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Burden of lung cancer attributable to occupational diesel engine exhaust exposure in Canada
  1. Joanne Kim1,2,
  2. Cheryl E Peters3,4,
  3. Victoria H Arrandale1,5,
  4. France Labrèche6,7,
  5. Calvin B Ge3,8,
  6. Christopher B McLeod9,
  7. Chaojie Song1,
  8. Jérôme Lavoué7,
  9. Hugh W Davies3,9,
  10. Anne-Marie Nicol3,10,
  11. Manisha Pahwa1,
  12. Paul A Demers1,3,5,9
  1. 1 Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
  2. 2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  3. 3 CAREX Canada, Simon Fraser University, Burnaby, British Columbia, Canada
  4. 4 Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
  5. 5 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  6. 6 Chemical and Biological Hazards Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail du Québec (IRSST), Montreal, Quebec, Canada
  7. 7 Département de santé environnementale et santé au travail, Université de Montréal, Montreal, Quebec, Canada
  8. 8 Institute for Risk Assessment Sciences, Universiteit Utrecht, Utrecht, The Netherlands
  9. 9 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  10. 10 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  1. Correspondence to Dr Paul A Demers; Paul.Demers{at}


Objective To estimate the population attributable fraction (PAF) and number of incident and fatal lung cancers in Canada from occupational exposure to diesel engine exhaust (DEE).

Methods DEE exposure prevalence and level estimates were used with Canadian Census and Labour Force Survey data to model the exposed population across the risk exposure period (REP, 1961–2001). Relative risks of lung cancer were calculated based on a meta-regression selected from the literature. PAFs were calculated using Levin’s equation and applied to the 2011 lung cancer statistics obtained from the Canadian Cancer Registry.

Results We estimated that 2.4% (95% CI 1.6% to 6.6%) of lung cancers in Canada are attributable to occupational DEE exposure, corresponding to approximately 560 (95% CI 380 to 1570) incident and 460 (95% CI 310 to 1270) fatal lung cancers in 2011. Overall, 1.6 million individuals alive in 2011 were occupationally exposed to DEE during the REP, 97% of whom were male. Occupations with the highest burden were underground miners, truck drivers and mechanics. Half of the attributable lung cancers occurred among workers with low exposure.

Conclusions This is the first study to quantify the burden of lung cancer attributable to occupational DEE exposure in Canada. Our results underscore a large potential for prevention, and a large public health impact from occupational exposure to low levels of DEE.

  • lung cancer
  • occupational cancer
  • burden of disease
  • diesel engine exhaust

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  • Contributors The project was initiated and conceptualised by PAD, in collaboration with CEP, FL, CBM, JL, HWD, AMN and MP. CEP and CBG created the DEE CAREX JEM, with input from VHA and PAD. JK designed and conducted the analysis, assisted by CS, with input from VHA, CBM and PAD. All authors provided input on the study methods. JK drafted the manuscript under the guidance of PAD and FL and all authors participated in its revision.

  • Funding This study was funded by the Canadian Cancer Society Research Institute Multi-sector Team Grant in Prevention Research (Grant No 701285).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.