{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:06:20Z","timestamp":1792497980638,"version":"4.5.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002706","name":"AFA F\u00f6rs\u00e4kring","doi-asserted-by":"publisher","award":["110114"],"award-info":[{"award-number":["110114"]}],"id":[{"id":"10.13039\/501100002706","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005760","name":"University of Gothenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005760","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Arch Occup Environ Health"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To elucidate whether occupational noise exposure increases the mortality from ischemic heart disease (IHD) and stroke, and if exposure to paper dust modified the risks.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We studied 6686 workers from soft paper mills, with occupational noise exposure,\u2009&lt;\u200985 dBA, 85\u201390 dBA and\u2009&gt;\u200990 dBA, and high (&gt;\u20095\u00a0mg\/m<jats:sup>3<\/jats:sup>) exposure to paper dust. Person-years 1960\u20132019 were stratified according to gender, age, and calendar-year. Expected numbers of deaths were calculated using the Swedish population as the reference and standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>SMR for IHD was 1.12 (95% CI 0.88\u20131.41) for noise\u2009&lt;\u200985 dBA, 1.18 (95% CI 0.90\u20131.55) for 85\u201390 dBA, and 1.27 (95% CI 1.10\u20131.47) among workers exposed\u2009&gt;\u200990 dBA. Joint exposure to high noise exposure and high exposure to paper dust resulted in slightly higher IHD mortality (SMR 1.39, 95% CI 1.15\u20131.67). SMR for ischemic stroke was 0.90 (95% CI 0.37\u20132.15) for noise\u2009&lt;\u200985 dBA, 1.08 (95% CI 0.45\u20132.59) for 85\u201390 dBA, and 1.48 (95% CI 0.99\u20132.00) among workers exposed\u2009&gt;\u200990 dBA. High noise exposure and high exposure to paper dust resulted in higher ischemic stroke mortality (SMR 1.83, 95% CI 1.12\u20132.98).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Noise levels\u2009&gt;\u200990 dBA was associated with increased IHD mortality. Combined exposures of noise and paper dust may further increase the risks. Our results do not provide support for a causal relationship for ischemic stroke. Residual confounding from smoking has to be considered. Workers need to be protected from occupational noise levels exceeding 90 dBA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00420-023-01980-x","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T12:02:23Z","timestamp":1685620943000},"page":"965-972","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Occupational exposure to noise and dust in Swedish soft paper mills and mortality from ischemic heart disease and ischemic stroke: a cohort study"],"prefix":"10.1007","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8509-7603","authenticated-orcid":false,"given":"Kjell","family":"Tor\u00e9n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L.","family":"Neitzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena P.","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"1980_CR1","first-page":"1","volume":"82","author":"NE Breslow","year":"1987","unstructured":"Breslow NE, Day NE (1987) Statistical methods in cancer research. 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