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Meta-Analysis
. 2019 May;62(5):367-384.
doi: 10.1002/ajim.22959. Epub 2019 Feb 18.

Non-malignant respiratory disease among workers in the rubber manufacturing industry: A systematic review and meta-analysis

Nirmala Thapa  1 , Suzanne E Tomasi  1   2 , Jean M Cox-Ganser  1 , Randall J Nett  1
Affiliations
Meta-Analysis

Non-malignant respiratory disease among workers in the rubber manufacturing industry: A systematic review and meta-analysis

Nirmala Thapa et al. Am J Ind Med. 2019 May.

Abstract

Background: Non-malignant respiratory disease (NMRD) cases have occurred among rubber manufacturing workers. We examined exposure to rubber manufacturing emissions as a risk factor for NMRD.

Methods: From a systematic literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (strong, intermediate, non-significant positive association, none) between exposure to rubber manufacturing emissions and NMRD-related morbidity and mortality, and conducted two meta-analyses.

Results: We analyzed 62 articles. We identified 11 cases of NMRD. Nine (30%) of 30 cross-sectional studies and one (4%) of 26 mortality studies had strong evidence. The summary odds ratio and SMR for the cross-sectional and mortality meta-analyses were 3.83 (95% confidence interval [CI], 2.28-6.51) and 0.90 (95%CI, 0.82-0.99), respectively.

Conclusion: Available evidence supports rubber manufacturing emissions as a potential risk factor for NMRD-related morbidity. Further investigations with longer follow-up periods and inclusion of short-tenured workers could further define risks for NMRD and identify prevention strategies.

Keywords: chronic bronchitis; chronic obstructive pulmonary diseases; emphysema; eosinophilia; non-malignant respiratory disease; occupational asthma; occupational lung disease; rubber.

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Conflict of interest statement

DISCLOSURE BY AJIM EDITOR OF RECORD

John D. Meyer declares that he has no conflict of interest in the review and publication decision regarding this article.

Figures

FIGURE 1
FIGURE 1
Flow diagram illustrating process for inclusion of studies analyzing the association between occupational exposure to rubber manufacturing emissions and non-malignant respiratory disease. NMRD, non-malignant respiratory disease; SMR, standardized mortality ratio
FIGURE 2
FIGURE 2
Forest plot of cross-sectional studiesc for the association between occupational exposure to rubber manufacturing emissions and development of respiratory symptoms or non-malignant respiratory disease. aCaluculated odds ratios and CI from values reported in manuscripts. bStudy included multiple odds ratio values so selected highest odds ratio value for a lower respiratory symptom. cCross-sectional studies included in the meta-analysis were studies that reported odds ratios with CI for respiratory symptoms or NMRDs, or reported data to calculate odds ratios and CI. CI, Confidence Interval; NMRD, non-malignant respiratory disease
FIGURE 3
FIGURE 3
Forest plot of mortality studiesa for the association between occupational exposure to rubber manufacturing emissions and NMRD-related mortality. aMortality studies that reported summary standardized mortality ratios for male employees who died of NMRDs (ICD code: 427–527). CI, Confidence Interval; NMRD, non-malignant respiratory disease
See this image and copyright information in PMC

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