Appendix
1. Z-statistic
The contribution of each study to the total heterogeneity of the pooled data was calculated
through a Z-statistic for each study in the meta-analysis. This contribution is determined by two
components: the first is the difference between individual risk estimates and the pooled estimate;
the second component is the study size. Studies reporting risk estimates lower than the pooled
estimate will have a negative Z-score, the others a positive one. Larger studies with extreme
deviations from the pooled estimate will have a greater effect on the pooled analysis results and
will therefore have larger Z-scores. This information allows us to interpret the representativeness
of individual epidemiologic studies in the context of data totality, as well within surrogate
exposure categories. The following equation was used:
zi = (Ti – Ť) / [SE(Ti)]
where:
zi = z-score for the ith study
Ti = risk ratio for the ith study
Ť = pooled estimate for the true effect value
[SE(Ti)] = standard error of Ti
For this meta-analysis z-scores are reported for exposures associated with exposure to wood dust,
leather dust, formaldehyde, textile industry, farming, construction (case-control studies) and
Nickel/Chromium compounds (cohort studies).
a) Exposure to Wood dust
9
d'Errico 2009
7
pooled estimate = 5.91
z-scores
5
Hayes RB 1986
3
1
-1
Risk Estimate (OR/RR)
-3
-5
b) Exposure to Leather dust
c) Exposure to Formaldehyde
Exposure to Nickel/Chromium compounds
Davies JM 1991
30
pooled
estimate
= 18 = 17.71
pooled
estimate
20
z-scores
10
30.4
28.5
81.7
20.2
20.0
40.5
36.6
75.2
67.1
41.1
18.2
18.0
14.3
10.8
5.5
8.8
13.7
8.3
5.1
2.7
17.7
15.0
10.0
10.0
10.0
0
10.0
d)
-10
-20
Sorahan T 1988
Risk Estimate (SIR/SMR)
e)
Exposure to Textile industry
f)
Exposure to Farming
g)
Exposure to Construction
2. Influence plots
Influence plots combine Z-scores with study weights (elevated to 0.5) and provide a graphical representation of relative heterogeneity due to each
study. They are reported for exposures associated with exposure to wood dust, leather dust, formaldehyde, textile industry, farming, construction and
Nickel/Chromium compounds.
3. Egger’s test
In a meta-analysis publication bias is related to differential inclusion of studies whose results are
significant, interesting, from large well-funded studies, or of higher quality, that are more likely to be
published than the others. The resulting bias may invalidate the conclusions. If no publication bias is
present the plot is shaped like a funnel. Results from small studies distribute widely at the bottom of the
graph, with the spread restricting among larger studies. This is expected because studies of smaller size
have increasingly large variation in the estimates of their effect size, as random variation becomes
increasingly significant. Conversely, when publication bias is present - since smaller or non-significant
studies are less likely to be published - studies in the bottom left hand corner of the plot are often
missing, creating a degree of asymmetry in the funnel. In the linear regression method used to measure
funnel plot asymmetry [49], the standard normal deviate (SND), defined as the log risk ratio divided by
its standard error, is regressed against the estimate's precision, the latter being defined as the inverse of
the standard error. The regression equation (SND = a + b x precision) applied specifically to the present
meta-analysis, becomes:
[lnRRi/SE(lnRRi)] = a + b x [1/SE(lnRRi)]
The intercept provides a measure of asymmetry: the larger its deviation from zero, the more
pronounced the asymmetry. Evidence of asymmetry is based on p-value <0.1 and intercepts are
reported with 90% confidence intervals This choice depends on the generally small number of studies
included in the meta-analysis, that limits the statistical power of the test.
4. Details of single studies included in the meta-analysis
Once the full text papers of the selected studies for the meta-analysis were available, an abstract form
was created of the most relevant information provided (number of cases/controls and
observed/expected in each study, relative risk estimates with their 95% confidence intervals, histology,
duration and level of exposure, covariates controlled, notes). The results of this work were tabulated in
a data extraction form. The following tables (A, B) report authors estimates of risk ratio and study
properties for selected publications relating to occupational exposures and sinonasal cancer. Some of
these studies provided independent data according to the type and level of exposure (duration and level
of exposure), type of occupational setting, subtype of cancer and sex of the studied population.
