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

  • OCCUPATIONAL EPIDEMIOLOGY
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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.

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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

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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

Authors and 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
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  2. Marie Lewné
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  3. Nils Plato
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  4. Johan Hallqvist
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  5. Magnus Alderling
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  6. Carolina Bigert
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  7. Christer Hogstedt
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  8. Per Gustavsson
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Corresponding author

Correspondence to Anna Ilar.

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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

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

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