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A Meta-analysis of Asbestos and Lung Cancer: Is Better Quality Exposure Assessment Associated with Steeper Slopes of the Exposure–Response Relationships?

Lenters, Virissa, Vermeulen, Roel, Dogger, Sies, Stayner, Leslie, Portengen, Lützen, Burdorf, Alex, Heederik, Dick·2011·Environmental Health Perspectives
DOI 10.1289/ehp.1002879PMC PMC3226488
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Abstract

Background: Asbestos is a well-recognized cause of lung cancer, but there is considerable between-study heterogeneity in the slope of the exposure–response relationship. Objective: We considered the role of quality of the exposure assessment to potentially explain heterogeneity in exposure–response slope estimates. Data sources: We searched PubMed MEDLINE (1950–2009) for studies with quantitative estimates of cumulative asbestos exposure and lung cancer mortality and identified 19 original epidemiological studies. One was a population-based case–control study, and the others were industry-based cohort studies. Data extraction: Cumulative exposure categories and corresponding risks were abstracted. Exposure–response slopes [KL (lung cancer potency factor of asbestos)] were calculated using linear relative risk regression models. Data synthesis: We assessed the quality of five exposure assessment aspects of each study and conducted random effects univariate and multivariate meta-regressions. Heterogeneity in exposure–response relationships was greater than expected by chance (I2 = 64%). Stratification by exposure assessment characteristics revealed that studies with well-documented exposure assessment, larger contrast in exposure, greater coverage of the exposure history by exposure measurement data, and more complete job histories had higher meta-KL values than did studies without these characteristics. The latter two covariates were most strongly associated with the KL value. Meta-KL values increased when we incrementally restricted analyses to higher-quality studies. Conclusions: This meta-analysis indicates that studies with higher-quality asbestos exposure assessment yield higher meta-estimates of the lung cancer risk per unit of exposure. Potency differences for predominantly chrysotile versus amphibole asbestos-exposed cohorts become difficult to ascertain when meta-analyses are restricted to studies with fewer exposure assessment limitations.

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Figure 1 Forest plot with KL × 100 values (closed diamonds) and 95% CIs (lines) of included studies (for study numbers and details, see Table 1). The size of each square is proportional to the weight the study received in the meta-analysis. The open diamond denotes the meta-KL. Intercepts (α), KL values, and 95% CIs are listed. For scaling purposes, study 19 (Gustavsson et al. 2002) is not displayed in the plot.
Figure 1 Forest plot with KL × 100 values (closed diamonds) and 95% CIs (lines) of included studies (for study numbers and details, see Table 1). The size of each square is proportional to the weight the study received in the meta-analysis. The open diamond denotes the meta-KL. Intercepts (α), KL values, and 95% CIs are listed. For scaling purposes, study 19 (Gustavsson et al. 2002) is not displayed in the plot.CC0 · PubMed Central

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Metadata

Authors
Lenters, V., Vermeulen, R., Dogger, S., Stayner, L., Portengen, L., Burdorf, A., & Heederik, D.
Affiliations
  • Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
  • Health Council of the Netherlands, the Hague, the Netherlands
  • Department of Epidemiology and Biostatistics, University of Chicago, Chicago, Illinois, USA
  • Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands
Venue
Environmental Health Perspectives
Publisher
American Chemical Society (ACS)
Published
2011-06-27
Volume
119
Issue
11
Pages
1547-1555
ISSN
  • 0091-6765
  • 1552-9924
DOI
10.1289/ehp.1002879
PMC
PMC3226488
Cited by
79
References
2
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor, 2377 d)

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CoChat. (2026). Citation check: A Meta-analysis of Asbestos and Lung Cancer: Is Better Quality Exposure Assessment Associated with Steeper Slopes of the Exposure–Response Relationships? https://app.cochat.ai/papers/10.1289/ehp.1002879
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Lenters, V., Vermeulen, R., Dogger, S., Stayner, L., Portengen, L., Burdorf, A., & Heederik, D. (2011). A Meta-analysis of Asbestos and Lung Cancer: Is Better Quality Exposure Assessment Associated with Steeper Slopes of the Exposure–Response Relationships? Environmental Health Perspectives. https://doi.org/10.1289/ehp.1002879