Cumulative Occupational Exposure Research Articles

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

ObjectivesThe impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking.MethodsData...

Parkinson's disease and occupational exposure to organic solvents in Finland: a nationwide case-control study.

This study aimed to investigate the association between Parkinson's disease (PD) and occupational exposure to organic solvents generally and chlorinated hydrocarbons (CHC) in particular. We assembled a Finland-wide case-control study for birth years 1930-1950 by identifying incident PD cases from the register of Reimbursement of Medical Costs and drawing two controls per case using incidence density sampling from the Population Information System, matched on sex, birth year, and residency in Finland in 1980-2014. Occupation and socioeconomic status (SES) were identified from national censuses. We assessed cumulative occupational exposures via FINJEM job-exposure matrix. Smoking was based on occupation-specific prevalence by sex from national surveys. We estimated confounder-adjusted PD incidence rate ratios (IRR) via logistic regression and evaluated their sensitivity to errors in FINJEM through probabilistic bias analysis (PBA). Among ever-employed, we identified 17 187 cases (16.0% potentially exposed to CHC) and 35 738 matched controls. Cases were more likely to not smoke and belong to higher SES. Cumulative exposure (CE) to CHC (per 100 ppm-years, 5-year lag) was associated with adjusted IRR 1.235 (95% confidence interval 0.986-1.547), with stronger associations among women and among persons who had more census records. Sensitivity analyses did not reveal notable associations, but stronger effects were seen in the younger birth cohort (1940-1950). PBA produced notably weaker associations, yielding a median IRR 1.097 (95% simulation interval 0.920-1.291) for CHC. Our findings imply that PD is unlikely to be related to typical occupational solvent exposure in Finland, but excess risk cannot be ruled out in some highly exposed occupations.

Occupational Benzene Exposure and Lung Cancer Risk: A Pooled Analysis of 14 Case-Control Studies.

Rationale: Benzene has been classified as carcinogenic to humans, but there is limited evidence linking benzene exposure to lung cancer. Objectives: We aimed to examine the relationship between occupational benzene exposure and lung cancer. Methods: Subjects from 14 case-control studies across Europe and Canada were pooled. We used a quantitative job-exposure matrix to estimate benzene exposure. Logistic regression models assessed lung cancer risk across different exposure indices. We adjusted for smoking and five main occupational lung carcinogens and stratified analyses by smoking status and lung cancer subtypes. Measurements and Main Results: Analyses included 28,048 subjects (12,329 cases, 15,719 control subjects). Lung cancer odds ratios ranged from 1.12 (95% confidence interval, 1.03-1.22) to 1.32 (95% confidence interval, 1.18-1.48) (Ptrend = 0.002) for groups with the lowest and highest cumulative occupational exposures, respectively, compared with unexposed subjects. We observed an increasing trend of lung cancer with longer duration of exposure (Ptrend < 0.001) and a decreasing trend with longer time since last exposure (Ptrend = 0.02). These effects were seen for all lung cancer subtypes, regardless of smoking status, and were not influenced by specific occupational groups, exposures, or studies. Conclusions: We found consistent and robust associations between different dimensions of occupational benzene exposure and lung cancer after adjusting for smoking and main occupational lung carcinogens. These associations were observed across different subgroups, including nonsmokers. Our findings support the hypothesis that occupational benzene exposure increases the risk of developing lung cancer. Consequently, there is a need to revisit published epidemiological and molecular data on the pulmonary carcinogenicity of benzene.

