International journal of hygiene and environmental health最新文献

{"title":"Metal biomarkers and bone mineral density in women undergoing DXA: Associations with cadmium and selenium balance in a hospital-based study","authors":"Iman Al-Saleh,&nbsp;Reem Al-Rouqi,&nbsp;Ruba Alsaeed,&nbsp;Yara Aljerayed,&nbsp;Hissah Alnuwaysir,&nbsp;Ahmed Sherif Mahmoud,&nbsp;Abdullah Alkhenizan,&nbsp;Ghada Hussein,&nbsp;Ahmad Almuhaideb","doi":"10.1016/j.ijheh.2026.114904","DOIUrl":"10.1016/j.ijheh.2026.114904","url":null,"abstract":"<div><h3>Background</h3><div>Toxic metals may affect bone health, but biomonitoring evidence from Middle Eastern populations is limited. We examined associations between cadmium (Cd), lead, mercury, arsenic, and selenium (Se) and bone mineral density (BMD) among women undergoing dual-energy X-ray absorptiometry (DXA) in a tertiary-care setting.</div></div><div><h3>Methods</h3><div>This hospital-based cross-sectional study included 646 women aged ≥40 years referred for DXA at King Faisal Specialist Hospital and Research Centre (2021–2024). Metals were measured in urine and hair using inductively coupled plasma–mass spectrometry (ICP-MS). Primary analyses used multivariable linear regression to evaluate lumbar spine and femoral neck T-scores as continuous outcomes. Secondary analyses evaluated low BMD as a binary outcome using multivariable logistic regression. Models were adjusted for relevant demographic and exposure-related covariates.</div></div><div><h3>Results</h3><div>In the primary continuous-outcome analyses, urinary Cd was inversely associated with femoral neck T-score in individual models (β = −0.148; <em>P</em> = 0.010) and multi-metal models (β = −0.177; <em>P</em> = 0.006). Urinary Se was positively associated with femoral neck T-score (β = 0.223; <em>P</em> = 0.047). In exploratory analyses, the selenium–cadmium balance (lnSe − lnCd) was positively associated with lumbar spine (β = 0.165; <em>P</em> = 0.030) and femoral neck T-scores (β = 0.184; <em>P</em> = 0.003). Secondary analyses using low BMD as a binary outcome showed no significant associations with individual metals or metal burden indices.</div></div><div><h3>Conclusions</h3><div>In this hospital-based DXA-referral cohort, urinary Cd was inversely associated and urinary Se positively associated with femoral neck T-score, while a higher Se-to-Cd balance was positively associated with T-scores at both skeletal sites. Direct Cd × Se interaction analyses did not provide consistent evidence of effect modification, and the Se-to-Cd balance findings should therefore be considered exploratory and hypothesis-generating. Binary low-BMD analyses were null. These findings support further investigation of Cd and Se in relation to site-specific BMD in more representative populations.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"278 ","pages":"Article 114904"},"PeriodicalIF":4.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model building a national human biomonitoring programme from the ground up: A framework informed by a comprehensive review of global state-of-the-art practices","authors":"Richa Singh,&nbsp;Holger Martin Koch,&nbsp;Marike Kolossa-Gehring,&nbsp;André Conrad,&nbsp;Alison Connolly","doi":"10.1016/j.ijheh.2026.114909","DOIUrl":"10.1016/j.ijheh.2026.114909","url":null,"abstract":"<div><div>Global chemical production is projected to increase sharply by 2050, intensifying concerns about population exposure and related health and environmental risks. Human biomonitoring (HBM) provides a direct measure of aggregate internal exposure to chemicals and can act as an early warning tool for emerging health risks. There are growing international efforts to strengthen chemicals management and integrated risk assessment, including the EU's One Substance, One Assessment (OSOA) framework. Systematic HBM data are increasingly recognised as essential for translating exposure information into actionable evidence for chemical risk assessment and policy development. Several countries have established national HBM programmes, demonstrating their value for public health, regulatory decision-making, transparency for citizens and chemical safety. Yet many countries still lack such programmes despite having