{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:44:10Z","timestamp":1765820650093,"version":"3.48.0"},"reference-count":67,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/501100004737","name":"National Health Research Institutes","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004737","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Institute of Labor, Occupational Safety and Health"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,10,16]]},"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Exposure to asbestos is the major cause for malignant pleural mesothelioma (MPM), but the causal link of individual cases is difficult to establish for lack of exposure information and long disease latency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We established a retrospective cohort of workers employed in asbestos industries during the period of 1950\u20131989 and the occurrence of MPM during the period of 1980\u20132009 was examined with the Taiwan Cancer Registry. Estimated rate ratios (eRRs) were computed for each factory where any case of MPM was diagnosed by assuming Poisson distribution with a minimal latency of 20 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 18 MPM (17 males, 1 female) in eight factories were found. The incidence rate of MPM for the eight factories was 18.0 per million, ranging from 6.2 per million (military factory) to 268.2 per million (asbestos cement). We observed significantly increased risks for MPM in asbestos cement, thermal insulation and shipbuilding industries, with eRR (genders combined) of 113.6, 87.5 and 15.8, respectively. The sensitivity analyses considering latency showed similar findings in latency\n                      <jats:bold>\u2265<\/jats:bold>\n                      30 years, and the shipbuilding industry presented a significant eRR given a latency\n                      <jats:bold>\u2265<\/jats:bold>\n                      40 years. The gender-specific eRR showed similar results in men, but high eRR of 729.6 was observed in an asbestos cement factory where a female MPM was diagnosed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This nationwide study in Taiwan comprehensively shows that different asbestos manufacturing processes, including asbestos cement, thermal insulation and shipbuilding industries, were at significantly increased risks for MPM. We recommend to establish a medical screening programme for workers previously exposed to asbestos to identify MPM and other asbestos-related diseases at an earlier stage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-021063","type":"journal-article","created":{"date-parts":[[2018,12,10]],"date-time":"2018-12-10T07:15:43Z","timestamp":1544426143000},"page":"e021063","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Clustering of malignant pleural mesothelioma in asbestos factories: a subgroup analysis in a 29-year follow-up study to identify high-risk industries in Taiwan"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1095-6877","authenticated-orcid":false,"given":"Lukas Jyuhn-Hsiarn","family":"Lee","sequence":"first","affiliation":[{"name":"National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan"},{"name":"Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan"},{"name":"Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Kuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Hong","family":"Pan","sequence":"additional","affiliation":[{"name":"Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, Taiwan"},{"name":"School of Public Health, National Defense Medical Center, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yawen","family":"Cheng","sequence":"additional","affiliation":[{"name":"Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Yin","family":"Chang","sequence":"additional","affiliation":[{"name":"National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saou-Hsing","family":"Liou","sequence":"additional","affiliation":[{"name":"National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Der","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"},{"name":"Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,9]]},"reference":[{"key":"2025121509415625000_8.12.e021063.1","doi-asserted-by":"crossref","unstructured":"Smith DD . 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