radiat Res 2017; 189:165-176. [PMID: 29215327 DOI: 10.1667/rr14889.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
It is still not fully understood whether and how factors such as time, age and smoking modify the relationship between lung cancer and radon at low exposures and exposure rates. Improved knowledge is necessary for the dose conversion of radon in working level month (WLM) into effective dose, as currently discussed by the International Commission on Radiological Protection (ICRP). An update of the German uranium miner cohort study (n = 58,974 men) with a 10-year extension of mortality follow-up (1946-2013) was used to further examine this issue. Internal Poisson regression was applied to estimate the excess relative risk (ERR) for lung cancer mortality per unit of cumulative radon exposure in WLM with exponential time-related effect modifiers. In the full cohort restricted to <100 WLM the estimated overall ERR/WLM was 0.006 [95% confidence interval (CI): 0.003; 0.010] based on 1,254 lung cancer deaths and 1,620,190 person-years at risk. Both age at and time since exposure turned out to be important modifiers of the ERR/WLM and were included in the final model. Here, the ERR/WLM centered on age at exposure of 30 years, and 20 years since exposure was 0.016 (95% CI: 0.008; 0.028). This value decreased statistically significantly by approximately 40% and 60% for each 10-year increase in age at exposure and time since exposure, respectively. The joint effect of smoking and radon exposure was investigated in the sub-cohort of miners hired in 1960 or later, which includes data on smoking status. The centered ERR/WLM was slightly higher for non/light smokers compared to moderate/heavy smokers (0.022 versus 0.013). The current findings provide evidence for an increased lung cancer risk at low radon exposures or exposure rates that is modified by age and time. The observed risk is lower, but statistically compatible to those of other miner studies at low exposures or exposure rates. These findings reject an additive- and support a sub- to (supra-) multiplicative interaction between smoking and radon.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - C Sobotzki
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - M Schnelzer
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - N Fenske
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
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