A critical review of the relationship between occupational exposure to diesel emissions and lung cancer risk

Figures & data

Table 1. Description of the study base for cohort- or nested case-control studies included in the review and their most recent results (sorted according to order in the review).

Reference	Population	Follow-up period	Exposure assessment	Special adjustment factors	Highest exposure category used for comparison	Risk estimate (95% CI)	Considered in IARC’s 2012 decision
Studies on non-metal miners
Silverman et al. (2012)	12,315 male employees in 8 US non-metal mines, after dieselization (1947–1967)	1947–1997	REC measurements 1998–2001; Modelling of historical REC exposure	Work location cross-classified by smoking status and smoking intensity, History of respiratory disease, Former high-risk job	Cumulative REC, lagged 15 years, ≥536 μg/m^3-years	OR = 2.83 (1.28–6.26) [nested case-control analysis]	Yes
Möhner et al. (2013)	5819 male employees in Potash mining, Germany, employed in 1970 or later	1970–2001	Measurements of TC in 1991; assumption of stable exposure over time	Smoking, Former jobs	Cumulative EC, lagged 5 years, ≥1550 μg/m^3-years	OR = 1.04 (0.47–2.27) [nested case-control analysis]	No
Studies on railroad workers
Howe et al. (1983)	43,826 retired railroad workers, Canada, <1965–1977	1965–1977	Job group at time of retirement	–	“Probably exposed” to DE	IRR = 1.35 (not reported)	Yes
Nokso-Koivisto and Pukkala (1994)	8391 members of Finish Locomotive Drivers’ Association, 1953–1991	1953–1991	Job group	–	≥30 years since first employment as a locomotive driver	SIR = 0.89 (0.77–1.02)	Yes
Garshick et al. (2006)	39,388 occupationally active US railroad workers in 1959, with 10–20 years of service, age 40–64 years	1959–1996	Job group	Years worked, Years off-work, Smoking, Work in a repair shop	≥20 years worked as engineer or conductor	HR = 1.22 (1.02–1.47) [Analysis was restricted to deceased workers]	Yes
Studies on professional drivers and related jobs
Steenland et al. (1998)	US Teamsters Union members with at least 20 years of union membership that had died between 1982–1983	Deaths between 1982–1983	EC measurements in trucking industry jobs in 1990; Modelling of historical EC exposure	Smoking, Asbestos	Cumulative EC, lagged 5 years, ≥331 μg/m^3-years	OR = 1.64 (1.09–2.49) [nested case-control study based on 994 deaths from lung cancer and 1085 “other deaths”]	Yes
Garshick et al. (2012)	31,135 male workers employed in US unionized trucking industry in 1985, age ≥40	1985–2000	REC measurements 2001–2006; Modelling of historical REC exposure	Total years of employment	Cumulative REC, lagged 5 years, ≥1803 μg/m^3-months	HR = 1.36 (0.98–1.89)	Yes
Gustavsson et al. (1990)	695 bus garage workers in Stockholm, 1945–1970	1952–1986	Each work period was described in terms of DE exposure intensity (six categories)	–	Highest cumulative DE exposure (DE index >30)	OR = 2.43 (1.32–4.47) [nested case-control analysis]	Yes
Balarajan and McDowall (1988)	3392 professional drivers from London, 1939	1950–1984	Job group	–	Professional driver	SMR = 1.47 (1.32–1.64)	Yes
Guberan et al. (1992)	6630 men from Geneva with a professional driver’s licence, 1949–1961	1949–1986	Job group noted on professional driver’s licence	–	≥45 years since start of work as “professional driver”	SMR = 2.59 (1.60–3.96)	Yes
Rafnsson and Gunnarsdottir (1991)	868 truck drivers in 1939 or later and 726 taxi drivers in 1943 or later from Reykjavik	1951–1988	Job group	–	Truck driver	SMR = 2.14 (1.37–3.18)	Yes
Guo et al. (2004)	Economically active Fins participating in the National Population Census 1970, including 667,121 men	1971–1995	Application of NO2-based FINJEM job exposure matrix to longest occupation	Smoking, Asbestos, Quartz dust, SES	Cumulative NO2, lagged 20 years, ≥10 mg/m^3-years (male subgroup)	IRR = 0.95 (0.83–1.10)	Yes
Soll-Johanning et al. (2003)	18,174 bus drivers and tramway employees, Copenhagen, 1900-1994	1943–1992	Job group	Smoking, Exposure to diesel exhaust in ?other jobs?	≥20 years employed as driver in public transport, lagged 10 years	OR = 0.54 (0.28–1.03)	Yes
Petersen et al. (2010)	2037 male urban bus drivers, Denmark, 1978	1979–2003	Job group	Smoking	≥25 years worked as public bus driver, lagged 10 years	HR = 0.8 (0.5–1.4)	Yes
Hansen (1993)	14,225 truck drivers and 43,024 other unskilled male laborers in the Danish Census 1970	1970–1980	Job group	–	Truck driver in comparison to other unskilled laborers	SMR = 1.60 (1.26–2.00)	Yes
Study on dock workers
Emmelin et al. (1993)	Male dock workers in Swedish ports, 1950–1974	1960–1982	Annual diesel fuel consumption (liter) in each port	–	High cumulative exposure to DE (“Exposed time”)	OR = 2.9 (90% CI: 0.8–10.7) [nested case-control analysis]	Yes
Studies in the construction industry
Järvholm & Silverman (2003)	140,712 male employees (including 6364 truck drivers) from the Swedish construction industry, 1971–1993	1971–1995	Job group	Smoking	Truck drivers in comparison to carpenters and electricians	SMR = 1.37 (1.04–1.78)	Yes
Wong et al. (1985)	34,156 male members of US heavy construction equipment operators union, 1964–1978	1964–1978	Job group	–	≥20 years membership in heavy construction equipment operators union	SMR = 1.07 (0.91–1.25)	Yes