Table A. Case-control studies (N=17) included in the meta-analysis
reference
sex
cases
NE NNE
controls
NE
NNE
RR estimate (95%CI)
histology
type of exposure
duration of exposure
level of exposure
Brinton LA et al 1985
M+F
M
F
F
F
34
4
4
12
7
126
9
7
45
45
48
28
20
20
20
242
155
87
87
87
RR
RR
RR
RR
RR
M
31
60
34
161
M
M
M
M
M
M
M
M
50
8
7
6
3
7
17
10
41
48
39
12
2
48
39
12
75
11
20
5
4
7
24
11
M
M
M
M
M
M
M
M
23
15
24
16
26
7
6
5
2
48
39
12
2
33
26
33
M
M
M
13
12
19
M
M
M
M
M
M
M
M
=
=
=
=
=
1.32 (0.8-2.2)
4.7 (1.2-17.8)
3.4 (0.8-14.1)
3.9 (1.4-11.0)
1.4 (0.5-3.8)
industries
industries
industries
industries
industries
covariates controlled
year of hospital admission, age,
sex, race, residence, year of death
all
AC
AC
all
all
textile/clothing
textile/clothing
textile/clothing
textile/clothing
textile/clothing
RRA = 2.5 (90% CI: 1.5-4.3)
all
formaldehyde
120
143
117
18
3
143
117
18
RRB
RRA
RRB
RRA
all
all
all
all
all
all
all
all
formaldehyde
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (3+)
formaldehyde adj wood dust (3+)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (3+)
any (1-9)
low (1-2)
low (1-2)
low (1-2)
low (1-2)
moderate to high (3+)
moderate to high (3+)
moderate to high (3+)
27
18
44
16
31
11
20
7
3
143
117
18
3
143
117
143
RRA = 2.5 (90% CI: 1.2-5.0)
RRB = 1.6 (90% CI: 0.9-2.8)
RRA = 1.9 (90% CI: 0.7-5.5)
RRA = 2.7 (90% CI: 1.0-7.2)
RRB = 1.4 (90% CI: 0.5-3.4)
RRA = 3.1 (90% CI: 0.9-10.0)
all
all
all
all
all
SCCA
SCCB
SCCA
formaldehyde adj wood dust (3+)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (3+)
formaldehyde adj wood dust (3+)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
moderate to high (3+)
any (1-9)
any (1-9)
any (1-9)
any (1-9)
low (1-2)
low (1-2)
moderate to high (3+)
26
33
26
24
18
44
117
143
117
RRB = 2.4 (90% CI: 1.1-5.1)
RRA = 3.0 (90% CI: 1.3-6.4)
RRB = 1.9 (90% CI: 1.0-3.6)
SCCB
SCCA
SCCB
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
formaldehyde adj wood dust (0-2)
moderate to high (3+)
any (1-9)
any (1-9)
13
9
8
6
113
117
81
83
117
138
97
130
2348
2327
2368
2335
OR
OR
OR
OR
=
=
=
=
2.3
1.3
2.4
1.3
(0.9-5.8)
(0.6-2.8)
(0.8-7.4)
(0.5-3.6)
SCC
SCC
SCC
SCC
formaldehyde adj wood dust
wood dust adj formaldehyde
formaldehyde adj wood dust
wood dust adj formaldehyde
ever
ever
≥10 years
≥10 years
17
18
12
13
10
9
9
7
1074
269
1049
142
1391
2196
1416
2323
OR
OR
OR
OR
=
=
=
=
2.2 (0.7-7.2)
16.3 (5.2-50.9)
1.8 (0.5-6.0)
30.4 (8.9-103.9)
AC
AC
AC
AC
formaldehyde adj wood dust
wood dust adj formaldehyde
formaldehyde adj wood dust
wood dust adj formaldehyde
ever
ever
≥10 years
≥10 years
<10 years
≥10 years
Hayes RB et al 1986(a)
Olsen JH, Asnaes S 1986
=
=
=
=
1.9
2.2
1.0
1.8
(90%
(90%
(90%
(90%
CI: 1.5-4.3)
CI: 0.8-5.4)
CI: 0.4-2.5)
CI: 0.4-7.3)
RRA = 3.0 (90% CI: 1.0-8.7)
RRB = 2.1 (90% CI: 1.1-4.1)
RRA = 1.4 (90% CI: 0.5-4.0)
>6 months
since 1st exposure
since 1st exposure
since 1st exposure
since 1st exposure
any (1-9)
exposed
exposed
exposed
exposed
(likely/possible)
(likely/possible)
(likely/possible)
(likely/possible)
exposed
exposed
exposed
exposed
(likely/possible)
(likely/possible)
(likely/possible)
(likely/possible)
smoking, wood dust
11
11
2
10
1
7
12
3
6
15
14
4
3
12
3
1
2
17
17
18
18
21
22
80
12
48
81
22
43
79
20
44
66
6
66
6
33
33
5
33
5
33