145 Cumulative Occupational Exposure to Nanoparticles, Inflammatory Biomarkers and Respiratory Health in the Nanoexplore Cohort

Abstract Exposure to nanomaterials (NMs) may harm biological systems by altering the redox status and triggering inflammatory processes, which in turn may affect respiratory health. In the NanoExplore cohort of 141 workers, we observed a positive dose-response relationship between the short-term exposure to NMs and biomarkers of inflammation, measured in Exhaled Breath Condensate (EBC), but no relationship with lung function parameters (LFP). This study focuses on the association between cumulative exposure to NMs over the last 10 years and changes in LFP and the potential mediating role of airways inflammation. Individual cumulative exposure was estimated by multiplying the nanoparticle concentration, measured at workers’ workstations by DiSCmini, by the duration of worker’s employment at the corresponding workstation up to last 10 years. In EBC, we measured High-Sensitivity CRP (Hs-CRP), IL-1β, TNF-α, and IL-10 as biomarkers of inflammation. LFP were assessed according to ATS/ERS standards. Their association with cumulative exposure was examined using logistic regression models adjusted for tobacco consumption (in pack-years), among 136 workers with complete data (19-62 yrs., 70% males). We found that per unit increase in 10-year exposure, the risk of observing FEV1 values below the normal limit increases by 0.3% (95%CI: 1.000-1.005, p=0.049) and by 0.8% (95%CI: 1.000-1.015, p=0.039) with the exposure expressed as number of particles and lung deposited surface area, respectively. The ongoing mediation analysis will investigate the potential mediating role of inflammation in the association between cumulative exposure to NMs and lung function

Ever and cumulative occupational exposure and lung function decline in longitudinal population-based studies: a systematic review and meta-analysis

ObjectivesAdverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This study aims to examine this association using findings reported by longitudinal population-based...

The National Institute for Occupational Safety and Health recommended exposure level for noise needs to be revised downwards

Noise-induced hearing loss (NIHL) is caused by cumulative occupational and non-occupational noise exposure. The National Institute for Occupational Safety and Health (NIOSH) developed recommendations for occupational noise exposure in 1972, revised in 1998. Fifty years after the NIOSH 85 dBA recommended exposure level (REL) was first published, it needs to be revised downwards. In its calculations, NIOSH assumed that workers have quiet (&amp;lt;60 dBA) when not at work, something no longer true. Everyday public noise exposure now exceeds the Environmental Protection Agency's safe noise level, a time-weighted average of 70 dB for 24 hours, with multiple studies reporting average exposures near 75 dBA. Also, NIOSH calculations were based on occupational studies of material hearing loss measured by limited frequency pure tone audiometry, an insensitive measure of noise-induced auditory damage. Modern audiology techniques include extended range audiometry, speech in noise testing, diffusion product otoacoustic emissions testing, and questions about tinnitus and hyperacusis. Doing the needed research to support downward REL revision, detecting auditory damage in noise-exposed workers with these newer techniques, is a daunting task, but this is necessary both to protect workers and because the NIOSH REL forms the basis for the world's recommendations for non-occupational noise exposure.

Cumulative Blast Exposure Estimate Model for Special Operations Forces Combat Soldiers.

Special Operations Forces (SOF) Service members endure frequent exposures to blast and overpressure mechanisms given their high training tempo. The link between cumulative subconcussive blasts on short- and long-term neurological impairment is largely understudied. Neurodegenerative diseases such as brain dysfunction, cognitive decline, mild cognitive impairment, and dementia may develop with chronic exposures. This hypothesis remains unproven because of lack of ecologically valid occupational blast exposure surveillance among SOF Service members. The purpose of the study was to measure occupational blast exposures in a close quarter battle (CQB) training environment and to use those outcomes to develop a pragmatic cumulative blast exposure (CBE) estimate model. Four blast silhouettes equipped with a field-deployable wireless blast gauge system were positioned in breaching positions during CQB training scenarios. Silhouettes were exposed to flashbangs and three interior breaching charges (single strand roll-up interior charge, 300 grain (gr) explosive cutting tape (ECT), and Jelly charge). Mean blast measures were calculated for each silhouette for flashbangs (n = 93), single strand roll-up interior charge (n = 80), 300 gr ECT (n = 28), and Jelly charge (n = 71). Mean peak blast pressures per detonation are reported as follows: (1) flashbangs (1.97 pounds per square inch [psi]); (2) single strand roll-up interior charge (3.88 psi); (3) 300 gr ECT (2.78 psi); and (4) Jelly charge (1.89 psi). Pragmatic CBE estimates for SOF Service members suggest 36.8 psi, 184 psi, and 2760 psi may represent daily, weekly, and training cycle cumulative pressure exposures. Estimating blast exposures during routine CQB training can be determined from empirical measures taken in CQB environments. Factoring in daily, weekly, training cycle, or even career length may reasonably estimate cumulative occupational training blast exposures for SOF Service members. Future work may permit more granular exposure estimates based on operational blast exposures and those experienced by other military occupational specialties.

