Objectives To examine gender and racial disparities in heart disease mortality related to metalworking fluid exposures and in the healthy worker survivor effect.

Method We examined ischaemic heart disease (IHD) mortality from 1941 to 1995 in a cohort of autoworkers with quantitative exposure to cumulative respirable particulate matter from water-based metalworking fluids. Cox models were used to estimate the exposure-response to soluble and synthetic fluids separately in white men, black men, and white women. In separate analyses, we used g-estimation to adjust for the healthy worker survivor effect.

Results The risk of IHD was increased among black men (295 deaths) exposed to synthetic fluid with a hazard ratio (HR) of 3.47 (95% CI: 1.52, 7.92) in the highest cumulative exposure category. White women (119 deaths) had increased risk of IHD with increased soluble fluid (HR: 2.44 (0.93, 6.38)) in the second to highest category. However, Cox models show no increased risk in white men (2246 deaths). In contrast, g-estimation results indicate that if white men had been always unexposed to soluble and synthetic fluid, then on average for each case, 2.99 and 2.77 years of life would have been saved, respectively.

Conclusions We found increased risk of IHD for black men and white women exposed to metalworking fluids using Cox regression. After adjusting for the healthy worker survivor effect, increased risk was observed for white men. The ability to leave work for health related reasons may be an option more available to white male workers.