5
5
2
1
14
14
14
24
24
24
25
25
25
3
3
5
5
21
17
17
17
17
55
55
55
55
55
181
181
181
171
171
171
170
170
170
170
170
170
170
140
140
140
140
140
140
140
140
140
140
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
1.7 (90% CI: 1.0-2.9)
11.9 (90% CI: 4.9-31.2)
0.5 (90% CI: 0.1-1.2)
0.9 (90% CI: 0.6-1.5)
0.2 (90% CI: 0.0-0.7)
1.2 (90% CI: 0.7-2.2)
1.0 (90% CI: 0.6-1.7)
1.1 (90% CI: 0.4-2.7)
0.9 (90% CI: 0.4-1.7)
12.5 (90% CI: 3.9-52.6)
139.8 (90% CI: 31.6-999.4)
2.1 (90% CI: 0.5-7.9)
16.3 (90% CI: 2.8-85.3)
2.5 (90% CI: 1.1-5.2)
0.7 (90% CI: 0.2-2.4)
1.6 (90% CI: 0.1-12.3)
0.5 (90% CI: 0.1-1.9)
26.3 (90% CI: 9.3-85.5)
1.3 (90% CI: 0.7-2.4)
8.5 (90% CI: 3.4-25.4)
10.1 (90% CI: 1.7-54.4)
33.0 (90% CI: 8.3-164.3)
38.4 (90% CI: 12.1-144.9)
all
AC
SCC
all
AC
SCC
all
AC
SCC
all
AC
all
AC
SCC
SCC
AC
SCC
AC
SCC
AC
AC
AC
AC
paper/wood industries
paper/wood industries
paper/wood industries
agriculture (farming)
agriculture (farming)
agriculture (farming)
construction
construction
construction
furniture/cabinet
furniture/cabinet
joinery/carpentry
joinery/carpentry
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
age, smoking
<10 years
≥10 years
≥30 years
high (5-9)
high (5-9)
high (5-9)
high (5-9)
low (1-2)
moderate (3-4)
moderate (3-4)
high (5-9)
high (5-9)
any (1-9)
any (1-9)
high (5-9)
high (5-9)
high (5-9)
2
independent
reviews
of
formaldehyde
exposure
labelled:
Assessment A and Assessment B
sex, age, year of diagnosis, wood exp and non exp controls estimated
dust, formaldehyde
by means of OR
Hayes RB et al 1986(b)
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
notes
cases and controls estimated by
means of OR (exposed controls by
industry obtained from Hayes18, Table
VI)
Table A. (continued)
reference
Merler E et al 1986
Vaughan TL et al 1986
Roush GC et al 1987
sex
cases
NE NNE
controls
NE
NNE
RR estimate (95%CI)
M+F
M
F
M
M+F
M+F
M
M+F
M+F
M+F
M+F
M+F
M+F
18
15
3
11
7
13
8
5
18
9
3
9
3
3
1
2
1
3
1
1
1
3
44
50
44
50
10
7
3
2
8
10
2
8
10
121
42
127
44
29
22
7
29
29
23
29
29
29
431
510
425
508
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
15.7 (4.6-54.0)
47.1 (8.7-255.1)
3.5 (0.2-59.0)
121.0 (17.3-844.3)
7.5 (1.8-31.7)
41.4 (7.6-226.8)
88.0 (12.1-642.0)
20.4 (2.7-152.0)
12.9 (1.6-104.4)
0.8 (0.4-1.7)
0.3 (0-1.7)
0.7 (0.3-1.4)
0.4 (0.1-1.9)
M+F
M+F
M+F
M+F
21
16
9
7
148
131
148
131
79
51
27
14
430
410
430
410
OR
OR
OR
OR
=
=
=
=
0.8 (0.5-1.3)
1 (0.5-1.8)
1 (0.5-2.2)
1.5 (0.6-3.9)
histology
all
all
all
all
all
AC
AC
AC
all
type of exposure
duration of exposure
years
years
years
years
years
years
years
years
years
leather dust
leather dust
leather dust
leather dust
leather dust
leather dust
leather dust
leather dust
leather dust adj solvents
formaldehyde
formaldehyde
formaldehyde
formaldehyde
≥12
≥12
≥12
≥12
≥12
≥12
≥12
≥12
≥12
formaldehyde
formaldehyde
formaldehyde
formaldehyde
most
most
most
most
Luce D et al 1992
14
1
67
24
24
1
138
49
RR = 1.2
RR = 2.0
SCC
SCC
M
3
78
13
149
RR = 2.9 (p<0.05)
SCC
F
M
F
M
F
7
3
1
16
4
18
78
24
65
21
6
6
1
27
7
44
156
49
135
43
RR
RR
RR
RR
RR
=
=
=
=
=
2.0
2.0
1.0
1.3
1.1
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
6
6
6
15
15
15
4
4
4
3
3
3
4
4
2
2
2
2
4
4
4
3
3
3
11
11
11
11
11
11
2
2
5
5
5
3
3
1
2
2
37
37
37
15
15
15
48
48
48
4
4
4
53
53
53
44
44
