D
DESCRIPTIVE TABLES OF CANCER STUDIES

This appendix contains two tables that describe the studies used in Chapter 4 (on cancer). Table D.1 provides information on cohort studies related to exposures to fuels and combustion products, and Table D.2 provides information on case-control studies. The studies are referred to repeatedly in Chapter 4. For each study, the following information is provided: a description of the study population, the number of subjects in the study group, how the type of cancer was determined, how exposure was assessed, what type of analysis was conducted, and which potential confounders were adjusted for.



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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 D DESCRIPTIVE TABLES OF CANCER STUDIES This appendix contains two tables that describe the studies used in Chapter 4 (on cancer). Table D.1 provides information on cohort studies related to exposures to fuels and combustion products, and Table D.2 provides information on case-control studies. The studies are referred to repeatedly in Chapter 4. For each study, the following information is provided: a description of the study population, the number of subjects in the study group, how the type of cancer was determined, how exposure was assessed, what type of analysis was conducted, and which potential confounders were adjusted for.

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 TABLE D.1 Description of Cohort Studies Related to Exposure to Fuels and Combustion Products Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Imperial Oil Cohort Hanis et al. 1979 Mortality experience (1964–1973) of male Imperial Oil workers (at least 1 yr for active workers; at least 5 yrs for inactive workers) in Canada; internal comparison of refinery and non-refinery workers 15,032; 5,731 refinery, 9,301 non-refinery Vital status followed through provincial registrars, Statistics Canada Job titles classified as in or outside refinery work RR; age Schnatter et al. 1992 Mortality experience (1964–1983) of Imperial Oil workers (at least 1 yr) in Canada; external comparison with Canadian general population 34,597 Vital status followed through Statistics Canada, internal data sources, NDI Company employment in 11 operating segments and HC exposure assigned by industrial hygienists on basis of detailed work histories SMR; sex, age, calendar period Schnatter et al. 1993 Mortality experience (1964–1983) of male Imperial Oil petroleum-marketing and distribution workers (at least 1 yr) in Canada; external comparison with Canadian general population 6,672 Vital status followed through Statistics Canada, internal data sources, NDI HC exposure frequency assigned by industrial hygienists based on basis of detailed work histories SMR; sex, age, calendar period Schnatter et al. 1996 Nested cases of lymphohematopoietic malignancies among Imperial Oil workers (at least 1 yr) in Canada; internal controls selected from males in cohort, matched 4:1 on age and were alive at case date of death 14 leukemia 7 MM 8 NHL Cause of death on death certificates coded by Statistics Canada Company employment in 11 operating segments and HC exposure assigned by industrial hygienists on basis of detailed work histories Mantel-Haenszel OR; age, smoking, family cancer history, frequency of chest x rays Lewis et al. 2000 Mortality experience (1964–1994) of Imperial Oil workers (at least 1 yr in 1964–1983) in Canada; external comparison with Canadian general population 34,560 Vital status followed through Statistics Canada, internal data sources, NDI Company employment in 11 operating segments and presumed HC exposure derived from job titles SMR; sex, age, calendar period

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Lewis et al. 2003 Incidence and mortality experience (1964–1994) of Imperial Oil workers (at least 1 yr, first hire in 1964–1994) in Canada; external comparison with Canadian general population 25,292 Vital status and cancer incidence followed through Statistics Canada, internal data sources, NDI Similar exposure-group codes developed by industrial hygienist from detailed work histories SIR, and SMR; sex, age, calendar period Mobil Oil Cohort Raabe et al. 1998 Mortality experience (1946–1987) of Mobil Oil employees (at least 1 yr in 1945–1987) in Beaumont, Texas; external comparison with US general population 7,119 Vital status followed through company records, Pension Benefits Information Inc., SSA, NDI Company employment; two job categories assigned on basis of job title SMR; age, sex, race, calendar period Rosamilia et al. 1999 Cases of lung cancer and controls in cohort of Mobil Oil employees (at least 1 yr in 1946–1987) in Beaumont, Texas 112 cases, 490 controls Vital status followed through company records, Pension Benefits Information Inc., SSA, NDI Four job categories assigned from work-history records OR (nested case-control); age, race, smoking, prior job assignments Wong et al. 2001 Mortality experience (1946–1996) of Mobil Oil employees (at least 1 yr in 1945–1996) in Beaumont, Texas; external comparison with US general population 7,543 Vital status followed through company records, Pension Benefits Information Inc., SSA, NDI Company employment; two job categories assigned on basis of job title SMR; age, sex, race, calendar period Texaco Mortality Study Divine et al. 1985 Mortality experience (1947–1977) of white male Texaco refinery, petrochemical-plant, and research laboratory workers (at least 5 yrs) in the US; external comparison with US white male population 19,077 Vital status followed through company records, SSA Company employment SMR; race, sex

