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Original research
Effects of chronic intermittent hypobaric hypoxia on prostate-specific antigen (PSA) in Chilean miners
  1. Diana Elizabeth Alcantara-Zapata1,2,
  2. Shrikant I Bangdiwala3,
  3. Daniel Jiménez1,
  4. Manolis Kogevinas4,
  5. Nella Marchetti5,
  6. Carolina Nazzal1
  1. 1 School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
  2. 2 Faculty of Sciences and Philosophy, and Laboratory of Investigation and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
  3. 3 Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  4. 4 Barcelona Institute for Global Health - Campus MAR, Barcelona, Spain
  5. 5 Occupational Health Department, School of Public Health. University of Chile, Santiago, Chile
  1. Correspondence to Dr Carolina Nazzal, School of Public Health, Faculty of Medicine, University of Chile, 939 Av. Independencia, 8380453, Santiago, Chile.; cnazzal{at}


Objective The aim was to determine the effects of chronic intermittent hypobaric hypoxia (CIHH) on prostate-specific antigen (PSA) levels in Chilean miners who work at different altitudes.

Methods A cross-sectional study was conducted between April and July 2019. Miners from five mines (N=338) at different altitudes were evaluated. We recorded sociodemographic, working and altitude information. Haemoglobin oxygen saturation (SaO2) and haemoglobin (Hb) were measured in situ, while PSA and testosterone were analysed at a low level. Linear mixed-effect models were used to evaluate the association between PSA level and two CIHH exposures: composite CIHH (with four descriptors) and ChileStd-CIHH (CIHH Chilean standard; based on the Chilean technical guide for occupational exposure to CIHH). All models were adjusted by age, body mass index and day of the work the samples were taken.

Results Highest and lowest PSA levels were found in mines ≥3000 m above sea level (mine 3: median=0.75, IQR=−0.45; mine 4: median=0.46, IQR=−0.35). In the multilevel models, the wider altitude difference between mining operation and camp showed lower PSA levels (model D: βPSA=−0.93 ng/mL, βlogPSA=−0.07, p<0001), adjusted for other CIHH descriptors, SaO2, Hb and testosterone. The descriptors of composite CIHH explained better PSA variations than ChileStd-CIHH (model D: marginal R2=0.090 vs model A: marginal R2=0.016).

Conclusions Occupational health regulations and high altitude medicine should consider these results as initial evidence on the inclusion of new descriptors for CIHH and the possible effect of this exposure on PSA levels in this male-dominated occupational sector.

  • miners
  • occupational health
  • environment
  • public health surveillance
  • urology

Data availability statement

Data may be obtained from Superintendencia de Seguridad Social (SUSESO), a Chilean autonomous public agency.

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Data availability statement

Data may be obtained from Superintendencia de Seguridad Social (SUSESO), a Chilean autonomous public agency.

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  • Twitter @DianaAlcantara7, @KogevinasM

  • Contributors DEA-Z and CN designed the study. DEA-Z and SIB analysed the data. DEA-Z drafted the paper. DEA-Z, SIB, DJ, MK, NM and CN contributed to manuscript writing and revision. All authors read and approved the final version of the manuscript.

  • Funding This study was funded by Chile's Superintendence of Social Security (Superintendencia de Seguridad Social del Gobierno de Chile, SUSESO) (ID: 1607-12-LQ18). The results and conclusions are the sole responsibility of the authors. DEA-Z acknowledges financial support from the NIH Fogarty International Center, National Institute of Environmental Health Sciences, National Cancer Institute, Centers for Disease Control and the NIH under Award Number U2R TWOIOI14 for her doctoral studies. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.