44
55
55
55
56
56
56
55
55
57
57
57
57
55
55
55
56
56
56
48
48
48
48
48
48
80
80
77
77
77
79
79
81
80
80
45
45
45
67
67
67
34
34
34
78
78
78
43
53
37
42
37
54
19
22
15
8
9
7
6
21
7
3
9
8
14
17
12
7
18
2
19
7
46
13
5
33
46
25
36
27
60
19
12
6
9
6
7
7
8
9
14
1
17
31
10
20
11
28
277
267
283
278
283
266
301
298
305
312
311
313
314
299
313
317
311
312
306
303
308
313
302
318
301
313
274
307
315
287
274
295
284
293
260
301
308
314
311
314
313
313
312
311
306
319
303
289
310
300
309
292
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
0.73
0.57
0.86
2.23
2.57
1.69
1.18
0.97
1.51
2.12
1.88
2.26
3.87
1.01
1.62
3.43
1.24
1.42
1.56
1.32
1.86
2.28
0.89
8.10
3.68
10.3
1.36
5.40
15.8
1.98
0.15
0.29
0.51
0.70
0.28
0.60
0.95
0.66
0.85
1.30
35.4
38.5
32.5
7.38
4.74
48.0
25.2
13.1
44.5
0.78
1.45
0.54
(0.29-1.85)
(0.13-2.52)
(0.28-2.68)
(1.14-4.39)
(1.21-5.49)
(0.52-5.51)
(0.38-3.67)
(0.21-4.50)
(0.29-7.79)
(0.54-8.31)
(0.19-18.3)
(0.41-12.3)
(1.17-12.8)
(0.13-7.82)
(0.30-8.86)
(0.54-21.7)
(0.23-6.57)
(0.26-7.74)
(0.48-5.05)
(0.25-7.04)
(0.38-9.03)
(0.58-8.99)
(0.09-8.63)
(1.30-50.3)
(1.69-8.00)
(3.87-27.6)
(0.38-4.95)
(2.41-12.1)
(5.56-44.7)
(0.53-7.39)
(0.04-0.59)
(0.07-1.28)
(0.20-1.33)
(0.23-2.10)
(0.05-1.63)
(0.19-1.89)
(0.28-3.17)
(0.09-5.05)
(0.16-4.60)
(0.22-7.83)
(18.1-69.3)
(16.0-92.5)
(13.8-76.3)
(3.45-15.8)
(1.96-11.5)
(8.84-260)
(14.6-43.6)
(6.61-26.0)
(21.9-50.3)
(0.28-2.17)
(0.31-6.81)
(0.14-2.09)
any vs never
any vs never
any vs never
heavy (++)
uncertain/light (+)
any vs never
heavy (++)
uncertain/light (+)
any vs never
low
medium-high
covariates controlled
age, sex, smoking,
year of death
vital
notes
status,
age, sex, smoking, alcohol
1-9 years
10+ years
working
working
working
working
Fukuda K et al 1987
M
F
level of exposure
>1 year
>1 year
SCC
SCC
SCC
SCC
SCC
plasterwork/construction
plasterwork/construction
carpentry/joinery/furniture/other
woodworks
carpentry/joinery/furniture/other
woodworks
boot/shoe/textile industry/tailoring
boot/shoe/textile industry/tailoring
farming
farming
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
SCC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
farming
farming
farming
farm working
farm working
farm working
textile industry/tailoring
textile industry/tailoring
textile industry/tailoring
shoe/leather industry
shoe/leather industry
shoe/leather industry
grain milling/bakery/pastry cook
grain milling/bakery/pastry cook
cabinetmaking
cabinetmaking
woodworking machine operating
woodworking machine operating
joinery/carpentry
joinery/carpentry
joinery/carpentry
wood manufacturing
wood manufacturing
wood manufacturing
construction working
construction working
construction working
construction industry
construction industry
construction industry
farming
farming
farm working
farm working
farm working
textile industry/tailoring
textile industry/tailoring
grain milling/bakery/pastry cook
paper/wood industries
paper/wood industries
cabinetmaking
cabinetmaking
cabinetmaking
woodworking machine operating
woodworking machine operating
woodworking machine operating
joinery/carpentry
joinery/carpentry
joinery/carpentry
construction industry
construction industry
construction industry
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
ever
>15 years
ever
