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. 2020 Jan 2;77(2):84–93. doi: 10.1136/oemed-2019-105962

Table 3.

HRs for outcomes of interest by exposure surrogate from models with and without adjustment for a healthy worker survivor effect using employment duration

Exposed-days (all)
referent 2500 days		 Fire-runs (CFD, PFD)
referent 2100 runs		 Fire-hours (CFD)
Referent 600 hours
Underlying causeICD-10 codes
Cox model*		 Cases HR @
8700 days		 95% CI P value† Cases HR @
8800 runs		 95% CI P value† Cases HR @
2300 hours		 95% CI P alue†
All cancersC00-C97
 Loglinear without HWSE adjustment 1807 0.92 0.83 to 1.01 1577 0.93 0.86 to 1.00 1058 0.97 0.87 to 1.08
 RCS without HWSE adjustment 0.90 0.80 to 1.02 0.58 0.89 0.82 to 0.98 0.11 0.92 0.81 to 1.05 0.17
 Fully adjusted loglinear 1.14 1.00 to 1.31 1.02 0.94 to 1.11 1.08 0.96 to 1.21
 Fully adjusted RCS 1.11 0.94 to 1.31 0.51 1.00 0.91 to 1.11 0.58 1.04 0.90 to 1.21 0.43
MN oesophagusC15
 Loglinear without HWSE adjustment 82 0.63 0.40 to 1.00 72 0.97 0.68 to 1.36 45 0.91 0.53 to 1.51
 RCS without HWSE adjustment 0.60 0.36 to 1.02 0.66 1.15 0.74 to 1.81 0.22 0.95 0.50 to 1.83 0.83
 Fully adjusted loglinear 0.73 0.40 to 1.36 1.10 0.75 to 1.58 1.17 0.65 to 2.05
 Fully adjusted RCS 0.65 0.33 to 1.36 0.55 1.45 0.88 to 2.44 0.10 1.31 0.64 to 2.75 0.61
MN stomachC16
 Loglinear without HWSE adjustment 52 1.13 0.62 to 2.16 45 1.07 0.68 to 1.62 30 1.34 0.70 to 2.45
 RCS 1.00 0.50 to 2.19 0.57 1.28 0.73 to 2.28 0.33 1.37 0.62 to 3.20 0.92
 Fully adjusted loglinear 1.75 0.74 to 4.53 1.25 0.76 to 1.95 1.45 0.71 to 2.87
 Fully adjusted RCS 1.40 0.51 to 4.44 0.49 1.67 0.87 to 3.31 0.18 1.54 0.63 to 3.94 0.84
MN colonC18
 Loglinear without HWSE adjustment 145 0.83 0.58 to 1.18 132 0.83 0.63 to 1.08 100 0.79 0.54 to 1.12
 RCS without HWSE adjustment 0.77 0.51 to 1.17 0.51 0.80 0.58 to 1.09 0.67 0.79 0.51 to 1.21 1.00
 Fully adjusted loglinear 0.87 0.56 to 1.38 0.89 0.66 to 1.18 0.84 0.56 to 1.26
 Fully adjusted RCS 0.75 0.45 to 1.31 0.36 0.87 0.61 to 1.23 0.80 0.84 0.52 to 1.36 0.97
MN rectumC19-C21
 Loglinear without HWSE adjustment 42 0.45 0.24 to 0.88 34 0.32 0.16 to 0.61 23 NR
 RCS without HWSE adjustment 0.41 0.21 to 0.83 0.44 0.39 0.17 to 0.87 0.33 NR
 Fully adjusted loglinear 0.49 0.21 to 1.19 0.36 0.16 to 0.75 NR
 Fully adjusted RCS 0.43 0.17 to 1.20 0.61 0.47 0.18 to 1.22 0.28 NR
MN lungC33-C34
 Loglinear without HWSE adjustment 556 0.97 0.81 to 1.16 516 1.06 0.93 to 1.19 348 1.27 1.06 to 1.52
 RCS without HWSE adjustment 1.01 0.81 to 1.27 0.50 0.95 0.82 to 1.11 0.02 1.20 0.95 to 1.51 0.40