EC: Elemental carbon; HR: Hazard ratio; IRR: Incidence rate ratio; OR: Odds ratio; REC: Respirable elemental carbon; SIR: Standardized incidence ratio; SMR: Standardized mortality ratio; TC: Total carbon

Table 2. Model comparison for the DEMS with respect to work location and smoking parameters based on unconditional logistic regression models.*

Model	Variables and interactions	d.f.	AIC	BIC
M0	–	1	932.1262	935.4144
M1	Work location	2	934.0882	940.6648
M2	Work location + smoking status	5	883.7319	900.1732
M3	Work location + smoking intensity	6	890.4929	910.2225
M4	Work location + smoking status + smoking intensity	7	881.3167	904.3345
M5	Work location + (smoking status × smoking intensity)	9	885.1182	914.7126
M6	Work location × smoking status × smoking intensity	16	884.8769	937.4892

* Number of cases and controls are taken from Table 2 in Silverman et al. (2012).

AIC: Akaike’s information criterion; BIC: Bayesian information criterion; d.f.: Degrees of freedom; +: Only main effects of the variables are included into the model; × : Main effect and interaction terms are included into the model.

Values for the best fitting model are given in bold.

Table 3. Comparison of odds ratios from different models for lung cancer risk in DEMS by work location and smoking status/intensity.

Smoking status/intensity	Surface-only worker				Ever-underground worker
	OR (M2)^b	OR (M4)^b	OR (M6)^b	OR (Silverman)^a	OR (M2)^b	OR (M4)^b	OR (M6)^b	OR (Silverman)^a
Never smoker	1.00	1.00	1.00	1.00	0.94	0.92	1.72	0.90
Former (0, 1)	3.47	2.79	1.12	1.36	3.25	2.57	4.77	2.51
Former [1, 2)	3.47	3.40	6.09	6.66	3.25	3.14	4.09	1.97
Former [2, ∞)	3.47	5.46	14.91	16.30	3.25	5.04	5.40	2.70
Current (0, 1)	6.91	5.26	4.64	5.22	6.48	4.85	9.94	5.71
Current [1, 2)	6.91	6.42	11.03	13.34	6.48	5.92	7.14	4.51
Current [2, ∞)	6.91	10.30	23.20	26.60	6.48	9.49	10.96	7.13
Unknown	3.63	3.63	3.62	2.86	3.40	3.35	5.80	2.65

^a Odds ratios from Table 2 in Silverman et al. (2012).