Association of noise exposure, plasma microRNAs with arterial stiffness among Chinese workers

Long-term noise exposure is reported to damage cardiovascular system, but the relationship between occupational noise exposure and arterial stiffness (AS) and the underlying mechanism is still unclear. We aimed to investigate the association of occupational noise exposure with arterial stiffness (AS), and further explore the mediation roles of microRNAs (miRNAs). A total of 838 workers were recruited from two companies in Wuhan, Hubei, China. Cumulative occupational noise exposure (CNE) was assessed through noise level of job title and work years in occupational noise. The AS for the participants were evaluated using brachial-ankle pulse wave velocity (baPWV) measured by an oscillometric device. Each 1-unit increase in CNE levels was significantly associated with a 0.002 (95% confidence interval (CI) = 0.001–0.003) unit increase in ln-transformed values of baPWV. In the sex-specific analysis, the association was significant in males (β = 0.002, 95%CI = 0.001–0.003). Meanwhile, the risk of bilateral hearing loss at high frequency was significantly higher in the high-exposed group than non-exposed group (OR = 1.895, 95%CI = 1.024–3.508), and participants with bilateral hearing loss at high frequency had a significantly higher level of ln-transformed baPWV (β = 0.032, 95%CI = 0.003–0.061). Occupational noise exposure and AS were both negatively associated with plasma miR-92a-3p and miR-21–5p, and the two miRNAs mediated 15.0% and 16.8% of the association of occupational noise with AS (P < 0.05). Our findings suggest that occupational noise exposure is positively associated with AS, and plasma miR-92a-3p and miR-21–5p may partly mediate such association.

Cumulative occupational exposure to inorganic dust and fumes and invasive pneumococcal disease with pneumonia

PurposeOccupational exposure to inorganic dust and fumes in the year preceding disease has been associated with increased pneumococcal pneumonia risk, but the impact of prior cumulative exposure has not been characterized.MethodsWe studied 3184 cases of invasive pneumococcal disease with pneumonia. The case index date was the day the infection was diagnosed. We selected six controls for each case from the Swedish population registry; each control was assigned the index date of their corresponding case. We linked job histories to a job-exposure matrix to calculate a cumulative exposure index, intensity-years, by multiplying the duration (maximum 5 years) of each exposure with the level of exposure (0 for unexposed, 1 for low and 4 for high). We used conditional logistic analyses to estimate the odds ratio (OR) of invasive pneumococcal disease with pneumonia adjusted for comorbidities, educational level, income and other occupational exposures.ResultsTaking other occupational exposures into account, greater than 5 intensity-years of exposure to silica dust or to fumes was each associated with increased odds for invasive pneumococcal disease with pneumonia (OR 2.53, 95% CI 1.49–4.32) and (OR 2.24, 95% CI 1.41–3.55), respectively. Five intensity-years or less of exposure to silica dust or fumes manifested lower odds (OR 1.45, 95% CI 1.20–1.76) and (OR 1.05, 95% CI 0.94–1.16), respectively.ConclusionThis study adds evidence that the risk of pneumococcal pneumonia increases with increasing cumulative exposure to dust and fumes, indicating the importance of cumulative exposure.

