ArticleSafety and health at work2025
Confounding Effects of Lifestyle Factors in Cancer Risk Estimation for Occupational Radiation Exposure.
Article in Safety and health at work, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches.Epidemiology and health · 2026Pooled it
- Article
- Beyond radiation dosimetry: metabolic burden and a possible healthy worker survivor pattern in the medical imaging workforce.Frontiers in public health · 2026Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The confounding effect of lifestyle factors is an important concern in occupational studies, particularly when the risk magnitude is relatively small. This study aimed to evaluate the potential confounding effects of lifestyle factors on the association between radiation exposure and cancer incidence. Methods: Data from all Republic of Korean diagnostic medical radiation workers enrolled in the national dose registry were merged with cancer incidence records up to 2018. Excess relative risks (ERRs) for cancer were calculated using Poisson regression models to quantify the radiation dose-response relationship. Major lifestyle factors were imputed using multiple imputations by chained equations based on survey data. The confounding effects were assessed by comparing ERRs before and after adjustment for lifestyle factors. Results: The baseline ERR for cancer incidence per Sievert was 0.44 (95% CI: -0.94, 1.83) after adjusting for attained age, sex, birth year, and employment duration. Further adjustment for lifestyle factors (smoking status, alcohol consumption, body mass index, physical exercise, sleep duration, and night shift work) did not substantially modify this risk coefficient, with change-in-estimate values ranging from 0% to 13.6%. Sensitivity analyses conducted with the survey-based cohort and sex-stratified analyses yielded consistent results. Conclusion: Our study found little evidence of significant confounding effects from unmeasured lifestyle factors on cancer risk when basic registry data variables were adjusted among medical radiation workers. Further studies are warranted to investigate the impact of unmeasured and unknown confounders to improve the accuracy of radiation risk estimates.
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