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Divine and Barren 1986 Mortality experience (1947–1977) of white male Texaco refinery, petrochemical-plant, and research-laboratory workers (at least 5 years) in the US; external comparison with US white male population 18,798 Vital status followed through company records, SSA Company employment; job or process unit determined from work histories SMR; race, sex Divine et al. 1999a Mortality experience (1947–1993) of Texaco refinery, petrochemical plant, and research laboratory workers (at least 5 yrs) in the US; external comparison with US general population 28,480 Vital status followed through company records, SSA, NDI, HCFA Company employment; job or process unit determined from work histories SMR; race, sex Divine et al. 1999b Mortality experience (1947–1993) of Texaco refinery, petrochemical-plant, and research lab workers (at least 5 yrs) in the US; external comparison with US general population 28,480 Vital status followed through company records, SSA, NDI, HCFA Company employment; job or process unit determined from work histories SMR; race, sex Italian Oil Refinery Cohort Bertazzi et al. 1989 Mortality experience (1949–1982) of male workers (ever employed) at refinery near Milan, Italy; external comparison with national and local (Lombardy region) male populations 1,595 Vital status followed through Population Statistics Office Company employment in 29 occupation units determined from work histories SMR; age, sex, calendar time Consonni et al. 1999 Mortality experience (1949–1991) of male workers (ever employed in 1949–1982) at refinery near Milan, Italy; external comparison with local (Lombardy region) male population 1,583 Vital status followed through Population Statistics Office Company employment in 29 occupation units determined from work histories SMR; age, sex, calendar time

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders ACS Cancer Prevention Study II Boffetta et al. 1988 Mortality experience (1982–1984) of male subjects, 40–79 yr old, enrolled in ACS Cancer Prevention Study II 461,981 Follow up through personal contact; death certificates obtained from state health departments Self-administered questionnaire at baseline assessed current, last, and longest-held occupations, exposure to 12 groups of substances RR; age, smoking factors, other occupational exposures Pope et al. 1995 Mortality experience (1982–1998) of subjects, at least 30 yr old with one household resident at least 45 yr old, enrolled in ACS Cancer Prevention Study II 552,138 Follow up through personal contact (through 1988) with death certificates obtained from state health departments; record linkage with NDI (through 1989) Mean concentrations of sulfate and fine-particle air pollution provided by EPA databases RR; age, sex, race, cigarette-smoking, exposure to passive cigarette-smoking, BMI, drinks per day of alcohol, education, occupational exposure Pope et al. 2002 Mortality experience (1982–1998) of subjects, at least 30 yr old with one household resident at least 45 yr old, enrolled in ACS Cancer Prevention Study II About 500,000 (number of subjects depends on pollution index used) Follow up through personal contact (through 1988) with death certificates obtained from state health departments; record linkage with NDI (through 1998) Mean concentrations of air pollution (PM, sulfate, SO2, NO2) provided by EPA databases RR; age, sex, race, smoking, education, marital status, body mass, alcohol consumption, occupational exposure, diet Other Cohorts Abbey et al. 1999 Mortality experience (1977–1992) of nonsmoking, white, Seventh Day Adventist residents of California who had lived at least 10 yr within 5 mi of current residence 6,338 Vital status followed through record linkage with California death-certificate files (1977–1992), NDI (1979–1992), church records Monthly estimates of ambient concentrations of air pollutants (PM10, SO2, NO2) provided by fixed-site monitoring stations maintained by CARB provided RR; sex, years of education, pack-years of past smoking, alcohol use

