Article Text

Original research
Lifetime cumulative exposure to rubber dust, fumes and N-nitrosamines and non-cancer mortality: a 49-year follow-up of UK rubber factory workers
  1. Mira Hidajat1,
  2. Damien Martin McElvenny2,
  3. Peter Ritchie2,
  4. Andrew Darnton3,
  5. William Mueller2,
  6. Raymond M Agius4,
  7. John W Cherrie2,5,
  8. Frank de Vocht1
  1. 1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Research Division, Institute of Occupational Medicine, Edinburgh, UK
  3. 3 Statistics and Epidemiology Unit, Health and Safety Executive, Bootle, UK
  4. 4 Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
  5. 5 Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh, Edinburgh, UK
  1. Correspondence to Frank de Vocht, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK; frank.devocht{at}


Objectives To examine associations between occupational exposures to rubber dust, rubber fumes and N-nitrosamines and non-cancer mortality.

Methods A cohort of 36 441 males aged 35+ years employed in British rubber factories was followed-up to 2015 (94% deceased). Competing risk survival analysis was used to assess risks of dying from non-cancer diseases (respiratory, urinary, cerebrovascular, circulatory and digestive diseases). Occupational exposures to rubber dust, rubber fumes, N-nitrosamines were derived based on a population-specific quantitative job-exposure matrix which in-turn was based on measurements in the EU-EXASRUB database.

Results Exposure–response associations of increased risk with increasing exposure were found for N-nitrosomorpholine with mortality from circulatory diseases (subdistribution hazard ratio (SHR) 1.17; 95% CI 1.12 to 1.23), ischaemic heart disease (IHD) (SHR 1.19; 95% CI 1.13 to 1.26), cerebrovascular disease (SHR 1.19; 95% CI 1.07 to 1.32) and exposures to N-nitrosodimethylamine with respiratory disease mortality (SHR 1.41; 95% CI 1.30 to 1.53). Increased risks for mortality from circulatory disease, IHD and digestive diseases were found with higher levels of exposures to rubber dust, rubber fumes and N-nitrosamines sum, without an exposure-dependent manner. No associations were observed between rubber dust, rubber fumes and N-nitrosamines exposures with mortality from asthma, urinary disease, bronchitis, emphysema, liver disease and some digestive diseases.

Conclusions In a cohort of rubber factory workers with 49 years of follow-up, increased risk for mortality from circulatory, cerebrovascular, respiratory and digestive diseases were found to be associated with cumulative occupational exposures to specific agents.

  • rubber
  • mortality studies
  • longitudinal studies

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Twitter @frankdevocht

  • Contributors MH and FdV conceived of the study. FdV, DMME, JWC and RMA obtained funding for the study. MH conducted the statistical analyses and wrote the first draft version of the manuscript. All authors contributed to interpretation of the results and commented on draft versions of the manuscript. All authors approved the final draft.

  • Funding This study was funded by Cancer Research UK (C29425/A16521). Additional funding for tracing of the cohort was provided by the UK Health and Safety Executive (PRJ787).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. Use of these data was granted by the NHS ethics committee, the Health Research Authority’s Confidentiality Advisory Group, the Office for National Statistics and NHS Digital’s Data Access Advisory Group (now Independent Group Advising on the Release of Data) for the specific purpose of this study only.