 Fully adjusted loglinear 1.38 1.08 to 1.78 1.21 1.05 to 1.38 1.48 1.21 to 1.80
 Fully adjusted RCS 1.45 1.06 to 2.01 0.60 1.12 0.95 to 1.33 0.20 1.46 1.13 to 1.88 0.85
MN prostateC61
 Loglinear without HWSE adjustment 126 0.88 0.62 to 1.25 104 0.87 0.66 to 1.14 76 0.78 0.53 to 1.14
 RCS without HWSE adjustment 0.80 0.52 to 1.27 0.52 0.81 0.58 to 1.13 0.43 0.63 0.40 to 1.01 0.13
 Fully adjusted loglinear 1.04 0.65 to 1.71 0.92 0.67 to 1.25 0.82 0.52 to 1.27
 Fully adjusted RCS 0.85 0.47 to 1.62 0.33 0.86 0.58 to 1.27 0.57 0.66 0.39 to 1.12 0.16
MN kidneyC64-C66
 Loglinear without HWSE adjustment 62 1.15 0.64 to 2.13 55 1.03 0.67 to 1.53 42 1.26 0.72 to 2.14
 RCS without HWSE adjustment 1.23 0.64 to 2.52 0.63 1.15 0.69 to 1.94 0.43 1.55 0.78 to 3.22 0.32
 Fully adjusted loglinear 1.03 0.50 to 2.24 0.94 0.59 to 1.46 1.15 0.63 to 2.08
 Fully adjusted RCS 1.16 0.50 to 2.92 0.58 1.08 0.61 to 1.96 0.43 1.56 0.72 to 3.58 0.22
MN bladderC67-C68
 Loglinear without HWSE adjustment 37 0.71 0.37 to 1.38 26 NR 20 NR
 RCS without HWSE adjustment 0.71 0.33 to 1.67 0.99 NR NR
 Fully adjusted loglinear 1.23 0.50 to 3.41 NR NR
 Fully adjusted RCS 2.66 0.67 to 14.7 0.14 NR NR
MN skinC43-C44, C46.0, C46.9
 Loglinear without HWSE adjustment 48 1.10 0.59 to 2.13 39 0.96 0.58 to 1.51 25 NR
 RCS without HWSE adjustment 1.09 0.52 to 2.55 0.96 1.00 0.56 to 1.84 0.78 NR
 Fully adjusted loglinear 0.99 0.45 to 2.31 0.94 0.54 to 1.54 NR
 Fully adjusted RCS 0.83 0.32 to 2.46 0.59 1.01 0.52 to 2.00 0.72 NR
MN brainC47, C70-C72
 Loglinear without HWSE adjustment 45 1.16 0.58 to 2.43 31 1.01 0.58 to 1.69 17 NR
 RCS without HWSE adjustment 0.67 0.32 to 1.52 0.02 1.07 0.55 to 2.14 0.78 NR
 Fully adjusted loglinear 1.04 0.44 to 2.69 0.99 0.53 to 1.76 NR
 Fully adjusted RCS 0.46 0.18 to 1.38 0.02 1.07 0.50 to 2.38 0.76 NR
NHLC46.3, C82-C85, C88.0, C88.3, C91.4, C96
 Loglinear without HWSE adjustment 76 0.94 0.60 to 1.50 65 0.70 0.47 to 1.01 40 0.61 0.35 to 1.04
 RCS without HWSE adjustment 0.96 0.54 to 1.82 0.92 0.71 0.45 to 1.11 0.90 0.79 0.39 to 1.68 0.24
 Fully adjusted loglinear 1.10 0.60 to 2.11 0.74 0.47 to 1.12 0.64 0.34 to 1.17
 Fully adjusted RCS 1.08 0.49 to 2.64 0.95 0.76 0.45 to 1.29 0.85 0.83 0.38 to 1.93 0.29
LeukemiaC91.0-C91.3, C91.5-C91.9, C92-C95
 Loglinear without HWSE adjustment 72 1.26 0.77 to 2.11 64 1.07 0.74 to 1.52 41 1.07 0.63 to 1.77
 RCS without HWSE adjustment 1.12 0.61 to 2.19 0.56 1.46 0.90 to 2.43 0.05 1.41 0.71 to 2.97 0.23
 Fully adjusted loglinear 2.32 1.13 to 5.19 1.15 0.77 to 1.67 1.17 0.65 to 2.05