capable laboratories or prior scientific HBM experience. Establishing a sustainable national HBM programme requires coordinated governance, stakeholder engagement, infrastructure, technical expertise, mechanisms for linking science to policy and communication strategies. This study addresses this gap by proposing a holistic and adaptable framework, informed by best practices identified across 14 countries. The framework outlines the key elements required for the establishment and operation of national HBM programmes, including governance structures that facilitate collaboration among relevant stakeholders through either cross-ministerial steering committees or centralised coordinating bodies. It further emphasises systematic chemical prioritisation, standardised operating procedures, quality assurance and quality control (QA/QC), harmonised sample collection and processing, transparent science-to-policy translation mechanisms, integration with existing health surveys, shared infrastructure, international collaboration, and strategic biobanking as essential components for ensuring comparability, cost-efficiency, and long-term sustainability.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"278 ","pages":"Article 114909"},"PeriodicalIF":4.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of phthalate exposure during early pregnancy with fetal growth and the effect modification by gestational stress [Letter]","authors":"Haeranah Ahmad,&nbsp;Fahrul Islam,&nbsp;Nurbaya Nurbaya,&nbsp;Nurfatimah Nurfatimah,&nbsp;Kadar Ramadhan","doi":"10.1016/j.ijheh.2026.114878","DOIUrl":"10.1016/j.ijheh.2026.114878","url":null,"abstract":"","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114878"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary biomarkers of PAHs, VOCs, OPEs, and metal(loid)s in firefighters responding in the wildland urban interface (WUI)","authors":"Miriam M. Calkins,&nbsp;Alexander C. Mayer,&nbsp;Derek J. Urwin,&nbsp;Steve Bertke,&nbsp;Christine Toennis,&nbsp;Shawn C. Beitel,&nbsp;Jeff Hughes,&nbsp;Jamie Gabriel,&nbsp;Antonia M. Calafat,&nbsp;Christopher M. Reese,&nbsp;Julianne Cook Botelho,&nbsp;Maria Ospina,&nbsp;Cynthia D. Ward-Momon,&nbsp;Jeffery M. Jarrett,&nbsp;Alberto J. Caban-Martinez,&nbsp;Judith M. Graber,&nbsp;Deborah Sammons,&nbsp;Kathleen M. DuBose,&nbsp;Jefferey L. Burgess","doi":"10.1016/j.ijheh.2026.114877","DOIUrl":"10.1016/j.ijheh.2026.114877","url":null,"abstract":"<div><div>Firefighters suppressing wildland urban interface (WUI) fires may be exposed to smoke from burning vegetation as well as structures and vehicles. To better understand firefighters’ internal dose exposures in the WUI environment, 250 firefighters from Southern California were enrolled into the Fire Fighter Cancer Cohort Study (FFCCS) in 2019, providing urine samples at enrollment and post-fire. One-hundred and twenty-five post-fire samples were collected from 89 participants. Samples were analyzed for metal(loid)s and metabolites of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and organophosphate esters (OPEs). We assessed the difference between creatinine-corrected urine concentrations for each chemical at enrollment compared with post-fire, controlling for the individual participant. We also compared these concentrations to the general U.S. population concentrations from the National Health and Nutrition Examination Survey (NHANES) and the American Conference of Governmental Industrial Hygienists Biological Exposure Indices (BEIs) when available. All seven PAH and 11 VOC metabolite concentrations increased significantly from enrollment to post-fire. Diphenyl phosphate, antimony, and cadmium also significantly increased from enrollment to post-fire. Maximum post-fire concentrations in firefighters also exceeded the BEI for 1-hydroxyprene and trans,trans-muconic acid (a metabolite of benzene). Firefighters assigned to structure defense had significantly higher increases in PAH metabolites compared to those assigned to wildland firefighting tasks. Personal protective equipment (PPE) usage was not evaluated in this study, but future studies could combine personal sampling with the collection of detailed PPE usage to develop effective practices and decontamination strategies during WUI fire responses.