ArticleAmerican journal of epidemiology2021
Lung Cancer Mortality and Styrene Exposure in the Reinforced-Plastics Boatbuilding Industry: Evaluation of Healthy Worker Survivor Bias.
Article in American journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021.Epidemiologic reviews · 2023Pooled it
- Occupational exposures and kidney cancer among 25 000 male offshore petroleum industry workers: relative risks and healthy worker survivor bias.American journal of epidemiology · 2026Article
- Exposure to volatile organic compounds and chronic respiratory disease mortality, a case-cohort study.Respiratory research · 2025Article
- Assessing occupational styrene exposure in the European and US Glass Reinforced Plastics Industry for the period between 1947 and 2020.International journal of hygiene and environmental health · 2025Article
- Healthy worker hire and survivor effects in a cohort of medical radiation workers.International journal of epidemiology · 2024Article
- Estimating impacts of reducing acrylonitrile exposure on lung cancer mortality in an occupational cohort with the parametric g-formula.Occupational and environmental medicine · 2024Article
- Procedural application of mode-of-action and human relevance analysis: styrene-induced lung tumors in mice.Critical reviews in toxicology · 2024Review
- The association between playing professional American football and longevity.Proceedings of the National Academy of Sciences of the United States of America · 2023Article
- Research Recommendations for Selected IARC-Classified Agents: Impact and Lessons Learned.Environmental health perspectives · 2023Review
- Risks of Leukemia in Various Industrial Groups in Korea: A Retrospective National Cohort Study.International journal of environmental research and public health · 2023Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
The evidence for styrene's being a human lung carcinogen has been inconclusive. Occupational cohorts within the reinforced-plastics industry are an ideal population in which to study this association because of their relatively high levels of exposure to styrene and lack of concomitant exposures to other known carcinogens. However, healthy worker survivor bias (HWSB), where healthier workers stay employed longer and thus have higher exposure potential, is a likely source of confounding bias for exposure-response associations, in part due to styrene's acute effects. Through December 31, 2016, we studied a cohort of 5,163 boatbuilders exposed to styrene in Washington State who were employed between 1959 and 1978; prior regression analyses had demonstrated little evidence for an exposure-response relationship between styrene exposure and lung cancer mortality. Based on estimates of necessary components of HWSB, we found evidence for a potentially large HWSB. Using g-estimation of a structural nested model to account for HWSB, we estimated that 1 year of styrene exposure at more than 30 parts per million accelerated time to lung cancer death by 2.29 years (95% confidence interval: 1.53, 2.94). Our results suggest possibly strong HWSB in our small cohort and indicate that large, influential studies of styrene-exposed workers may suffer from similar biases, warranting a reassessment of the evidence of long-term health effects of styrene exposure.
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