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Boffetta et al. 2001 Incidence experience (1971–1989) of occupationally active (1960 and 1970 censuses; excluding farmers) residents of Sweden; internal comparisons made across exposure intensities and probabilities; external comparison to Swedish general population 55,883 total exposed cancer cases Follow up for incidence through Swedish Cancer Register; vital status tracked through national Register of Causes of Death Job and industry titles classified for probability and intensity of exposure to diesel-engine emissions SIR, sex, age, calendar year RR; age, calendar period, geographic region, urban or rural residence Borgia et al. 1994 Mortality experience (1965–1988) of male taxi drivers (registered in 1950–1975) in Rome, Italy 2,311 Vital status tracked through local registry office or through record linkage with national or regional mortality files Taxi drivers registered in Rome SMR; age, calendar period Chow et al. 1994 Incidence experience (1961–1979) of stomach cancer in occupationally active (1960 census) Swedish men; external comparison with Swedish general population 16,872 cases Cancer incidence tracked through Swedish Cancer-Environmental Registry which links census data to Swedish Cancer Registry Occupation and industry codes from census data SIR; age, sex, region Chow et al. 1995 Incidence experience (1961–1979) of esophageal cancer in occupationally active (1960 census) Swedish men; external comparison with Swedish general population 2,394 cases Cancer incidence tracked through Swedish Cancer-Environmental Registry which links census data to Swedish Cancer Registry Occupation and industry codes from census data SIR; age, sex, region Gamble et al. 1996 Nested cases of kidney cancer among Exxon employees of at least 1 mo at three US refineries and chemical plants in 1970–1992; internal controls matched on sex, race, age, date of hire, at-risk status 37 cases, 148 controls Vital status followed through SSA, NDI Industrial hygienist constructed JEM from company records and job titles OR (nested case-control); logistic regression BMI, mean arterial pressure, smoking

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Guberan et al. 1992 Incidence and mortality experience (1949–1986) of lung and gastrointestinal cancer in male professional drivers (1949–1961) in canton of Geneva, Switzerland; external comparison with Geneva male population 6,630 Follow up for incidence through Geneva Cancer Registry; vital status tracked through National Office of Statistics Subjects had valid (in 1949) or new (1949–1961) licenses issued as drivers of heavy-duty-road goods vehicles, taxis, buses, coaches, professional transports; subjects classified as “more” or “less” exposed to exhaust gases SIR, SMR; age, year Gustavsson et al. 1990 Incidence (1958–1984) and mortality (1952–1986) experience of male bus garage workers (at least 6 mo in 1945–1970) from five locations in Stockholm, Sweden; external comparisons with Stockholm general population and occupationally active population in Sweden; internal comparisons made for cumulative exposure indices 695 Cancer incidence tracked through Swedish Cancer Registry; mortality ascertained from Statistics Sweden Industrial hygienist constructed JEM from historical data from garages on numbers and types of diesel engines present, ventilation, job types and duration SMR; age, sex, cause of death OR; conditional logistic regression, age Hansen 1993 Mortality experience (1970–1980) of truck drivers (1970 census) in Denmark compared with population of unskilled workers 14,225 truck drivers, 43,024 unskilled laborers Record linkage with Central Population Register, Death Certificate Register Truck-driver job title in 1970 census SMR (expected numbers of deaths in driver group calculated in reference to unskilled group); age, period Hansen 2000 Nested cases of male breast cancer among Pension Fund members in Denmark in 1970–1989; internal controls matched on age 230 cases Cancer incidence tracked through Danish Cancer Registry Job titles obtained from Pension Fund files and Central Person Registry; author assigned exposure to gasoline, combustion products Conditional logistic regression; birth year, SES

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Hoek et al. 2002 Mortality experience (1986–1994) of a subcohort of males, age 55–69 yr old, in Netherlands Cohort Study on Diet and Cancer 4,492 Vital status followed through Dutch Central Bureau of Genealogy Self-administered questionnaire at baseline gave location of residence in 1986; exposure to traffic-related air pollution determined through National Air Quality Monitoring Network data RR; age, sex, education, Quetelet index, occupation, active and passive cigarette-smoking, neighborhood SES score Huebner et al. 2000 Incidence experience of lymphohematopoietic malignancies among Exxon employees of at least 1 mo at three US refineries and chemical plants in 1970–1992 or US-based employees of at least 1 day in 1979–1982 with all subjects having current, final, or active (1983–1994) employment at Baton Rouge, Louisiana facility; internal controls matched on sex, race, age, date of hire, at-risk status 8,942 59 LH malignancies Record linkage with the Louisiana tumor registry Job type obtained from company records SIR; modified life-table approach stratified by sex, race, age, year of diagnosis Jarvholm and Silverman 2003 Incidence and mortality experience (1971–1995) of Swedish male construction workers (1971–1993); internal comparisons of truck drivers and heavy-equipment operators within carpenters and electricians; external comparisons to Swedish general population 6,364 truck drivers, 14,364 heavy equipment operators, 119,984 carpenters and electricians Record linkage with National Cancer Registry and National Death Registry Job title obtained at initial health examination (1971–1993) SIR, SMR; age, period, smoking habits Jarvholm et al. 1997 Incidence experience (1958–1991) of male workers (at least 1 yr) in 26 companies in petroleum industry in Sweden; external comparison with Swedish general population 4,128 Cancer incidence followed through the Swedish Cancer Registry Employment in refinery operations, distribution, other occupations determined from job titles SIR (90% CI); sex, age, calendar year

