Exposure–response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009)

• Published in: Occupational and environmental medicine (London, England) Vol. 72; no. 10; pp. 699 - 706
• Main Authors: Daniels, Robert D, Bertke, Stephen, Dahm, Matthew M, Yiin, James H, Kubale, Travis L, Hales, Thomas R, Baris, Dalsu, Zahm, Shelia H, Beaumont, James J, Waters, Kathleen M, Pinkerton, Lynne E
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group 01.10.2015; BMJ Publishing Group LTD
• Subjects: Adult; Age Distribution; Aged; Bladder cancer; Cancer; Careers; Cause of Death; Chicago; Chronic obstructive pulmonary disease; Cohort Studies; Exposure; Fire departments; Fire fighting; Fire stations; Firefighters; Firefighters - statistics & numerical data; Fires; Health risks; Humans; Incidence; Leukaemia; Leukemia; Leukemia - epidemiology; Leukemia - etiology; Leukemia - physiopathology; Lung cancer; Lung Neoplasms - epidemiology; Lung Neoplasms - etiology; Lung Neoplasms - physiopathology; Male; Middle Aged; Mortality; Mortality risk; Occupational Diseases - epidemiology; Occupational Diseases - etiology; Occupational Diseases - physiopathology; Occupational exposure; Occupational Exposure - adverse effects; Occupational health; Philadelphia; Prognosis; Proportional Hazards Models; Prostate; Retrospective Studies; Risk; Risk Assessment; San Francisco; Survival Analysis; Workplace; San Francisco; Chicago; Philadelphia; San Francisco California; Chicago Illinois; California; United States > US; Illinois; Pennsylvania; USA, Illinois, Chicago; USA, Pennsylvania, Philadelphia; INE, USA, California, San Francisco
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oemed-2014-102671

ObjectivesTo examine exposure–response relationships between surrogates of firefighting exposure and select outcomes among previously studied US career firefighters.MethodsEight cancer and four non-cancer outcomes were examined using conditional logistic regression. Incidence density sampling was used to match each case to 200 controls on attained age. Days accrued in firefighting assignments (exposed-days), run totals (fire-runs) and run times (fire-hours) were used as exposure surrogates. HRs comparing 75th and 25th centiles of lagged cumulative exposures were calculated using loglinear, linear, log-quadratic, power and restricted cubic spline general relative risk models. Piecewise constant models were used to examine risk differences by time since exposure, age at exposure and calendar period.ResultsAmong 19 309 male firefighters eligible for the study, there were 1333 cancer deaths and 2609 cancer incidence cases. Significant positive associations between fire-hours and lung cancer mortality and incidence were evident. A similar relation between leukaemia mortality and fire-runs was also found. The lung cancer associations were nearly linear in cumulative exposure, while the association with leukaemia mortality was attenuated at higher exposure levels and greater for recent exposures. Significant negative associations were evident for the exposure surrogates and colorectal and prostate cancers, suggesting a healthy worker survivor effect possibly enhanced by medical screening.ConclusionsLung cancer and leukaemia mortality risks were modestly increasing with firefighter exposures. These findings add to evidence of a causal association between firefighting and cancer. Nevertheless, small effects merit cautious interpretation. We plan to continue to follow the occurrence of disease and injury in this cohort.