^b Models as described in Table 2.

Table 4. Model comparison for the DEMS with respect to tertiles of cumulative REC exposure and smoking intensity based on unconditional logistic regression models.^a

Model	Variables and interactions	d.f.	AIC	BIC
M0	–	1	932.1262	935.4144
M7	Tertiles of cumulative REC	3	932.9279	942.7927
M8	Tertiles of cumulative REC + smoking intensity	7	890.2927	913.3106
M9	Tertiles of cumulative REC × smoking intensity	15	892.5585	941.8825

^a Number of cases and controls are taken from Table 6 in Silverman et al. (2012).

AIC: Akaike’s information criterion; BIC: Bayesian information criterion; d.f.: Degrees of freedom.

Values for the best fitting model are given in bold.

Table 5. Comparison of odds ratios from different models for lung cancer risk in DEMS by work location and smoking intensity.

Smoking packs/day	Tertile 1, 0 to <8 μg/m³-years			Tertile 2, 8 to <304 μg/m³-years			Tertile 3, ≥ 304 μg/m³-years
	OR (M8)^b	OR (M9)^b	OR (Silverman)^a	OR (M8)^b	OR (M9)^b	OR (Silverman)^a	OR (M8)^b	OR (M9)^b	OR (Silverman)^a
[0]	1.00	1.00	1.00	0.93	1.06	1.47	1.27	3.06	7.30
(0, 1)	3.40	4.80	6.25	3.15	4.01	7.42	4.30	7.56	16.35
[1, 2)	4.92	7.31	10.16	4.55	7.32	11.58	6.22	8.43	20.42
[2, ∞)	7.65	16.98	26.79	7.09	13.41	22.17	9.68	7.02	17.38
Unknown	3.60	3.15	4.13	3.33	3.42	3.79	4.55	14.75	27.85

^a Odds ratio from Table 6 in Silverman et al. (2012).

^b Models as described in Table 4.

Table 6. Lung cancer risk estimates for various categorizations of cumulative REC exposure in the DEMS.^c

Exposure/reference group	Unadjusted for smoking		Adjusted for smoking
	OR	95% CI	OR	95% CI
Reference: surface-only
Ever-underground	1.03	0.74–1.43	0.94^a	0.67–1.32
Reference: Cumulative REC, lagged 15 years, tertile 1 (0–8 μg/m³-years)
Tertile 2 (8–304 μg/m³-years)	0.89	0.60–1.31	0.93^b	0.62–1.38
Tertile 3 (≥304 μg/m³-years)	1.26	0.85–1.86	1.27^b	0.85–1.89
Reference: Cumulative REC, unlagged, quartile 1 (0–19 μg/m³-years)
Quartile 2 (19–246 μg/m³-years)	0.72	0.46–1.12
Quartile 3 (246–964 μg/m³-years)	1.03	0.65–1.62
Quartile 4 (≥964 μg/m³-years)	1.00	0.64–1.57
Reference: Cumulative REC, lagged 15 years, quartile 1 (0–3 μg/m³-years)
Quartile 2 (3–72 μg/m³-years)	0.71	0.45–1.10
Quartile 3 (72–536 μg/m³-years)	1.01	0.64–1.58
Quartile 4 (≥536 μg/m³-years)	1.31	0.83–2.07

^a Adjusted for smoking status and smoking intensity.

^b Adjusted for smoking intensity.

^c Derived by unconditional logistic regression, number of cases and controls are taken from Tables 2, 3, and 6 in Silverman et al. (2012).

