ORIGINAL ARTICLE

Mortality among a cohort of garment workers exposed to formaldehyde: an update

L E Pinkerton¹, M J Hein¹, L T Stayner²

¹ Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations and Field Studies, The National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
² Risk Evaluation Branch, Education and Information Division, The National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA

Correspondence to:
Correspondence to:
Dr L E Pinkerton
Epidemiology Section, Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations and Field Studies, The National Institute for Occupational Safety and Health, 4676 Columbia Parkway, R-15, Cincinnati, OH 45226, USA; LPinkerton{at}cdc.gov

Aims: To evaluate the mortality experience of 11 039 workers exposed to formaldehyde for three months or more in three garment plants. The mean time weighted average formaldehyde exposure at the plants in the early 1980s was 0.15 ppm but past exposures may have been substantially higher.

Methods: Vital status was updated through 1998, and life table analyses were conducted.

Results: Mortality from all causes (2206 deaths, standardised mortality ratio (SMR) 0.92, 95% CI 0.88 to 0.96) and all cancers (SMR 0.89, 95% CI 0.82 to 0.97) was less than expected based on US mortality rates. A non-significant increase in mortality from myeloid leukaemia (15 deaths, SMR 1.44, 95% CI 0.80 to 2.37) was observed. Mortality from myeloid leukaemia was greatest among workers first exposed in the earliest years when exposures were presumably higher, among workers with 10 or more years of exposure, and among workers with 20 or more years since first exposure. No nasal or nasopharyngeal cancers were observed. Mortality from trachea, bronchus, and lung cancer (147 deaths, SMR 0.98, 95% CI 0.82 to 1.15) was not increased. Multiple cause mortality from leukaemia was increased almost twofold among workers with both 10 or more years of exposure and 20 years or more since first exposure (15 deaths, SMR 1.92, 95% CI 1.08 to 3.17). Multiple cause mortality from myeloid leukaemia among this group of workers was also significantly increased (8 deaths, SMR 2.55, 95% CI 1.10 to 5.03).

Conclusions: Results support a possible relation between formaldehyde exposure and myeloid leukaemia mortality. Previous epidemiological studies supporting a relation between formaldehyde exposure and leukaemia mortality have been primarily of formaldehyde exposed professional groups, not formaldehyde exposed industrial workers. Limitations include limited power to detect an excess for rare cancers such as nasal and nasopharyngeal cancers and lack of individual exposure estimates.

Keywords: formaldehyde; cancer; mortality; leukaemia

Abbreviations: CI, confidence interval; LTAS, life table analysis system; MCOD, multiple causes of death; NDI, National Death Index; PYAR, person-years-at-risk; SMR, standardised mortality ratio; STEL, short term exposure limit; TWA, time weighted average

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