SPECIAL REPO SPECIAL REPORT 19 R T 19 HEA L TH HEA L TH Diesel Emissions and Lung EFFE CTS EFFE CTS INSTITUTE Risk Assessment Epidemiology and Quantitative Cancer: and Lung Emissions Diesel INSTITUTE Cancer: An Evaluation of Recent 101 Federal Street, Suite 500 Epidemiological Evidence for Boston, MA 02110, USA November 2015 +1-617-488-2300 Quantitative Risk Assessment www.healtheffects.org HEI Diesel Epidemiology Panel SPECIAL REPOrT 19 November 2015 November 2015 November Diesel Emissions and Lung Cancer: An Evaluation of Recent Epidemiological Evidence for Quantitative Risk Assessment HEI Diesel Epidemiology Panel Special Report 19 Health Effects Institute Boston, Massachusetts Trusted Science · Cleaner Air · Better Health Publishing history: The Web version of this document was posted at www.healtheffects.org in November 2015. Citation for document: HEI Diesel Epidemiology Panel. 2015. Diesel Emissions and Lung Cancer: An Evaluation of Recent Epidemiological Evidence for Quantitative Risk Assessment. Special Report 19. Boston, MA: Health Effects Institute. © 2015 Health Effects Institute, Boston, Mass., U.S.A. Cameographics, Belfast, Me., Compositor. Printed by Recycled Paper Printing, Boston, Mass. Library of Congress Catalog Number for the HEI Report Series: WA 754 R432. Cover paper: made with at least 55% recycled content, of which at least 30% is post-consumer waste; free of acid and elemental chlorine. Text paper: made with 100% post-consumer waste recycled content; acid free; no chlorine used in processing. The book is printed with soy-based inks and is of permanent archival quality. CONTENTS About HEI . .vii Contributors . ix Executive Summary . 1 Chapter 1: Introduction, Scientific Background, and. 9 Overview of the HEI Project 1.0 Introduction . 9 1.1 Scientific Background: A Brief History of Diesel Engines, Emissions, and Health. 9 1.2 Why HEI? A Long History of Diesel Research . 12 1.3 The HEI Diesel Epidemiology Project II . 13 1.3.1 Appointment and Charge to the Diesel Epidemiology Panel . 13 1.3.2 Overall Project Approach. 14 1.3.2.1 Internal Panel Deliberations . 14 1.3.2.2 Public Workshop . 14 1.3.2.3 Selected Analyses of the DEMS Data. 15 1.3.2.4 External Reviews . 15 1.3.3 Organization of the Report . 15 Chapter 2: Quantitative Risk Assessment and the Role of Epidemiology: The Panel’s Approach . 17 2.0 Introduction . 17 2.1 Evaluating the Role of Epidemiological Studies in Quantitative Risk Assessment. 18 2.2 The HEI Diesel Epidemiology Panel’s Approach . 20 2.2.1 Research Needs Identified for Epidemiological Studies on Diesel Exhaust and Lung Cancer . 20 2.2.2 Principles for the Evaluation of Epidemiological Studies . 20 2.3 Summary . 22 Health Effects Institute Special Report 19 © 2015 iii Special Report 19 Chapter 3: Evaluation of Lung Cancer and Elemental Carbon Exposure in the Trucking Industry . 23 3.0 Overview of Study, Methods, and Main Findings . 23 3.1 Panel Evaluation . 25 3.2 Study Design. 25 3.2.1 Cohort Selection . 25 3.2.2 Control for Confounding Factors . 25 3.3 Retrospective Exposure Assessment. 26 3.3.1 Choice of SEC for Historical Exposures to Diesel Exhaust . 27 3.3.2 Exposure Assessment Survey . 27 3.3.3 Baseline Exposure Model . 27 3.3.4 Spatial Extrapolation . 28 3.3.5 Job Group Scaling . 28 3.3.6 Temporal Extrapolation of Exposures. 28 3.3.7 Strengths of the Exposure Assessment Approach . 29 3.3.8 Limitations of the Exposure Assessment Approach . 30 3.4 Statistical Methods and Analysis . 31 3.5 Presentation and Interpretation of Main Findings . 32 3.6 Conclusions. 34 Chapter 4: Evaluation of the Diesel Exhaust in Miners Study . 37 4.0 Overview of Study Design, Analytical Methods, and Main Findings . 37 4.1 Replication of the Main Study Results . 39 4.2 Panel Evaluation . 39 4.2.1 Study Design . 40 4.2.2 Retrospective Exposure Assessment. 41 4.2.2.1 Choice of REC as a Marker of Exposure to Historical Diesel Exhaust . 41 4.2.2.2 Development and Assignment of Retrospective Exposures to REC. 42 4.2.2.3 Panel Assessment . 50 4.2.3 Statistical Analyses . 55 4.2.3.1 Cohort Study . 55 4.2.3.2 Nested Case–Control Study . 58 4.2.3.3 Subgroup Analyses of the DEMS Cohort. 59 iv Special Report 19 4.3 Control for Confounding Factors . .62 4.3.1 Control for Smoking. .62 4.3.1.1 Self Versus Proxy Reports. .63 4.3.1.2 Alternative Smoking Analyses by the HEI Panel. .63 4.3.2 Control for Confounding by Other Occupational Exposures. .68 4.3.2.1 HEI Panel Analyses of Adjustment for Radon . .68 4.4 Sensitivity of Alternative Statistical Models and Exposure Estimates on Risk of Lung Cancer in the Case–Control Study. .72 4.5 Conclusions . .76 Chapter 5: Summary and Conclusions . .79 5.1 Summary. ..