Table 7. Impact of birth cohorts on mortality rate ratios in the Cohort study among US railroad workers.^a

Job group	Birth cohort					Estimates from Poisson model
	1915–1919	1910–1914	1905–1909	1900–1904	1895–1899	MRR adjusted for age	MRR increase with calendar time (δ)
Engineer	1.45	1.23	1.38	1.20	0.68	1.19 (1.07–1.31)	1.11 (1.03–1.19)
Conductor	1.35	1.27	1.24	1.35	1.21	1.28 (1.17–1.41)	1.02 (0.95–1.08)
Shop worker	1.12	1.02	0.95	1.34	0.93	1.07 (0.97–1.18)	1.00 (0.93–1.07)
Engineer & Conductor	1.38	1.26	1.30	1.28	0.96	1.24 (1.14–1.35)	1.06 (0.99–1.12)

δ: Loglinear term describing risk increase with increasing year of birth, centered at the median birth cohort (calculated per 5 years).

^a Poisson regression models based on number of cases and person years from Table 2 in Garshick et al. (2004). DE-exposed job groups were compared to unexposed job groups.

Table 8. Lung cancer share in total deaths by birth cohort and 5-year age groups in white males for each 5th calendar year from 1959 to 1999, USA (expressed as a percentage).^a

Birth cohort	1915–1919	1910–1914	1905–1909	1900–1904	1895–1899
Age in 1959	40–44	45–49	50–54	55–59	60–64
Attained age
40–44	3.21
45–49	5.39	4.52
50–54	7.41	6.45	5.58
55–59	9.59	8.12	7.22	6.36
60–64	11.73	9.79	8.22	7.10	6.13
65–69	11.81	10.75	8.71	7.35	6.21
70–74	11.06	9.98	8.84	7.03	5.73
75–79	8.82	8.30	7.44	6.55	5.17
80–84	5.95	6.06	5.63	4.91	4.23
85–89		3.72	3.68	3.44	2.88
90–94			2.09	1.95	1.87
95–99				1.32	1.04
100+					0.81

^a Data from CDC-WONDER (2009), Ribicoff and Terry (1961): own calculations.

The reference values for study subjects involved in the US railroad worker study's case-control analysis who were deceased in 1981 (Garshick et al. 1987a) are shaded.

Table 9. Model comparison for the Swedish dock workers study with respect to work location and smoking parameters based on unconditional logistic regression models.^a

Model	Variables and interactions	d.f.	AIC	BIC
M1	Exposed time (3 categories)	3	231.0936	236.4462
M2	Smoking (2 categories)	2	216.9859	220.5543
M3	Exposed time + Smoking	4	219.0188	226.1556
M4	Exposed time × smoking	6	222.7429	233.4480

AIC: Akaike’s information criterion, BIC: Bayesian information criterion; d.f.: Degrees of freedom; +: Only mains effects of the variables are included into the model; × : Main effects and interaction terms are included into the model.

^a Number of cases and controls are taken from Table 5 in Emmelin et al. (1993).

Values for the best fitting model are given in bold.

Table 10. Hospital-based case-control studies.

Reference	Study region and subjects	Recruitment of cases	Sampling of controls	Proxy respondents in cases/controls	Adjustment for smoking^a	Adjustment for SES	Definition of exposure	Full adjusted OR (95% CI) for highest exposure category	Trend with increasing exposure^c	Considered in IARC’s 2012 decision
Boffetta et al. (1990)	6 US cities	1977–1987; 1985–1987 with information about employment duration in diverse jobs	Exclusion of tobacco-related diseases	0%	3^b	Years of education	Years of “probable” DE exposure	1.49 (0.72-3.11)	p = 0.18	Yes
							Years of truck driving	1.17 (0.40–3.41)	p = 0.25
Parent et al. (2007)	Canada, Montreal area; men	1979–85	Cancer despite lung cancer	29,4%/19,2%	4	Family income	Duration of DE exposure	1.0 (0.7–1.4)	No	Yes
							Level of DE exposure	1.0 (0.7–1.5)	No

SES: socio-economic status.

^a Smoking habits: 0 – no adjustment, 1 – adjustment for status (never, former, current), 2 – adjustment for status cross-classified by further information, 3 – packyears, 4 – packyears plus time since quitting.

