@article {Hart221, author = {J E Hart and F Laden and E A Eisen and T J Smith and E Garshick}, title = {Chronic obstructive pulmonary disease mortality in railroad workers}, volume = {66}, number = {4}, pages = {221--226}, year = {2009}, doi = {10.1136/oem.2008.040493}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background: There is little information describing the risk of non-malignant respiratory disease and occupational exposure to diesel exhaust.Methods: US railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II. In a retrospective cohort study we examined the association of chronic obstructive pulmonary disease (COPD) mortality with years of work in diesel-exposed jobs. To examine the possible confounding effects of smoking, multiple imputation was used to model smoking history. A Cox proportional hazards model was used to estimate an incidence rate ratio, adjusted for age, calendar year, and length of follow-up after leaving work (to reduce bias due to a healthy worker survivor effect).Results: Workers in jobs with diesel exhaust exposure had an increased risk of COPD mortality relative to those in unexposed jobs. Workers hired after the introduction of diesel locomotives had a 2.5\% increase in COPD mortality risk for each additional year of work in a diesel-exposed job. This risk was only slightly attenuated after adjustment for imputed smoking history.Conclusions: These results support an association between occupational exposure to diesel exhaust and COPD mortality.}, issn = {1351-0711}, URL = {https://oem.bmj.com/content/66/4/221}, eprint = {https://oem.bmj.com/content/66/4/221.full.pdf}, journal = {Occupational and Environmental Medicine} }