 Fully adjusted RCS 2.39 0.91 to 7.37 0.93 1.89 1.06 to 3.48 0.02 1.74 0.78 to 4.15 0.15
Ischaemic heart diseaseI20-I22, I24-I25, I51.3, I51.6
 Loglinear without HWSE adjustment 1165 0.74 0.65 to 0.84 1050 0.87 0.78 to 0.96 739 0.86 0.75 to 0.99
 RCS without HWSE adjustment 0.80 0.68 to 0.93 0.06 0.87 0.77 to 0.98 0.84 0.97 0.82 to 1.16 0.01
 Fully adjusted loglinear 1.06 0.88 to 1.27 1.01 0.91 to 1.13 1.01 0.86 to 1.18
 Fully adjusted RCS 1.18 0.95 to 1.47 0.06 1.06 0.93 to 1.21 0.23 1.18 0.97 to 1.44 0.006
Cerebrovascular diseaseG45.0-G45.2, G45.4-G45.9, I60-I69
 Loglinear without HWSE adjustment 201 0.86 0.64 to 1.15 180 0.85 0.67 to 1.07 119 0.87 0.62 to 1.20
 RCS without HWSE adjustment 1.02 0.71 to 1.50 0.11 1.02 0.76 to 1.38 0.03 1.00 0.66 to 1.52 0.27
 Fully adjusted loglinear 1.22 0.81 to 1.86 0.94 0.72 to 1.20 1.00 0.69 to 1.42
 Fully adjusted RCS 1.62 0.96 to 2.88 0.09 1.21 0.86 to 1.70 0.02 1.21 0.76 to 1.95 0.18
COPDJ40-J44
 Loglinear without HWSE adjustment 213 0.78 0.60 to 1.02 186 0.88 0.72 to 1.08 130 0.95 0.71 to 1.26
 RCS without HWSE adjustment 0.83 0.60 to 1.18 0.52 0.91 0.71 to 1.18 0.67 1.37 0.92 to 2.07 0.006
 Fully adjusted loglinear 1.14 0.79 to 1.67 1.05 0.84 to 1.31 1.14 0.82 to 1.56
 Fully adjusted RCS 1.46 0.88 to 2.50 0.15 1.19 0.88 to 1.60 0.22 1.76 1.13 to 2.82 0.004
Cirrhosis and other chronic liver diseaseK70, K73-K74, K76.0
 Loglinear without HWSE adjustment 148 0.96 0.63 to 1.50 128 0.82 0.58 to 1.12 83 0.95 0.60 to 1.49
 RCS without HWSE adjustment 0.96 0.62 to 1.54 0.98 0.76 0.52 to 1.10 0.42 1.10 0.63 to 1.93 0.34
 Fully adjusted loglinear 1.90 1.02 to 3.70 1.04 0.72 to 1.48 1.15 0.68 to 1.91
 Fully adjusted RCS 2.39 1.18 to 5.13 0.14 1.03 0.67 to 1.58 0.93 1.48 0.78 to 2.84 0.16

Findings in bold font are statistically significant with a 95% confidence interval that excludes 1.0.

*All models were adjusted by age (time scale) and race, birthdate (within 5 years) and fire department by matching; results for mesothelioma and multiple myeloma are not reported because there was less than 30 observed cases.

†P based on LRT comparing the RCS and loglinear models to assess for non-linearity.

CFD, Chicago Fire Department; COPD, chronic obstructive pulmonary disease; HR, hazard ratio; HWSE, healthy worker survivor effect; ICD, International Classification of Diseases; LRT, likelihood ratio test; MN, malignancy; NHL, non-Hodgkin's lymphoma; NR, not calculated because there are less than 30 observed cases; PFD, Philadelphia Fire Department; RCS, restricted cubic spline.