Occupational Medicine. 2007 Dec;57(8):581-9. Epub 2007 Oct 27. [Link]
Kelsh MA, Craven VA, Teta MJ, Mowat FS, Goodman M.
Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025, USA.
Background: The question of whether vehicle mechanics have an increased risk of mesothelioma has important public health implications. Calculations of relative risk using case reports from the Australian Mesothelioma Registry (AMR) indicate increased risks; however, this contrasts with the results of 19 epidemiologic studies that have found no association.
Aim: To evaluate potential explanations for the discrepancy of findings from epidemiologic studies and AMR reports.
Methods: We evaluated three hypotheses as possible explanations for the inconsistency between the AMR-based calculations and the findings from published epidemiologic studies: (i) differences in exposure characteristics of Australian vehicle mechanics versus vehicle mechanics in North America and Europe, (ii) limitations of the AMR data and (iii) errors in the risk calculations based on AMR data. We reviewed available exposure information specific to Australian vehicle mechanics and AMR data, obtained from the Australian National Occupational Health and Safety Commission, for this evaluation.
Results: We did not identify differences in workplace exposures, processes or fibre type among Australian vehicle mechanics compared to vehicle mechanics in other countries. Our analysis of primary AMR data identified several errors in exposure classification and in the assumptions used to calculate relative risk.
Conclusions: Discrepancies between epidemiologic studies and AMR-based calculations cannot be explained by differences in exposure. These discrepancies are most likely attributable to inadequate occupational information and classification in the AMR from 1986 forward and to erroneous assumptions used to derive relative risk estimates for mesothelioma among Australian vehicle mechanics.
Keywords: Asbestos; brakes; epidemiology; mesothelioma registry; motor mechanics; motor vehicle mechanics