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Kneller et al. 1990 Incidence experience (1980–1984) of stomach cancer in occupationally active (1982 census) residents over 30 yr old in Shanghai, China; internal comparison among census registrants 13,489 cases Cancer incidence tracked through Shanghai Cancer Registry Occupation at time of diagnosis or retirement ascertained through interview of patient or next of kin SIR; age, sex Krewski et al. 2000 Mortality experience (1974–1991) of participants in Six Cities Study in northeast and midwest US; audit of original study with updated exposure assessment methods 8,111 Annual letters mailed to assess vital status; nonrespondents prompted family follow up and NDI records searches Air-pollutant measurements from central locations in communities RR; sex, education, diabetes, hypertension, BMI, smoking history, occupational exposure to dusts or fumes Lagorio et al., 1994 Mortality experience (1981–1992) of self-employed gas-station attendants (in 1980) in Italy; external comparison with Latium region, Italian general population 2,665 Vital status followed through registries of last municipality of residence with record linkage with National Mortality File (pre-1986) or Regional Death Index Environmental survey, duration of employment SMR; age, sex Lan et al. 2002 Incidence experience (1976–1992) of lung cancer in farmers, 41–75 yr old, in Xuanwei County, China 21,232 Lung-cancer incidence tracked through record searches of six regional hospitals Interview with standardized questionnaire assessing kitchen practices as surrogates for indoor air pollution RR; sex, age, family history of lung cancer, chronic bronchitis or emphysema, tuberculosis, other SES and demographic variables

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Larkin et al. 2000 Mortality experience (1959–1976) of railroad workers, 40–64 yr old, with 10–20 yr of experience in 1959 55,395 Vital status tracked through US RBB records Interstate Commerce Commission job code obtained from US RBB records and classified for diesel exposure RR; age, calendar year McLaughlin et al. 1987 Incidence experience (1961–1979) of renal cancer in occupationally active (1960 census) Swedish men; external comparison to Swedish general population 7,405 renal-cell cases 821 renal-pelvis cases Cancer incidence tracked through Swedish Cancer-Environmental Registry, which links census data to Swedish Cancer Registry Occupation and industry codes from census data SIR; age, sex, region Nafstad et al. 2003 Incidence experience (1972–1998) of lung cancer in males, 40–49 yr old, in Oslo, Norway 16,209 Cancer incidence tracked through Norwegian cancer registry Estimated average concentrations of air pollutants (SO2, NOx) from Norwegian Institute for Air Research records; initial questionnaire established home address RR; age, education, tobacco-smoke exposure, other pollutant Nelson et al. 1985, 1987 Mortality experience (1970–1982) of Amoco Oil refinery workers (at least 6 mo, with 1 day in 1970–1980); external comparison with US general population 10,763 Vital status followed through SSA, NDI, company telephone survey Company employment industrial hygienist assigned three job types and exposure types; frequency on basis of job titles SMR; age, sex, race

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Study Group Health-Outcome Assessment Exposure Assessment Analysis, Adjustment for Potential Confounders Poole et al. 1993 Nested cases of kidney cancer and controls from several cohorts of workers in 36 petroleum refineries 102 cases, 408 controls Author and nosologist confirmed cases from death certificates obtained from each cohort Industrial hygienists assigned HC exposure types, intensity, and frequency on basis of detailed work histories RR (nested case-control), conditional logistic regression; control for matching factors: employer and location, age, at-risk status Rafnsson and Gunnars-dottir 1991 Mortality experience (1951–1988) of professional truck and taxi drivers in Reykjavik, Iceland; external comparison with general male population of Iceland 1,021 Record linkage with National Register, Register of Deceased Truck and taxi drivers identified through membership rolls of Hreyfill cooperative taxi agency SMR; age, calendar year Ritz 1999 Mortality experience (1951–1989) of male uranium-processing plant workers (at least 3 yr, with first hire in 1951–1972) in Ohio; external comparison with US general population; Internal comparison among workers monitored for exposure 3,814 Vital status followed through SSA (pre-1979) NDI (1979–1980) Exposure matrixes generated by employees, industrial hygienists SMR, RR (conditional logistic regression); age, calendar year, time since first hired, pay type, radiation dose Saverin et al. 1999 Mortality experience (1970–1994) of lung cancer in male potash miners (at least 1 yr from 1969–1991) in South Harz Mountains area, Germany; internal comparison within subcohort of subjects who worked underground at least 10 yr, held one job for 80% of their time, had three or fewer underground jobs; external comparison to general male population of Germany 5,536; 3,258 subcohort Vital status followed through local population registers Personal and area dust-sampling concentrations were averaged and assigned to work categories of production, maintenance, workshop RR, age SMR; age