<15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
>15 years
ever
<15 years
>15 years
ever
<15 years
ever
<15 years
ever
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
ever
<15 years
>15 years
life
life - 20+years prior to death
life - some years (high)
life - 20+years prior to death (high)
probable
probable
probable - high
probable - high
age at death, year of death,
availability
of
occupational
information
sex,
age,
residence,smoking,
education, history of nasal diseases,
domestic
heating
systems,
occupation
>1 year
>1
>1
>1
>1
>1
year
year
year
year
year
exp and non exp controls estimated
by means of OR
Table A. (continued)
reference
sex
cases
NE NNE
controls
NE
NNE
RR estimate (95%CI)
histology
type of exposure
duration of exposure
level of exposure
covariates controlled
notes
AC and SCC exp and non exp male
cases estimated proportioning total to
Comba P et al 1992(a)
Comba P et al 1992(b)
Magnani C et al 1993
Teschke K et al 1997
AC (13 cases) and SCC (25 cases) and
M
M
M
M
M
M
M
M
M
F
F
F
F
14
3
6
5
1
0,5
11
2
24
1
3
2
8
4
10
19
4
12
24,5
4
4
4
11
11
11
11
19
19
19
7
7
7
30
4
83
1
12
5
17
33
33
33
33
33
33
33
33
33
35
35
35
35
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
5.8 (90% CI: 2.2-15)
13.9 (90% CI: 3.10-62)
1.7 (90% CI: 0.42-7.2)
6.8 (90% CI: 1.9-25)
14.1 (90% CI: 2.6-76)
1.6 (90% CI: 0.21-12)
3.0 (90% CI: 1.1-8.4)
4.1 (90% CI: 0.84-20)
2.5 (90% CI: 0.95-6.4)
3.2 (90% CI: 0.32-32)
0.8 (90% CI: 0.24-2.7)
1.3 (90% CI: 0.28-5.7)
1.5 (90% CI: 0.60-3.7)
M
M
M
M
F
F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
3
4
5
4
3
4
9
3
6
8
1
7
3
3
3
6
4
3
3
6
4
2
2
3
2
4
2
10
10
2
2
5
4
1
1
1
1
1
1
5
5
5
11
8
6
13
7
7
7
11
42
44
45
45
42
44
46
46
45
46
44
46
38
38
46
46
43
44
47
47
20
18
75
63
18
12
12
5
6
5
7
53
53
53
4
3
3
3
3
27
25
13
12
22
21
13
10
44
43
8
5
23
19
7
5
73
75
18
30
25
31
83
90
89
90
88
42
42
42
89
156
156
156
156
132
134
146
147
137
138
146
149
115
116
151
154
136
140
152
154
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
11 (90% CI: 0.85-139)
17 (90% CI: 1.9-162)
1.2 (90% CI: 0.11-13)
1.9 (90% CI: 0.25-14)
0.82 (90% CI: 0.20-3.3)
2.0 (90% CI: 0.51-7.9)
4.4 (1.4-13.4)
3.5 (0.6-19.2)
5.8 (1.4-23.8)
22 (4.4-124)
0.9 (0.4-8.3)
0.8 (0.2-2.8)
0.8 (0.02-30)
0.8 (0.2-4.1)
3.5 (0.6-20.31)
7.6 (1.4-56.6)
5.0 (0.8-43.0)
3.1 (0.4-25.4)
3.1 (0.4-25.4)
1.0 (0.3-2.9)
0.7 (0.2-2.3)
0.5 (0.1-2.4)
0.5 (0.1-2.7)
0.4 (0.1-1.6)
0.3 (0-1.4)
0.9 (0.2-3.0)
0.7 (0.1-3.5)
0.9 (0.3-2.2)
0.9 (0.3-2.3)
0.9 (0.1-5.0)
1.4 (0.1-10.1)
0.9 (0.2-2.8)
0.7 (0.2-2.3)
0.5 (0-4.8)
0.7 (0-7.7)
M
M
M
M
M
M
M
M
49
3
3
4
30
7
1
4
8
54
54
53
4
27
33
30
1272
11
16
343
1272
209
113
343
636
1897
1892
1565
636
1699
1795
1565
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
2.5
9.1
5.9
0.3
2.5
2.1
0.5
0.5
AC
SCC
AC
SCC
all
all
all
AC
SCC
all
AC
SCC
all
woodworking
woodworking
woodworking
leather working
leather working
leather working
construction
textile working
farming
woodworking
textile working
garment working
farming
age, wood/leather industries
by means of corresponding ORs
woodworking
textile/garment working
mining/construction
farming
textile/garment working
farming
hardwood dust
hardwood dust
hardwood dust
hardwood dust
hardwood dust
textiles
textiles
textiles
leather dust
textile working
textile working
