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Objective To search for evidence of the relationship between occupational
silica exposure and heart disease. Design A systematic review and
meta-analysis. Background Growing evidences suggest a connection between
occupational silica exposure and heart disease; however, the link between
them is less clear. Data sources PubMed, ScienceDirect, Springer and
EMBASE were searched for articles published between 1 January 1995 and 20
June 2019. Articles that investigated the effects of occupational silica
exposure on heart disease risk were considered. Study selection We
included cohort studies, including prospective, retrospective
and retro-prospective studies. Data extraction and synthesis We extracted
data by using a piloted data collection form and conducted random-effects
meta-analysis and exposure-response analyses. The meta-relative risk
(meta-RR), a measure of the average ratio of heart disease rates for those
with and without silica exposure, was used as an inverse variance-weighted
average of relative risks from the individual studies. The
Newcastle-Ottawa Quality assessment Scale about cohort studies was used
for study quality assessment. Outcome measure We calculated heart disease
risks of pulmonary heart disease, ischaemic heart disease and other heart
diseases. Results Twenty cohort articles were included. Results
suggest a significant increase of overall heart
disease risk (meta-RR = 1.08, 95% CI = 1.03, 1.13). Stronger evidences of
association with pulmonary heart disease were found through both
categories of heart disease risk estimate (meta-RR = 1.24, 95% CI = 1.08,
1.43) and exposure-response analyses (meta-RR = 1.39, 95% CI = 1.19,
1.62). Moreover, our subgroup analyses revealed that the statistical
heterogeneity among studies could be attributed mainly to the diversities
of reference group, occupation and study quality score.
Conclusions Silica-exposed workers have increased risk of overall heart
disease, especially pulmonary heart disease. While further research is
needed to better clarify the relationship between occupational silica
exposure and ischaemic heart disease.
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