Skip to main content

Myocardial infarction and occupational exposure to motor exhaust: a population-based case–control study in Sweden

European Journal of Epidemiology volume 29, pages 517–525 (2014)Cite this article

Abstract

There is a well-established association between particulate urban air pollution and cardiovascular disease, but few studies have investigated the risk associated with occupational exposure to particles from motor exhaust. This study investigated the risk of myocardial infarction (MI) after occupational exposure to motor exhaust, using elemental carbon (EC) as a marker of exposure. A population-based case–control study of first-time non-lethal MI was conducted among Swedish citizens in ages 45–70 living in Stockholm County 1992–1994, including 1,643 cases and 2,235 controls. Working histories and data on potential confounders were collected by questionnaire and medical examination. The exposure to EC was assessed through a job-exposure matrix. Odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) were estimated by unconditional logistic regression. We investigated various exposure metrics: intensity, cumulative exposure and years since exposure. There was an exposure–response relation between the highest average exposure intensity during the work history and the risk of MI when adjusting for smoking and alcohol drinking (p for trend 0.034), with an OR of 1.30 (95 % CI 0.99–1.71) in the highest tertile of exposure compared to the unexposed. An exposure–response pattern was observed in the analysis of years since exposure cessation among formerly exposed. Additional adjustments for markers of the metabolic syndrome reduced ORs and trends to non-significant levels, although this might be an over-adjustment since the metabolic syndrome may be part of the causal pathway. Occupational exposure to motor exhaust was associated with a moderately increased risk of MI.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abbreviations

CO:

Carbon monoxide

CI:

Confidence interval

EC:

Elemental carbon

JEM:

Job-exposure matrix

MI:

Myocardial infarction

OR:

Odds ratio

SHEEP:

Stockholm Heart Epidemiology Program

References

  1. National Board of Health and Welfare. Causes of death 2010. (In Swedish). Stockholm, Sweden: National Board of Health and Welfare; 2011.

  2. Castelli WP. Epidemiology of coronary heart disease: the Framingham study. Am J Med. 1984;76(2A):4–12.

    CAS  PubMed  Article  Google Scholar 

  3. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:937–52.

    PubMed  Article  Google Scholar 

  4. Marmot M, Brunner E. Alcohol and cardiovascular disease: the status of the U shaped curve. BMJ. 1991;303:565–8.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  5. White IR, Altmann DR, Nanchahal K. Alcohol consumption and mortality: modelling risks for men and women at different ages. BMJ. 2002;325:191–8.

    PubMed Central  PubMed  Article  Google Scholar 

  6. Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: a meta-analysis. Addiction. 2000;95:1505–23.

    CAS  PubMed  Article  Google Scholar 

  7. Seaton A, MacNee W, Donaldson K, Godden D. Particulate air pollution and acute health effects. Lancet. 1995;345:176–8.

    CAS  PubMed  Article  Google Scholar 

  8. Mills NL, Donaldson K, Hadoke PW, et al. Adverse cardiovascular effects of air pollution. Nat Clin Pract Cardiovasc Med. 2009;6:36–44.

    CAS  PubMed  Article  Google Scholar 

  9. Brook RD, Rajagopalan S, Pope CA, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331–78.

    CAS  PubMed  Article  Google Scholar 

  10. Mustafic H, Jabre P, Caussin C, et al. Main air pollutants and myocardial infarction: a systematic review and meta-analysis. JAMA. 2012;307:713–21.

    CAS  PubMed  Article  Google Scholar 

  11. European Environment Agency (EEA). Air quality in Europe—2012 report. Report no. 4/2012. Copenhagen, Denmark: EEA; 2012.

  12. Omstedt G, Andersson S, Bergström R. Present and future air quality in Sweden. Estimates of NO2, PM10 and PM2.5 in Swedish traffic environments for future scenarios with reduced European emissions (in Swedish). SMHI Meteorol. 2010;140:1–56.

  13. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Diesel and gasoline engine exhausts and some nitroarenes. IARC Monogr Eval Carcinog Risks Hum 1989;46:1–458.

  14. Gustavsson P, Plato N, Hallqvist J, et al. A population-based case-referent study of myocardial infarction and occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. Stockholm Heart Epidemiology Program (SHEEP) Study Group. Epidemiology. 2001;12:222–8.

    CAS  PubMed  Article  Google Scholar 

  15. WHO. Diesel fuel and exhaust emissions—environmental health criteria 171. Geneva: World Health Organization; 1996.

    Google Scholar 

  16. Grumet J, Levin R, Marin A. Heavy-duty engine emissions in the Northeast. Washington, DC: Northeast States for Coordinated Air Use Management; 1997.

    Google Scholar 

  17. Lewné M, Plato N, Gustavsson P. Exposure to particles, elemental carbon and nitrogen dioxide in workers exposed to motor exhaust. Ann Occup Hyg. 2007;51:693–701.