pulp/paper mill working
pulp/paper mill working
carpenter/wood working
carpenter/wood working
forestry/logging working
forestry/logging working
sawmill working
sawmill working
cook
cook
farming/farm labourer
farming/farm labourer
construction foremen
construction foremen
construction labourer
construction labourer
bricklayers/plasters/cement workers
bricklayers/plasters/cement workers
age, wood/leather dusts
exp and non exp controls estimated
by means of OR
Zhu K et al 2002
(1.1-5.4)
(2.2-37.4)
(1.5-23.7)
(0.1-0.9)
(0.9-7.4)
(0.9-5.2)
(0.1-3.9)
(0.2-1.4)
all
all
all
all
SCC
SCC
SCC
SCC
cigarette smoking
blood products received
pesticides (2,4,5-T)
asbestos
cigarette smoking
chlorophenols (wood-related)
chromium compounds/alloys
asbestos
1-19 years
≥ 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
ever (≥ 6 months)
most recent 20 years
sex, age, cigarette smoking
removed
removed
removed
removed
removed
removed
removed
removed
removed
removed
age, cancer registry, ethnicity,
educational level, marital status
Table A. (continued)
reference
sex
cases
NE NNE
controls
NE
NNE
RR estimate (95%CI)
histology
type of exposure
duration of exposure
level of exposure
covariates controlled
notes
duration
d'Errico A et al 2009
of
exposure
meant
by
'cumulative exposure' as *continuous
M+F
50
63
22
314
OR = 11.4 (6.29-20.74)
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
41
2
9
7
1
3
1
7
6
12
6
2
12
20
31
46
62
77
89
9
72
111
104
106
112
110
112
106
107
101
107
111
101
93
82
67
51
36
24
104
22
22
2
2
2
3
3
5
5
31
31
31
22
22
22
22
22
22
22
2
314
314
334
334
334
333
333
331
331
305
305
305
314
314
314
314
314
314
314
334
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
M+F
M+F
10
9
103
104
2
2
334
334
OR = 16.5 (1.75-154.7)
OR = 14.3 (2.86-71.39)
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
1
2
1
2
2
2
15
29
50
72
90
101
108
7
29
19
112
111
112
111
111
111
98
84
63
41
23
12
5
106
84
94
42
42
42
27
27
27
22
22
22
22
22
22
22
2
2
2
294
294
294
309
309
309
314
314
314
314
314
314
314
334
334
334
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
M+F
M+F
39
51
74
62
42
42
294
294
OR = 3.7 (1.28-10.89)
OR = 5.7 (1.82-18.00)
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
43
14
20
26
34
44
54
21
36
70
99
93
87
79
69
59
92
77
42
31
31
31
31
31
31
27
27
294
305
305
305
305
305
305
309
309
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
4.3 (1.83-10.11)
1.44 (1.08-1.94)
2.1 (1.16-3.77)
3.0 (1.24-7.31)
4.3 (1.33-14.18)
6.3 (1.43-27.53)
9.1 (1.54-53.42)
2.6 (0.69-9.46)
5.4 (1.87-15.33)
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
M+F
28
21
77
11
8
28
26
25
14
61
105
27
33
44
40
26
31
85
92
36
102
105
85
87
88
99
52
8
86
80
69
73
87
82
27
22
22
2
2
42
42
27
27
22
22
2
2
42
42
27
27
309
314
314
334
334
294
294
309
309
314
314
334
334
294
294
309
309
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
OR
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
3.7 (1.59-8.81)
3.2 (1.36-7.44)
30.6 (11.93-78.30)
17.6 (1.84-168.5)
11.9 (1.12-127.1)
2.3 (1.15-4.46)
2.1 (0.65-6.67)
3.3 (1.47-7.26)
1.6 (0.34-7.75)
16.6 (5.10-54.04)
179.9 (55.37-584.4)
52.4 (3.71-740.2)
68.8 (5.60-844.7)
4.5 (1.54-12.90)
3.8 (0.67-21.58)
3.5 (1.31-9.60)
4.3 (1.01-18.10)
Mayr SI et al 2010
M+F
M+F
12
2
19
29
1
2