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Number of Cases Number of Controls Relevant Exposures Exposure Assessment Analysis; Adjustment for Potential Confounders Xu et al. 1996 Lung-cancer cases, 30–70 yr old, diagnosed among residents of Shenyang, China, in 1985–1987; controls randomly selected from population registers and matched on age, sex distribution; subcohort of 610 cases, 959 controls active or retired from Anshan Iron-Steel Complex was analyzed with respect to benzo[a]pyrene exposure 1,249 lung 1,345 Kang, coal, gas, indoor air pollution, Benzo[a]pyrene Interview with standardized questionnaire assessing cooking habits; indoor air-pollution index generated from questions on cooking fuel, place of cooking, weighted by duration; benzo[a]pyrene exposure assigned to subcohort on basis of indoor, outdoor measurements, person’s job history RR/ORs; age, education, smoking Yu et al. 1990 Nasopharyngeal-cancer cases, under 50 yr old, identified among residents of Guanzhou City, China, from files of Sun Yat-Sen University Tumor Hospital in 1983–1985; neighborhood controls selected, matched on sex, age 306 nasopharyngeal 306 Combustion products Interview with standardized questionnaire assessing occupational, dietary factors Conditional logistic regression; matched pairs, age, sex, dietary factors, birthplace, marital status Zheng et al. 1992 Oral- and pharyngeal-cancer cases, 20–75 yr old, identified through population-based cancer registry as newly diagnosed in 1988–1990; controls randomly selected from Shanghai Resident Registry, matched on age, sex 204 oral and pharyngeal 414 Petroleum products, kerosene-stove use In-person interview with standardized questionnaire assessing lifestyle factors Chi-squared test

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Number of Cases Number of Controls Relevant Exposures Exposure Assessment Analysis; Adjustment for Potential Confounders Zheng et al. 1994 Nasopharyngeal-cancer cases diagnosed beginning in 1986 at Wuzhou Cancer Institute or Nasopharyngeal Carcinoma Institute of Zangwu, China, with histologic confirmation; neighborhood controls selected, matched on sex, age, place of residence 88 nasopharyngeal 176 Wood-fuel use In-person interview with standardized questionnaire assessing lifestyle factors Conditional logistic regression; matched pairs, sociodemographic score Zheng et al. 1996 Cases of salivary-gland cancer, 20–75 yr old, identified through the Shanghai cancer registry and diagnosed in 1988–1990; controls randomly selected through Shanghai Resident Registry, matched on sex, age 41 salivary gland 414 Petroleum products, kerosene, coal, gas In-person interview with standardized questionnaire assessing job history, household exposures, and dietary factors Mantel-Haenszel OR; sex, age, income Zheng et al. 2002 Bladder-cancer cases, age 40–85 yr old, identified and histologically confirmed by State Health Registry of Iowa among Iowa residents in 1986–1989; controls randomly selected through driver’s license records (under 65 yr old) or HCFA listing (65 yr old and older), matched on sex, age 1,452 bladder 2,434 Petroleum, coal products industry, petroleum-refining industry Mailed questionnaires obtained lifetime occupational histories of all jobs held 5 yr or more Unconditional logistic regression; age, lifetime pack-years of cigarette-smoking, family history of bladder cancer

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Gulf War and Health: Fuels, Combustion Products, and Propellants - Volume 3 Reference Population Number of Cases Number of Controls Relevant Exposures Exposure Assessment Analysis; Adjustment for Potential Confounders NOTE: HCFA=Health Care Financing Administration; NHL=non-Hodgkin’s lymphoma; HD=Hodgkin’s disease; JEM=job exposure matrix; MM=multiple myeloma; NIOSH=National Institute for Occupational Safety and Health; OR=odds ratio; RDD=random-digit dialing; RR=relative risk; SES=socioeconomic status; SIR=standardized incidence ratio; SMR=standardized mortality ratio.

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