Article Text
Abstract
Objective To evaluate mortality risks of angiosarcoma of the liver (ASL), primary hepatocellular carcinoma (HCC) and other cancers among 9951 men employed between 1942 and 1972 at 35 US vinyl chloride (VC) or polyvinyl chloride plants followed for mortality through 31 December 2013.
Methods SMR and time-dependent Cox proportional hazards analyses were used to evaluate mortality risks by cumulative VC exposure.
Results Liver cancer mortality was elevated (SMR=2.87, 95% CI 2.40 to 3.40), and ASL and HCC were strongly associated with cumulative VC exposure ≥865 parts per million-years (ppm-years) (ASL: HR=36.3, 95% CI 13.1 to 100.5; and HCC: HR=5.3, 95% CI 1.6 to 17.7 for ≥2271 ppm-years). Excess deaths due to connective and soft tissue cancers (SMR=2.43, 95% CI 1.48 to 3.75), mesothelioma (SMR=2.29, 95% CI 1.18 to 4.00) and explosions (SMR=3.43, 95% CI 1.25 to 7.47) were seen. Mortalities due to melanoma, brain cancer, lung cancer and non-Hodgkin’s lymphoma were not increased or associated with VC exposure.
Conclusion The association between VC and ASL first reported in this cohort 44 years ago persisted and was strongest among workers most highly exposed. VC exposure also was associated with HCC mortality, although it remains possible that misdiagnosis of early ASLs influenced findings.
- vinyl chloride
- angiosarcoma of the liver
- hepatocellular carcinoma
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Footnotes
Contributors KAM and LDD designed the study and data analysis plan. LC and AEG performed statistical analysis of the data. All authors made significant contributions to the interpretation of data and participated in drafting and revising the manuscript. All authors have approved the final version.
Funding The study was sponsored and paid for by the American Chemistry Council. The sponsor had no role in the design, conduct, analysis, reporting of results or preparation of the manuscript. The sponsor was given the opportunity to review a draft manuscript at the time of external peer review. The purpose of such review was to allow input on the clarity of the science presented but not in interpretation of the research findings.
Competing interests All authors are employed by Ramboll Environ US Corporation. Ramboll Environ received financial support from the American Chemistry Council to conduct the study described in the manuscript. Ramboll Environ also has received financial support from, and contracts with, the American Chemistry Council for work on scientific topics unrelated to the submitted manuscript.
Patient consent This study used administrative records only. The outcomes of interest were mortality data. No medical records were reviewed nor obtained.
Ethics approval ENVIRON Institutional Review Board (USDHHS/OHRP/IRB#1265;FWA#00006387).
Provenance and peer review Not commissioned; externally peer reviewed.