^b Adjustment for average quantity of cigarettes/day (continuous); this seems to be not straightforward as the actual 8-level-definition of smoking in this study involves current smokers (1–20, 21–40, 41+ cigarettes/day), ex-smokers (1–20, 20–40, 40+ cigarettes per day); pipe and/or cigar smokers, and non-smokers.

^c No: trend not detected; p-value given if reported.

Table 11. Pooled analysis of European and Canadian case-control studies (Olsson et al. 2011; Straif et al. 2010; further indicated references reported about type of controls).

Part of analysis	Type of study/controls	OR estimates (95% CI) for highest cumulative exposure category	Considered in IARC’s 2012 decision
Complete pooled analysis
Olsson et al. (2011)		1.31 (1.19–1.43)	Yes
Straif et al. (2010)		1.27 (1.14–1.41)	No
		1.14 (1.03–1.26), adjusted for education
Component studies of pooled analysis Olsson et al. (2011)
INCO studies (Zeka et al. 2006; Cassidy et al. 2007)
Czech Republic	H (excl. cancer and TRD)	1.16 (0.64–2.13)
Hungary	H (excl. cancer and TRD)	1.27 (0.76–2.11)
Poland	H (excl. cancer and TRD), P (PR)	1.77 (1.08–2.90)
Romania	H (excl. cancer and TRD)	0.99 (0.40–2.48)
Russia	H (excl. cancer and TRD)	1.17 (0.74–1.86)
Slovakia	H (excl. cancer and TRD)	1.60 (0.80–3.18)
UK	P (HC)	0.93 (0.59–1.46)
Separate studies on DE and lung cancer (see also Table 12)
AUT (Germany), (Brüske-Hohlfeld et al. 1999)	P (PR, RDD)	1.67 (1.38–2.03)
HdA (Germany), (Brüske-Hohlfeld et al. 1999)	P (PR)	1.20 (0.87–1.66)
EAGLE (Italy), (De Matteis et al. 2012)	P (HC)	0.98 (0.75–1.27)
TURIN/VENETO (Italy), (Richiardi et al. 2004; Richiardi et al. 2006)	P (PR)	1.18 (0.89–1.57)
LUCAS (Sweden), (Gustavsson et al. 2000)	P (PR; two control groups, of which one is matched to cases regarding vital status in 1990 (with exclusion of smoking-related causes of death))	1.20 (0.91–1.59)
MONTREAL (Canada), (Pintos et al. 2012)	P (ER)	1.36 (0.96–1.91)
Additional studies
MORGEN (The Netherlands)	Nested in a prospective cohort study	0.62 (0.05–7.42)
LUCA (France), (Stücker et al. 1995; Stücker et al. 1999; Stücker et al. 2002)	H (excl. cancer and absence of non-cancerous lung diseases among controls)	0.95 (0.52–1.74)
PARIS (France), (Boffetta et al. 1998)	H (excl. TRD)	1.76 (0.80–3.90)
ROME (Italy), (Bochicchio et al. 2005)	H (excl. TRD and diseases related to dietary habits)	1.23 (0.74–2.06)

H: hospital-based control group; P: population-based control group; PR: population-registry; HC: healthcare-related database; RDD: random-digit-dialing; ER: electoral rolls; TRD: tobacco-related diseases.

Table 12. Population-based case-control studies.