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114877"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of a risk-based air quality index for Germany","authors":"Katherine Ogurtsova,&nbsp;Myriam Tobollik,&nbsp;Tomke Zschachlitz,&nbsp;Wolfgang Straff,&nbsp;Florian Pfäfflin,&nbsp;Antonia Fritz,&nbsp;Volker Diegmann,&nbsp;Barbara Hoffmann","doi":"10.1016/j.ijheh.2026.114867","DOIUrl":"10.1016/j.ijheh.2026.114867","url":null,"abstract":"<div><h3>Objectives</h3><div>We developed and evaluated a risk-based Air Quality Index (AQI) for Germany that harmonizes pollutant categories on risk equivalence, incorporates hourly concentrations, and improves health-relevant communication.</div></div><div><h3>Methods</h3><div>We identified pollutant-outcome pairs with causal or likely causal evidence, extracted effect estimates from systematic reviews and meta-analyses, and transformed daily mean effects into hourly effect estimates using German monitoring data. Equivalence coefficients were derived via Monte Carlo simulations and standardized to PM_2.5 as the reference pollutant. PM_2.5 thresholds were anchored in WHO Air Quality Guideline 2021 and the EU information threshold; risk-equivalent thresholds for PM₁₀, NO₂, O₃, and SO₂ were generated accordingly. An additional module was developed to account for concurrent elevation of multiple pollutants. The index was empirically evaluated using hourly data from German monitoring stations for 2019 and 2022, and the results were compared with the previous AQI. In sensitivity analyses, we assessed the effects of incorporating updated evidence and excluding asthma-related outcomes.</div></div><div><h3>Results</h3><div>Application of the risk-based AQI resulted in a marked shift from “very good” to “good” and “moderate” categories in comparison with the previous AQI, particularly for PM_2.5 and O₃, reflecting stricter concentration thresholds. “Poor” classifications increased modestly, while “very poor” remained rare. The multipollutant episodes module affected less than 1% of hours.</div></div><div><h3>Conclusion</h3><div>Overall, the risk-based AQI represents a significant step toward health-based communication of air quality in Germany. By integrating scientific evidence into its design and providing tailored guidance, it enhances preventive public health protection. Its implementation may improve risk awareness and support behavioural changes that reduce exposure.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114867"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary metal concentrations in Korean preschool children: Elevated levels and associations with allergic rhinitis in the 5th Korean National Environmental Health Survey","authors":"Yunseo Heo,&nbsp;Seungho Lee,&nbsp;Ok-Jin Kim,&nbsp;Jihyon Kil,&nbsp;Kyungho Choi","doi":"10.1016/j.ijheh.2026.114882","DOIUrl":"10.1016/j.ijheh.2026.114882","url":null,"abstract":"<div><div>Heavy metals can adversely affect neurodevelopment, immune function, and overall health during early childhood. However, few studies have evaluated heavy metal exposure in children. Therefore, we assessed urinary metal concentrations in Korean children and their association with allergic rhinitis. The study included 648 preschool children aged 3–5 years who participated in the Korean National Environmental Health Survey (KoNEHS, 2021–2023) Cycle 5. Urinary Hg was measured using a mercury analyzer, whereas V, Mn, Ni, Mo, Cd, Sb, Pb, and Cr were analyzed using inductively coupled plasma mass spectrometry. The geometric mean concentrations of Ni (3.33 μg/L), Mo (113 μg/L), and Sb (0.088 μg/L) were more than 1.5-fold higher than those reported in international biomonitoring surveys. Ni was positively correlated with Mo (<em>r</em> = 0.531) and Cd (<em>r</em> = 0.573). Urinary Ni concentrations differed significantly based on allergic rhinitis status (<em>p</em> = 0.006), whereas Mo showed a marginally significant association(<em>p</em> = 0.054). Logistic regression analysis showed that a 1-unit increase in log-transformed urinary Ni concentration was associated with a 37% increase in the odds of allergic rhinitis (OR = 1.37, 95% CI = 1.09–1.73). In the multivariable model including Ni, Cd, and Mo, the odds of allergic rhinitis increased by 34% (OR = 1.34, 95% CI: 1.02–1.76). After adjusting for sex, age, and ponderal index, the association remained statistically significant, with 35% increased odds ratio (OR = 1.35, 95% CI: 1.02–1.77). The association between urinary Ni concentration and allergic rhinitis was consistent across models. These findings support continued monitoring of heavy metal exposure and associated health effects in Korean children.