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Donguk Park 1 Article
A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry
Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee
Epidemiol Health. 2021;43:e2021057.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021057
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.
METHODS
Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMRx/SMRnot x) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).
RESULTS
The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).
CONCLUSIONS
Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.
Summary
Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.
Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

Citations

Citations to this article as recorded by  
  • Health risks, emergency preparedness and Norwegian-Russian cooperation on Svalbard. A systematic review
    Turid Austin Wæhler, Tor Ingebrigtsen
    International Journal of Circumpolar Health.2022;[Epub]     CrossRef

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