Risk of stomach cancer associated with 12 workplace hazards: analysis of death certificates from 24 states of the United States with the aid of job exposure matrices.

OBJECTIVE To investigate the risk of gastric cancer associated with 12 workplace exposures suspected or discussed as aetiological agents in previous reports. METHODS A case-control study was conducted based on the death certificates of several million deaths in 24 states of the United States in 1984-96. Overall, the data base included 41,957 deaths from stomach cancer among subjects aged > or = 25 years. These were 20,878 white men, 14,125 white women, 4215 African American men, and 2739 African American women. Two controls for each case were selected from among subjects who died from non-malignant diseases, frequency matched to cases by geographic region, race, sex and 5 year age group. Each three digit occupation and industry code listed in the 1980 United States census was classified for probability and intensity of exposure to asbestos, inorganic dust, metals, lead, polycyclic aromatic hydrocarbons (PAHs), nitrogen oxides, nitrosamines, sulphuric acid, fertilisers, herbicides, other pesticides (including insecticides and fungicides), and wood dust. These job exposure matrices were subsequently applied to the occupation-industry combinations in the death certificates of study subjects, separately by sex and race. RESULTS Risk of stomach cancer showed a modest association with occupational exposure to inorganic dust (odds ratio (OR) = 1.06; 95% confidence interval (95% CI) 1.03 to 1.11) with significant increasing trends by probability and intensity of exposure overall and by cross classification of the two exposure matrices. Workplace exposure to nitrosamines also showed a modest association (OR = 1.06; 95% CI 1.01 to 1.11), but the excess risk was even smaller after adjusting for inorganic dust exposure. Risk of gastric cancer was not associated with any of the other workplace exposures considered in this study. CONCLUSIONS Non-differential misclassification of exposure may have caused negative findings in this study, and inorganic dust may be a partial surrogate for exposure to other unknown risk factors. Alternatively, our results suggest that occupational factors contribute little to the aetiology of gastric cancer. Inorganic dust might act through non-specific mechanisms, similar to those proposed for salt, aspirin, and heat by other authors.