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114882"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial assessing infectious disease risk from bathing in inland recreational waters","authors":"Edward K.S. Lam,&nbsp;Márta Vargha,&nbsp;Daniel Thomas,&nbsp;Roland Salmon,&nbsp;Mihály Kádár,&nbsp;Maria José Figueras Salvat,&nbsp;Julii Brainard,&nbsp;Jamie Bartram,&nbsp;Zsofia Barna,&nbsp;Paul R. Hunter","doi":"10.1016/j.ijheh.2026.114888","DOIUrl":"10.1016/j.ijheh.2026.114888","url":null,"abstract":"<div><div>Evidence to determine the suitability of water quality standards to prevent illness from recreation exposure in inland waters is limited. We present a secondary analysis of previously unpublished data from four Hungarian freshwater sites included in the Epibathe study, a large randomised controlled trial. A total of 2368 participants were randomly allocated either to bathe for 10 min undertaking at least three head immersions, or to remain on the shoreside without water contact. Concurrent water sampling quantified individual-level faecal indicator organism densities and health outcomes were assessed at one-week follow-up.</div><div>Generalised estimating equation models quantified the relative risk for adverse health outcomes for bathers versus shoreline-only (non-bather) participants, as well as the change in risk per unit increase in FIO concentration; crude, covariate-adjusted and covariate-adjusted models with multiple imputation are reported. Higher concentrations of <em>Escherichia coli</em> and somatic coliphage were each associated with increased risk of gastrointestinal illness (adj. RR = 1.73; 95% CI 1.13–2.65 and RR = 1.46; 95% CI 1.04–2.04 respectively). Bathing itself, independent of any individual microbial indicator, was associated with increased risk for skin ailments (adj. RR = 2.17; 95% CI 1.55-3.03). Low prevalence of eye, ear or respiratory infections precluded reliable estimation of exposure-response relationships.</div><div>These findings confirm the value of <em>E. coli</em> and potential of somatic coliphage densities as indicators of freshwater quality relevant to recreation-associated gastrointestinal illness risk. In freshwater settings, <em>E. coli</em> and coliphages appear to be more informative than enterococci as predictors of gastrointestinal illness, contrasting with evidence from marine waters.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114888"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148777924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal change in PCDD/F and PCB levels in the serum of the general population following the start-up of an energy recovery plant in northern Spain","authors":"Loreto Santa Marina,&nbsp;Ziortza Barroeta,&nbsp;Amaia Irizar,&nbsp;Nerea Urbieta,&nbsp;Nuria Errasti,&nbsp;Maria Generosa Martrat,&nbsp;Jordi Parera,&nbsp;Jesús Ibarluzea,&nbsp;Alba Jimeno-Romero,&nbsp;Miren Begoña Zubero,&nbsp;Aitana Lertxundi","doi":"10.1016/j.ijheh.2026.114879","DOIUrl":"10.1016/j.ijheh.2026.114879","url":null,"abstract":"<div><div>The study assessed temporal trends and spatial variation in serum concentrations of PCDD/Fs and dl-PCBs in the general population before and after the commissioning of an energy recovery plant (ERP) in northern Spain (2017–2023). A longitudinal observational design included 154 adults living either near the ERP or in a control area. Serum concentrations of PCDD/Fs and dl-PCBs were measured in the same participants and compared within them at two time points (before and after the ERP began operations). Linear mixed models were applied to evaluate the effects of study period and area of residence, adjusting for sociodemographic, anthropometric, lifestyle, and dietary variables. Among them, 54.5% resided in