84
83
OR = 60.7 (7.5-493.8)
OR = 2.9 (0.4-21.3)
Greiser EM et al 2012
M+F
M+F
M+F
34
6
19
393
393
393
70
23
24
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
58.6 (23.74-144.8)
0.85 (0.19-3.83)
14.4 (3.03-68.87)
26.6 (5.09-139.0)
5.0 (0.44-56.83)
2.8 (0.55-14.06)
2.1 (0.22-21.1)
4.3 (1.32-14.10)
9.5 (2.62-34.20)
1.4 (0.68-2.97)
1.9 (0.70-5.10)
0.52 (0.12-2.34)
1.77 (1.46-2.14)
3.1 (2.13-4.56)
5.5 (3.11-9.74)
9.7 (4.53-20.80)
17,1 (6.61-44.42)
30.2 (9.64-94.86)
53.4 (14.07-202.6)
14.7 (1.37-156.7)
1.4 (0.61-3.26)
3.5 (1.50-8.09)
2.2 (1.17-3.97)
2.4 (0.92-6.38)
3.0 (1.13-8.00)
2.7 (1.31-5.45)
2.24 (1.76-2.85)
5.0 (3.09-8.10)
11.2 (5.42-23.04)
25.0 (9.53-65.55)
55.9 (16.74-186.5)
124.9 (29.4-530.7)
279.3 (51.67 to >999)
11.3 (0.91-141.3)
58.1 (5.84-579.3)
32.8 (5.96-181.1)
2331 OR = 2.33 (1.4-3.91)
2331 OR = 2.08 (0.56-7.74)
2331 OR = 13.07 (3.44-49.7)
all
AC
SCC
all
AC
SCC
all
AC
all
AC
all
AC
SCC
all
all
all
all
all
all
all
all
wood dust
age, sex, co-exposures
wood dust
wood dust
leather dust
leather dust
leather dust
chromium
chromium
formaldehyde
formaldehyde
textile dusts
textile dusts
textile dusts
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
leather dust adj wood dust
5 years*
10 years*
15 years*
20 years*
25 years*
30 years*
35 years*
1-5 years**
all
all
leather dust
leather dust
over 5 years**
ever**
all
all
all
all
all
all
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
solvent vapours adj wood dust
solvent vapours adj wood dust
solvent vapours adj wood dust
welding fumes adj wood dust
welding fumes adj wood dust
welding fumes adj wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
wood dust
leather dust adj wood dust
leather dust adj wood dust
leather dust adj wood dust
1-10 years**
over 10 years**
ever**
1-10 years**
over 10 years**
ever**
5 years*
10 years*
15 years*
20 years*
25 years*
30 years*
35 years*
1-5 years**
over 5 years**
ever**
AC
AC
solvent vapours
solvent vapours
adj wood dust
1-10 years**
over 10 years**
AC
AC
AC
AC
AC
AC
AC
SCC
SCC
solvent vapours adj wood dust
textiles
textiles
textiles
textiles
textiles
textiles
welding fumes adj wood dust
welding fumes adj wood dust
ever**
5 years*
10 years*
15 years*
20 years*
25 years*
30 years*
1-10 years**
over 10 years**
SCC
all
all
all
all
all
all
all
all
AC
AC
AC
AC
AC
AC
SCC
SCC
welding fumes adj wood dust
wood dust
wood dust
leather dust
leather dust
solvent vapours
solvent vapours
welding fumes
welding fumes
wood dust
wood dust
leather dust
leather dust
solvent vapours
solvent vapours
welding fumes
welding fumes
ever**
AC
AC
primary wood-processing
formaldheyde
32 years
25 years
all
all
all
hardwood dust
hardwood dust
hardwood dust
at least 1 year
exposure (tertile) < 8 years
24+ years
adj wood dust
adj wood dust
adj wood dust
variable or **categorical variable;
exp and non exp cases estimated by
means of OR
low
high
low
high
low
high
low
high
low
high
low
high
low
high
low
high
latency: 43 years
latency: 35 years
Year of birth, community size,
educational attainment, cigarette
pack-years (all study participants),
snuff package-years, years of
exposure to asbestos, organic
solvents,
use of nasal spray/nasal lavage and
ever-use of insecticides in homes,
duration of exposure to softwood
dust and to chipboard dust.