Reference (additional papers for study description)	Study region and subjects	Recruitment of cases	Sampling of controls	Response rate among controls	Proxy respondents in cases/controls	Adjustment for smoking^a	Adjustment for SES	Definition of exposure	OR (95% CI) for highest exposure category, adjusted	Trend with increasing exposure^b	Considered in IARC’s 2012 decision
Gustavsson et al. (2000)	Sweden, Stockholm County, men	Cancer registry, 1985–1990	PR; two control groups, of which one is matched to cases regarding vital status in 1990 (with exclusion of smoking-related causes of death)	88% (normal controls), 82% (mortality-matched controls)	93%/19% (normal controls), 89% (mortality-matched controls)	2	–	Cumulative	1.63 (1.14–2.33)	Possible	Yes
Parent et al. (2007) (Siemiatycki 1991)	Canada, Montreal area, men	All large hospitals, 1979–1985	PR (electoral roll, n = 375), RDD (n=158)	72% (PR: 69.3%; RDD: 79.4%)	29.4%/12.6%	4	Family income	Ever – never	1.2 (0.8–1.8)	n.a.	Yes
								Duration	1.0 (0.6–1.7)	(no)
								Exposure level	1.6 (0.9–2.8)	Possible
Pintos et al. (2012) (Update of Parent et al. 2007, with a new series of cases and controls; Siemiatycki 1991)	Canada, Montreal area, men	All large hospitals, 1979–1985, 1996–2001	1979–1985: PR (electoral roll, n = 375), RDD (n = 158); 1996–2001: PR (electoral rolls, n = 894)	1979-1985: 72% (PR: 69,3%; RDD: 79,4%) 1996-2001: 70%^c	1979–1985: 29.4%/12.6%; 1996–2002: 39.8%/9.7%	4	Family income, schooling level	Ever – never	1.34 (1.1–1.7)	n.a.	Yes
								Duration	1.23 (0.9–1.7)	(no)
								Exposure level	1.80 (1.3–2.6)	Possible
Villeneuve et al. (2011) (Johnson 1998; Villeneuve et al. 1999)	Canada, 8 (of 10) provinces, men	Provincial cancer registries, 1994–1997	HC (5 provinces), RDD (2 provinces), property assessments database (1 province)	60.8%	0%	3	–	Ever – never	1.06 (0.89–1.25)	n.a.	Yes
								Cumulative	1.12 (0.89–1.40)	p = 0.07
Lerchen et al. (1987)	New Mexico, USA, men	Tumor registry, 1980–1982	RDD, HC (additionally only for older subjects)	83%	50%/2%; not controlled for in analysis	2	–	Ever employment in DE related job	0.6 (0.2–1.6)	n.a.	No
Brüske-Hohlfeld et al. (1999)	Study 1: West Germany; Study 2: West and East Germany, men	Hospitals, study 1: 1988–1992; study 2: 1990–1994	Study 1: PR; Study 2: PR, RDD	Study 1: 68%; Study 2: 41%	0%	4	–	Ever – never	1.43 (1.23–1.67)	n.a.	Yes
							Education		1.26, p < 0.05
							–	Duration	1.35 (0.95–1.93)	(no)
Richiardi et al. (2006)	Italy, Turin	Hospitals, 1991–1992	PR	84.8%	0%	2	–	Ever - never	1.04 (0.79–1.37)	n.a.	Yes
							Educational level		0.95 (0.72–1.26)	n.a.
							–	Cumulative	0.95 (0.63–1.45)	(no)
							Educational level		0.86 (0.56–1.31)	(no)
De Matteis et al. (2012) (Landi et al. 2008)	Italy, Lombardy region, men	13 hospitals with 80% coverage of all cases, 2002–2005	HC	72.4% or 57.2% (own computation) when relating participants to responding or all contacted subjects, respectively	0%	4	Adjustment for education did not change OR	Ever - never	0.82 (0.67–1.00)	n.a.	Indirectly in pooled analysis (Olsson et al. 2011)
								Cumulative	0.88 (0.65–1.19)	p = 0.36
Matrat et al. (2015) (Luce et al. 2011)	France, 10 regions (coverage 13% of total population), men	Cancer registries, 2001–2007	RDD	82%	Shortened direct or proxy interview: 8.9%/2.2%; not controlled for in analysis	4	- (In subjects with no exposure to asbestos, the OR dropped from 1.62 to 1.47 when excluding subjects with highest education)	Ever definite	1.20 (1.0–1.44)	n.a.	No
								Cumulative	1.20 (0.96–1.51)	p = 0.12
Wild et al. (2012)	Northeastern France, men	Hospitals, 2006–2010	RDD	Not reported (possibly 66.4%^d)	Not reported (probably 0%)	4	Socio-economic class	Ever - never	1.66 (1.11–2.49)	n.a.	No
Menvielle et al. (2003)	France, New Caledonia (South Pacific), men	Cancer Registry, 1993–1995	PR (electoral rolls)	95.3%	(25.4%/<1%)	3	–	Ever - never	0.8 (0.5–1.2)	n.a.	No
								Cumulative	0.7 (no CI given)	no
Tse et al. (2012)	China, Hong Kong, men	Largest oncology centre, 2004–2006	RDD	48%	0%	3	Education level	Ever regular	2.10 (1.20–3.69)	n.a.	No
								Duration	1.30 (0.68–2.49)	(no)
Tse et al. (2011)	China, Hong Kong, men	Largest oncology centre, 2004–2006	RDD	Not reported (48% in study with full cohort, Tse et al. 2012)	0%	Analysis restricted to non-smokers	Education level	Ever regular	3.47 (1.08–11.14)	n.a.	Yes
								Duration	1.05 (0.18–6.26)	(no)

