Mortality among workers employed in the titanium dioxide production industry in Europe

Objectives: To assess the risk of lung cancer mortality related to occupational exposure to titanium dioxide (TiO(2)). Methods: A mortality follow-up study of 15,017 workers (14,331 men) employed in 11 factories producing TiO(2) in Europe. Exposure to TiO(2) dust was reconstructed for each occupational title; exposure estimates were linked with the occupational history. Observed mortality was compared with national rates, and internal comparisons were based on multivariate Cox regression analysis. Results: The cohort contributed 371,067 person-years of observation (3.3% were lost to follow-up and 0.7% emigrated). 2652 cohort members died during the follow-up, yielding standardized mortality ratios (SMRs) of 0.87 (95% confidence interval [CI] 0.83-0.90) among men and 0.58 (95% CI 0.40-0.82) among women. Among men, the SMR of lung cancer was significantly increased (1.23, 95% CI 1.10-1.38); however, mortality from lung cancer did not increase with duration of employment or estimated cumulative exposure to TiO(2) dust. Data on smoking were available for over one third of cohort members. In three countries, the prevalence of smokers was higher among cohort members compared to the national populations. Conclusions: The results of the study do not suggest a carcinogenic effect of TiO(2) dust on the human lung.