    PubMed  Article  Google Scholar 

  18. Birch ME, Cary RA. Elemental carbon-based method for monitoring occupational exposures to particulate diesel exhaust. Aerosol Sci Technol. 1996;25:221–41.

    CAS  Article  Google Scholar 

  19. Birch ME, Noll JD. Submicrometer elemental carbon as a selective measure of diesel particulate matter in coal mines. J Environ Monit. 2004;6:799–806.

    CAS  PubMed  Article  Google Scholar 

  20. Reuterwall C, Hallqvist J, Ahlbom A, et al. Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the SHEEP study. The SHEEP Study Group. J Intern Med. 1999;246:161–74.

    CAS  PubMed  Article  Google Scholar 

  21. Statistical database: Statistics Sweden. Population by county, marital status, age and sex. Year 1968-2012. Stockholm, Sweden: Statistics Sweden; 2013. http://www.ssd.scb.se/databaser/makro/Visavar.asp?yp=tansss&xu=C9233001&huvudtabell=BefolkningNy&deltabell=L1&deltabellnamn=Population+by+county%2C+marital+status%2C+age+and+sex%2E++Year&omradekod=BE&omradetext=Population&preskat=O&innehall=Folkmangd&starttid=1968&stopptid=2012&Prodid=BE0101&fromSok=&Fromwhere=S&lang=2&langdb=2. Accessed 19 Jan 2014.

  22. The National Labour Market Board. Nordic Classification of Occupations. (In Swedish). Stockholm, Sweden: The National Labour Market Board; 1983.

  23. Brook RD, Rajagopalan S. Particulate matter, air pollution, and blood pressure. J Am Soc Hypertens. 2009;3:332–50.

    PubMed  Article  Google Scholar 

  24. Coogan PF, White LF, Jerrett M, et al. Air pollution and incidence of hypertension and diabetes mellitus in black women living in Los Angeles. Circulation. 2012;125:767–72.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  25. Andersen ZJ, Raaschou-Nielsen O, Ketzel M, et al. Diabetes incidence and long-term exposure to air pollution: a cohort study. Diabetes Care. 2012;35:92–8.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  26. Hange D, Sigurdsson JA, Björkelund C, Lapidus L, Bengtsson C. Main causes of death among Swedish women born 1914 and 1918: 32-year follow-up of the Population Study of Women in Gothenburg. Int J Gen Med. 2012;5:597–601.

    PubMed Central  PubMed  Article  Google Scholar 

  27. Attfield MD, Schleiff PL, Lubin JH, et al. The diesel exhaust in miners study: a cohort mortality study with emphasis on lung cancer. J Natl Cancer Inst. 2012;104:869–83.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  28. Hammar N, Linnersjö A, Gustavsson A, Hallqvist J, Reuterwall C, Sandberg, E. Myocardial Infarction in Stockholm County 1980–1995. Report no. 2/1998. Stockholm, Sweden: Unit of Epidemiology, Community Medicine, Stockholm. County Council; 1998 (In Swedish).

  29. McGuire V, Nelson LM, Koepsell TD, et al. Assessment of occupational exposures in community-based case–control studies. Annu Rev Public Health. 1998;19:35–53.

    CAS  PubMed  Article  Google Scholar 

  30. Pronk A, Coble J, Stewart PA. Occupational exposure to diesel engine exhaust: a literature review. J Expo Sci Environ Epidemiol. 2009;19:443–57.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  31. Zaebst DD, Clapp DE, Blade LM, et al. Quantitative determination of trucking industry workers’ exposures to diesel exhaust particles. Am Ind Hyg Assoc J. 1991;52:529–41.

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the Swedish Council for Working Life and Social Research (FAS) [93-0541].

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77, Stockholm, Sweden

    Anna Ilar, Marie Lewné, Nils Plato, Carolina Bigert, Christer Hogstedt & Per Gustavsson

  2. Centre for Occupational and Environmental Medicine, Stockholm County Council, Box 210, SE-171 77, Stockholm, Sweden

    Marie Lewné, Nils Plato, Magnus Alderling, Carolina Bigert & Per Gustavsson

  3. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Johan Hallqvist

  4. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Johan Hallqvist

Authors
  1. Anna Ilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Lewné
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nils Plato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan Hallqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Magnus Alderling
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carolina Bigert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christer Hogstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Per Gustavsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Ilar.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ilar, A., Lewné, M., Plato, N. et al. Myocardial infarction and occupational exposure to motor exhaust: a population-based case–control study in Sweden. Eur J Epidemiol 29, 517–525 (2014). https://doi.org/10.1007/s10654-014-9933-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-014-9933-0

Keywords

  • Myocardial infarction
  • Occupational diseases
  • Occupational exposure
  • Particulate matter
  • Vehicle emissions
  • Gasoline