SES: socio-economic status; RDD: random-digit dialing; PR: population registry; HC-health-care-related database.

^a Smoking habits: 0 – no adjustment, 1 – adjustment for status (never, former, current), 2 – adjustment for status cross-classified by further information, 3 – packyears, 4 – packyears plus time since quitting.

^b No: trend not detected; (no): OR in highest category lower than in lower categories; possible – OR was highest in highest category; p-value given if reported; n.a.: not applicable

^c The number of interviewed controls (n = 894) divided by the given number of eligible controls (n = 1024) actually results in 86%; the given interview completion rate of 70% is probably derived from the number of eligible controls of 1294 reported in other publications about this study (Vallieres et al. 2012).

^d It is reported that 800 male controls initially declared willingness to participate; the study was run with 531 controls, however, which possibly would give a final interview rate of 66.4%

Table 13. Lung cancer risk estimates in a German case-control study (Brüske-Hohlfeld et al. 1997) assuming different response rates among professional drivers in the control group.

Work as a professional driver	Cases	Controls	OR	95% CI	OR^a
Original distribution of control subjects (conditional logistic regression model)
Never	2263	2401	1.00		1.00
Ever	426	234	1.96	1.65–2.33	1.47
Original distribution of control subjects (unconditional logistic regression model)
Never	2263	2401	1.00		1.00
Ever	426	234	1.93	1.62–2.30	1.41
Model 1: SER = 0.64; nc = 133
Never	2263	2268	1.00		1.00
Ever	426	367	1.16	1.00–1.36	0.85^b
Model 2: SER = 0.7; nc = 100
Never	2263	2301	1.00		1.00
Ever	426	334	1.30	1.11–1.52	0.95^b
Model 3: SER = 0.8; nc = 58
Never	2263	2343	1.00		1.00
Ever	426	292	1.51	1.28–1.78	1.10^b
Model 4: SER = 0.9; nc = 26
Never	2263	2375	1.00		1.00
Ever	426	260	1.72	1.45–2.03	1.26^b

SER: standardized employment ratio, i.e. the ratio of the prevalence of professional driving in the control group and the source population of the study; nc: Number of control subjects that change from unexposed to exposed status.

^a Adjusted for smoking and asbestos.

^b Assuming that the proportional risk reduction due to confounding factors is the same as in the unconditional logistic model based on the original data.

Table 14. Impact of smoking adjustment on DE-related lung cancer risk estimates in a case-control study in Germany (Brüske-Hohlfeld et al. 1999).^#

Smoking related variables	Other variables	OR	95%CI
–	–	1.91	1.68–2.18
ln(PY), ex-smoking(3), pipe/cigar(1)	–	1.47	1.26–1.70
ln(PY), ex-smoking(3), pipe/cigar(1)	Asbestos(1)	1.43	1.24–1.67
ln(PY), ex-smoking(3), pipe/cigar(1)	Asbestos(1), SES(3)	1.27	1.09–1.48
Current, former, never (Garshick et al. 2008)	–	1.63	1.41–1.88
Never, 1–49 PY, 50+ PY (Garshick et al. 1987a, 1987b)	–	1.64	1.43–1.88

PY: pack years; SES: socio-economic status; Number of parameters in parentheses.

^# Comparison of ever DE-exposed vs. never exposed.

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