Table B. Cohort studies (N=11) included in the meta-analysis
reference
Pippard EC, Acheson ED 1985
sex
M
N
exp
N
obs
10
1.87
RR estimate (95%CI)
SMR = 538 (257-985)
type of exposure
duration of
exposure
level of exposure
3
2
1
3
2
1
0.3
0.2
0.1
0.2
0.1
0.1
SMR
SMR
SMR
SMR
SMR
SMR
=
=
=
=
=
=
1000
1000
1000
1500
2000
1000
(p<0.05)
(p<0.05)
(p<0.01)
(p<0.05)
notes
boot/shoe manuf.ind.
sex,
year
of
starting
employment,
age
at
starting employment
Sorahan T et al 1988
M+F
M
F
M+F
M
F
covariates controlled
nickel/chrome plating
nickel/chrome plating
nickel/chrome plating
chrome bath
chrome bath
chrome bath
SMRA: SMR adjusted for class and
Davies JM et al 1991
Andersen A et al 1996
Fu H et al 1996
M
M
2
2
0.07
0.07
SMRA = 3042 (p<0.01)
SMRN = 2852 (p<0.05)
chromate production
chromate production
≤50 years*
≤50 years*
M
2
0.11
SMRA = 1824 (p<0.01)
chromate production
<30 years**
M
2
0.11
SMRN = 2024 (p<0.05)
chromate production
<30 years**
M
32
1.8
SIR = 18.0 (12.3-25.4)
soluble nickel comp.
all
all
M
2
0.7
SIR = 2.7 (0.3-9.8)
soluble nickel comp.
<1 mg/m3year
all
M
M
M
M
M
M
M
6
11
13
14
2
1
15
0.3
0.3
0.4
1.0
0.4
0.2
0.2
SIR
SIR
SIR
SIR
SIR
SIR
SIR
soluble
soluble
soluble
soluble
soluble
soluble
soluble
1-4 mg/m3year
5-14 mg/m3year
≥15 mg/m3year
all
all
all
<1 mg/m3
1-4 mg/m3
5-14 mg/m3
≥15 mg/m3
M+F
M+F
12
1
0.02
0.001
SMRE = 741 (383-1294)
SMRF = 909 (23-5065)
=
=
=
=
=
=
=
14.3 (5.2-31.2)
40.5 (20.2-72.5)
36.6 (19.5-62.5)
13.7 (7.5-23.0)
5.1 (0.6-18.5)
5.5 (0.1-30.5)
81.7 (45-135)
nickel
nickel
nickel
nickel
nickel
nickel
nickel
comp.
comp.
comp.
comp.
comp.
comp.
comp.
all
all
all
all
area; SMRN: SMR based on national
unadjusted rates
social class, area
*early; **prechange
smoking
duration of exposure meant by
'cumulative exposure';
expected
cases
estimated
by
means of SIR
age, sex, leather
solvents exposure
shoe manufacturing
shoe manufacturing
dust, E = English cohort; F = Florence
cohort;
duration
of
exposure
estimated
from the number of person-years
Järup L et al 1998
M+F
M+F
M+F
M+F
M+F
12
9
1
2
1
0.01
0.01
0.0004
0.01
0.001
SMRE
SMRE
SMRE
SMRE
SMRF
=
=
=
=
=
805 (416-1410)
1170 (534-2220)
2500 (63-13900)
385 (47-1390)
1250 (31-6970)
M
3
0.36
SIR = 832 (172-2430)
leather dust/solvents
leather dust
leather dust
solvents
leather dust/solvents
25
25
25
25
27
years
years
years
years
years
all
probable
high
probable
all
at risk and the number of workers
battery (Cd/Ni)
M
M
2
2
0.18
0.19
SIR = 1110 (134-4000)
SIR = 1080 (131-3900)
cadmium
nickel
≥ 1000 μg Cd/m *yrs
≥ 2000 μg Ni/m3*yrs
M+F
M+F
M+F
M+F
2
2
2
2
0.2
0.05
0.03
0.03
SIR
SIR
SIR
SIR
nickel
nickel refinery
nickel refinery
nickel refinery
<
<
<
<
Innos K et al 2000
M+F
3
1.6
SIR = 1.87 (0.39-5.46)
furniture
Coggon D et al 2003
M+F
2
2.3
SIR = 0.87 (0.11-3.14)
formaldehyde
Hemelt M et al 2004
M
87
45
SIR = 1.91 (1.53-2.36)
wood workers
Siew SS et al 2012
M
32
20
SIR = 1.59 (1.06-2.38)
wood dust
all
M
17
15
SIR = 1.11 (0.66-1.87)
formaldehyde
all
Anttila A et al 1998
=
=
=
=
8.79
41.1
67.1
75.2
(1.06-31.7)
(4.97-148)
(8.12-242)
(9.10-271)
10 year latency period applied to
SNC; cumulative exposure for the
cohort members
3
≥ 5 years
0.5
0.5
0.5
0.5
mg/m3
mg/m3
3
mg/m
mg/m3
age, sex, 7-years calendar
period
latency (20 years)