the vicinity of the ERP, 53.2% reported not consuming alcohol, 11% were non-smokers, and 40% reported consuming locally produced food. The mean serum concentration of PCDD/Fs + dl-PCB in TEQ-WHO2005, over the entire study period was 10.04 pg TEQ/g lipids. Slightly higher concentrations were observed in the post-startup phase (11.47 pg/g lipids), compared with the pre-startup period (10.56 pg/g lipids), although this difference was not statistically significant. Mixed models indicated higher PCDD/Fs + dl-PCB concentrations among residents of the exposed area in both periods. Men exhibited higher dl-PCB concentrations than women. Consumption of locally produced food was associated with higher PCDD/F concentrations. Although spatial differences suggest greater exposure near the ERP, no evidence indicates that its commissioning increased serum PCDD/F or dl-PCB levels. The levels observed are comparable to those recorded in other developed countries.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114879"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing paraben exposure and source contributions in Korea: A personalized exposure factor-based approach (PerFactExpo)","authors":"Areum Jo,&nbsp;Sunmi Kim,&nbsp;Kiyoung Lee,&nbsp;Gowoon Lee,&nbsp;Kyungho Choi","doi":"10.1016/j.ijheh.2026.114876","DOIUrl":"10.1016/j.ijheh.2026.114876","url":null,"abstract":"<div><div>Parabens are widely used preservatives with diverse exposure pathways across diet and personal care products (PCPs). Although a comprehensive exposure assessment is essential for effective exposure management, it remains highly challenging. Conventional exposure assessment methods that rely on representative contamination levels and standard exposure factors often produce overly conservative high-end estimates, particularly for reasonable maximum exposure (RME). To address these limitations, we developed the Personalized Exposure Factor-Based Exposure Assessment (PerFactExpo) model, which integrates individual-level dietary and product-use data from national databases to estimate aggregate paraben exposure in the Korean population. To evaluate the model's performance, deterministic central tendency exposure (CTE) and RME estimates were compared directly with the corresponding individual-based PerFactExpo estimates. While CTE estimates from the PerFactExpo model were comparable to those from the deterministic approach, its RME estimates were up to 7.6-fold lower, demonstrating a substantial reduction in the inflation of upper-bound exposure estimates.</div><div>The plausibility of the exposure sources identified by the model was supported by their general consistency with national biomonitoring data. PCPs predominantly drove methyl-, propyl-, and butylparaben exposure, particularly in females, whereas ethylparaben exposure was primarily associated with traditional fermented soy-based condiments. These findings suggest that imported mustard products may contribute to PrP exposure; however, product-origin-specific concentration data are warranted to confirm this interpretation. These findings demonstrate the utility of this personalized, aggregate multi-source exposure assessment framework for identifying major exposure contributors and offering insights for developing targeted exposure reduction strategies for such widely used consumer chemicals.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114876"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung cancer mortality of workers occupationally exposed to titanium dioxide in Germany: new insights from a retrospective cohort study after accounting for smoking status","authors":"Hansa Jannis,&nbsp;Merzenich Hiltrud,&nbsp;Langner Ingo,&nbsp;Blettner Maria,&nbsp;Klug Stefanie J,&nbsp;Gianicolo Emilio","doi":"10.1016/j.ijheh.2026.114890","DOIUrl":"10.1016/j.ijheh.2026.114890","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div><div>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.</div><div>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.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"277 ","pages":"Article 114890"},"PeriodicalIF":4.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148777923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}