Lung cancer mortality of workers occupationally exposed to titanium dioxide in Germany: new insights from a retrospective cohort study after accounting for smoking status

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

International journal of hygiene and environmental health Pub Date : 2026-08-01 Epub Date: 2026-08-20 DOI:10.1016/j.ijheh.2026.114890

Hansa Jannis, Merzenich Hiltrud, Langner Ingo, Blettner Maria, Klug Stefanie J, Gianicolo Emilio

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引用次数: 0

Abstract

Evidence regarding carcinogenic effects of inhaled titanium dioxide (TiO₂) dust is inconclusive. Several cohort studies investigated worker populations in TiO₂ factories, the largest of which included 15,017 individuals in multiple European countries. We have re-analyzed the data of the German sub-cohort from this European study to investigate the association between TiO₂ exposure and lung cancer mortality.

The observation period covered 50 years (1950–1999). Standardized mortality ratios (SMR) were calculated and indirectly adjusted for smoking. Cox regression analysis was used to estimate hazard ratios (HR), stratified by smoking status, adjusted for co-exposures, and lagged by 0/10/20 years. Cumulative exposure was estimated through a job-exposure matrix.

4862 male workers from three TiO₂ factories were included (131,475 person-years). Smoking status was available for 55% of workers. At the end of follow-up, 1015 deaths were recorded, 115 of which due to lung cancer.

The adjusted SMR for lung cancer mortality was 1.67 (n = 4650; 95%CI: 1.41–1.98), with no trend across exposure levels. Adjusted Cox models showed no increased hazard for ever-smokers and workers with unknown smoking status, and a weak association for never-smokers (n = 2880; HR = 1.07; 95%CI: 0.96–1.21), with exposure lagged by 20 years.

This is one of the few occupational cohort studies on TiO₂ inhalation where smoking was accounted for in analyses. Exposure-response associations of similar magnitude for TiO₂ dust and lung cancer mortality have been reported by other studies. However, findings need to be interpreted with caution due to several methodological limitations, highlighting the need for further research with new data.

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肺癌死亡率的工人职业暴露于二氧化钛在德国：新的见解从回顾性队列研究后考虑吸烟状况

关于吸入二氧化钛（TiO2）粉尘的致癌作用的证据尚无定论。几个队列研究调查了二氧化钛工厂的工人群体，其中最大的研究包括多个欧洲国家的15017人。我们重新分析了这项欧洲研究的德国亚队列数据，以调查二氧化钛暴露与肺癌死亡率之间的关系。观察期50年（1950-1999）。计算标准化死亡率（SMR），并对吸烟因素进行间接调整。采用Cox回归分析估计危险比（HR），按吸烟状况分层，调整共暴露，滞后0/10/20年。通过工作暴露矩阵估计累积暴露。共纳入3家TiO2工厂4862名男性工人（131475人-年）。55%的员工有吸烟状况。在随访结束时，记录了1015例死亡，其中115例死于肺癌。肺癌死亡率调整后的SMR为1.67 (n = 4650;95%CI: 1.41-1.98)，不同暴露水平间无趋势。调整后的Cox模型显示，吸烟者和吸烟状况未知的工人的风险没有增加，而不吸烟者的风险较弱（n = 2880;HR = 1.07;95%CI: 0.96-1.21），暴露滞后20年。这是为数不多的将吸烟纳入分析的二氧化钛吸入职业队列研究之一。其他研究报告了二氧化钛粉尘与肺癌死亡率之间类似程度的暴露反应关联。然而，由于一些方法上的限制，研究结果需要谨慎解释，强调需要用新数据进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of hygiene and environmental health 医学-传染病学

CiteScore

11.50

自引率

5.00%

发文量

151

审稿时长

22 days

期刊介绍： The International Journal of Hygiene and Environmental Health serves as a multidisciplinary forum for original reports on exposure assessment and the reactions to and consequences of human exposure to the biological, chemical, and physical environment. Research reports, short communications, reviews, scientific comments, technical notes, and editorials will be peer-reviewed before acceptance for publication. Priority will be given to articles on epidemiological aspects of environmental toxicology, health risk assessments, susceptible (sub) populations, sanitation and clean water, human biomonitoring, environmental medicine, and public health aspects of exposure-related outcomes.