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Occupational lung disease
Original research
Risk of asbestosis, mesothelioma, other lung disease or death among motor vehicle mechanics: a 45-year Danish cohort study
  1. Reimar Wernich Thomsen1,
  2. Anders Hammerich Riis1,
  3. Esben Meulengracht Flachs2,
  4. David H Garabrant3,
  5. Jens Peter Ellekilde Bonde2,
  6. Henrik Toft Sørensen1
  1. 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Kobenhavn, Denmark
  3. 3School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Reimar Wernich Thomsen, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark; rwt{at}clin.au.dk

Abstract

Introduction The risk of asbestosis, malignant mesothelioma and lung cancer among motor vehicle mechanics is of concern because of potential exposure to chrysotile asbestos during brake, clutch and gasket repair and maintenance. Asbestos has also been used in insulation and exhaust systems.

Methods We examined the long-term risk of incident mesothelioma, lung cancer, asbestosis and other lung diseases and mortality due to mesothelioma, lung cancer, asbestosis and other lung diseases in a nationwide cohort of all men registered as motor vehicle mechanics since 1970 in Denmark. This was compared with the corresponding risk in a cohort of male workers matched 10:1 by age and calendar year, with similar socioeconomic status (instrument makers, dairymen, upholsterers, glaziers, butchers, bakers, drivers, farmers and workers in the food industry, trade or public services).

Results Our study included 138 559 motor vehicle mechanics (median age 24 years; median follow-up 20 years (maximum 45 years)) and 1 385 590 comparison workers (median age 25 years; median follow-up 19 years (maximum 45 years)). Compared with other workers, vehicle mechanics had a lower risk of morbidity due to mesothelioma/pleural cancer (n=47 cases) (age-adjusted and calendar-year-adjusted HR=0.74 (95% CI 0.55 to 0.99)), a slightly increased risk of lung cancer (HR=1.09 (95% CI 1.03 to 1.14)), increased risk of asbestosis (HR=1.50 (95% CI 1.10 to 2.03)) and a chronic obstructive pulmonary disease risk close to unity (HR=1.02 (95% CI 0.99 to 1.05)). Corresponding HRs for mortality were 0.86 (95% CI 0.64 to 1.15) for mesothelioma/pleural cancer, 1.06 (95% CI 1.01 to 1.12) for lung cancer, 1.79 (95% CI 1.10 to 2.92) for asbestosis, 1.06 (95% CI 0.86 to 1.30) for other lung diseases caused by external agents and 1.00 (95% CI 0.98 to 1.01) for death due to all causes.

Conclusions We found that the risk of asbestosis was increased among vehicle mechanics. The risk of malignant mesothelioma/pleural cancers was not increased among vehicle mechanics.

  • clinical epidemiology
  • asbestos induced lung disease
  • lung cancer
  • occupational lung disease
  • mesothelioma

Data availability statement

Data may be obtained from a third party and are not publicly available. Danish law does not allow researchers to share raw data or datasets, which include individual-level datapoints from the registries with third parties. Information on contents of the DOC*X database used in this study, and on how to gain access, is available at the DOC*X website: www.doc-x.dk/en. Data linked in the DOC*X database are available through online access at Statistics Denmark under standard conditions and can be accessed by researchers through application to Statistics Denmark: https://www.dst.dk/en%23.

https://doi.org/10.1136/thoraxjnl-2020-215041

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Danish law does not allow researchers to share raw data or datasets, which include individual-level datapoints from the registries with third parties. Information on contents of the DOC*X database used in this study, and on how to gain access, is available at the DOC*X website: www.doc-x.dk/en. Data linked in the DOC*X database are available through online access at Statistics Denmark under standard conditions and can be accessed by researchers through application to Statistics Denmark: https://www.dst.dk/en%23.

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    Footnotes

    • Twitter @dr_rwt

    • Correction notice This article has been corrected since it was published Online First. An author first name was incorrectly added to their last name.

    • Contributors RWT, DHG, JPEB and HTS conceived and designed the study. EMF, JPEB and AHR retrieved the data. AHR analysed the data. All authors participated in the interpretation of the results of the data analysis. RWT drafted the initial manuscript. All authors revised the manuscript critically and approved the final manuscript for submission.

    • Funding This study was supported by a research grant from EpidStat Institute, USA, to Aarhus University.

    • Competing interests DHG has served as the president of EpidStat Institute and has served as an expert witness in matters involving mesothelioma, lung cancer and asbestosis among vehicle mechanics on behalf of defendants including motor vehicle manufacturers; brake, clutch and gasket manufacturers; and motor vehicle parts distributors. EpidStat received payment for DHG’s services as an expert witness.

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

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