{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:36:59Z","timestamp":1793824619253,"version":"4.6.1"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Danish Working Environment Research Fund","award":["34\u20132016-09"],"award-info":[{"award-number":["34\u20132016-09"]}]},{"name":"Deutsche Gesetzliche Unfallversicherung to elaborate SYNJEM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exposure to respirable crystalline silica is suggested to increase the risk of autoimmune rheumatic diseases. We examined the association between respirable crystalline silica exposure and systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus and small vessel vasculitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a cohort study of the total Danish working population, we included 1 541 505 male and 1 470 769 female workers followed since entering the labour market 1979\u20132015. Each worker was annually assigned a level of respirable crystalline silica exposure estimated with a quantitative job exposure matrix. We identified cases of autoimmune rheumatic diseases in a national patient register and examined sex-specific exposure-response relations by cumulative exposure and other exposure metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 4673 male and 12\u00a0268 female cases. Adjusted for age and calendar year, men exposed to high levels of respirable crystalline silica compared with non-exposed showed increased incidence rate ratio (IRR) for the four diseases combined of 1.53 [95% confidence interval (CI): 1.39\u20131.69], for systemic sclerosis of 1.62 (1.08\u20132.44) and rheumatoid arthritis of 1.57 (1.41\u20131.75). The overall risk increased with increasing cumulative exposure attained since entering the workforce [IRR: 1.07 (1.05\u20131.09) per 50\u2009\u00b5g\/m3-years]. Female workers were less exposed to respirable crystalline silica, but showed comparable risk patterns with overall increased risk with increasing cumulative exposure [IRR: 1.04 (0.99\u20131.10) per 50\u2009\u00b5g\/m3-years].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study shows an exposure-dependent association between occupational exposure to respirable crystalline silica and autoimmune rheumatic diseases and thus suggests causal effects, most evident for systemic sclerosis and rheumatoid arthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyaa287","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T23:20:52Z","timestamp":1609802452000},"page":"1213-1226","source":"Crossref","is-referenced-by-count":82,"title":["Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study"],"prefix":"10.1093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0740-0878","authenticated-orcid":false,"given":"Signe Hjuler","family":"Boudigaard","sequence":"first","affiliation":[{"name":"Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivi","family":"Schl\u00fcnssen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark"},{"name":"National Research Center for the Working Environment, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesper Medom","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"S\u00f8ndergaard","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjell","family":"Tor\u00e9n","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Goteborg, Goteborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5662-1971","authenticated-orcid":false,"given":"Susan","family":"Peters","sequence":"additional","affiliation":[{"name":"Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Kromhout","sequence":"additional","affiliation":[{"name":"Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik A","family":"Kolstad","sequence":"additional","affiliation":[{"name":"Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,18]]},"reference":[{"key":"2021083121311312200_dyaa287-B1","volume-title":"Toxicological Profile for Silica","author":"Roney","year":"2019"},{"key":"2021083121311312200_dyaa287-B2","volume-title":"Arsenic, Metals, Fibres, and Dusts","year":"2012"},{"key":"2021083121311312200_dyaa287-B3","volume-title":"Silica, Some Silicates, Coal Dust and Para-Aramid Fibrils","year":"1997"},{"key":"2021083121311312200_dyaa287-B4","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1136\/oem.59.11.723","article-title":"Exposure-response analysis and risk assessment for silica and silicosis mortality in a pooled analysis of six cohorts","volume":"59","author":"T Mannetje","year":"2002","journal-title":"Occup Environ Med"},{"key":"2021083121311312200_dyaa287-B5","first-page":"395","article-title":"The mortality experience of an occupational group exposed to silica dust, compared with that of the general population and an occupational group exposed to dust not containing silica","volume":"15","author":"Collis","year":"1933","journal-title":"J Indust Hyg"},{"key":"2021083121311312200_dyaa287-B6","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1136\/oem.59.8.545","article-title":"Systemic sclerosis and occupational risk factors: a case-control study","volume":"59","author":"Diot","year":"2002","journal-title":"Occup Environ Med"},{"key":"2021083121311312200_dyaa287-B7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1445-5994.2000.tb00810.x","article-title":"Male systemic sclerosis and occupational silica exposure - 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