Health status and cancer related mortality among nuclear plant workers exposed to ionizing radiation

Background: The investigation of potential adverse health effects of occupational exposures to ionizing radiation, on nuclear plant workers, is an important area of research. In this study, we aimed to calculate the incidence and risk of cancer development and mortality during last five years (2015-2019). Material and methods: 456 nuclear industry workers were included into this study (39 cancer patients and 417 healthy. For this cohort, the cancer mortality has been assessed by data obtained from national health registry excluded for the probability of known causes of death. The associations between cumulative occupational radiation exposures (radon, gamma radiation and long-lived radionuclides) and cancer mortality were calculated. Results: Radon and Gamma exposure was significantly higher among workers who developed cancer [8.4 (0; 3,224.5) vs 19.7 (0; 128.4), p=0.03] and [12.0 (2.1; 110.0) vs 24.5 (0; 470.1), p=0.02]. However, no significant association was found between long-lived radionuclides and risk of cancer (p=0.07). Conclusion: In conclusion, significant association has been observed between the risk of cancer development and radon and gamma exposure among nuclear industry workers, but no association was found between cancer and long-live nucleoids exposure. Keywords: ionizing radiation; nuclear industry; cancer; mortality.

Ethyl chloroformate mediated gas chromatographic-mass spectrometric biomonitoring of acidic biomarkers of occupational exposure and endogenous metabolites in human urine

Numerous industrial organic pollutants such as aromates, alkoxyalcohols, other organic solvents and monomers are absorbed, metabolized, and finally excreted in urine mostly as carboxylic acids that are determined as biomarkers of exposure. For a number of these xenometabolites, biological limits (levels of biomarkers in biological material) have been established to prevent damage to human health. Till now, most of the analytical procedures used have been optimized for one or a few analytes. Here, we report a more comprehensive approach enabling rapid GC-MS screening of sixteen acidic biomarkers in urine that are metabolized in the human body from several important industrial chemicals; benzene, toluene, styrene, xylenes, alkoxyalcohols, carbon disulfide, furfural and N,N-dimethylformamide. The new method involves immediate in situ derivatization – liquid liquid microextraction of urine by an ethyl chloroformate-ethanol-chloroform-pyridine medium and GC-MS analysis of the derivatized analytes in the lower organic phase. The xenometabolite set represents diverse chemical structures and some of hippuric and mercapturic acids also provided unusual derivatives that were unambiguously elucidated by means of new ethyl chloroformates labeled with stable isotopes and by synthesis of the missing reference standards. In the next step, an automated routine was developed for GC-MS/MS analysis using a MetaboAuto® sample preparation workstation and the new method was validated for fourteen metabolites over the relevant concentration range of each analyte in the spiked pooled human urine. It shows good linearity (R2 ≥ 0.982), accuracy (from 85% to 120%), precision (from 0.7% to 20%) and recovery (from 89% to 120%). The method performance was further successfully proved by GC-MS/MS analysis of the certified IP45 and RM6009 reference urines. Moreover, we show that the new method opens up the possibility for biomonitoring of combined and cumulative occupational exposures as well as for urinary metabolite profiling of persons exposed to harmful industrial chemicals.

What we know about intra-operative radiation exposure and hazards to operating theatre staff: A systematic review.

The widespread adoption of minimally invasive surgery and increased use of intra-operative fluoroscopy places surgeons and trainees at risk of cumulative occupational radiation exposure. Unfortunately, there is limited published data specific to surgeons on the potential health implications. This study aims to review current literature regarding the hazards of cumulative radiation exposure among operating theatre staff. A systematic review was conducted of four databases for studies reporting on cumulative intra-operative radiation exposure for operating theatre staff and the hazards associated with prolonged and frequent use. References from relevant studies were screened for additional texts. English language studies, controlled trials and cross-sectional studies were included. Abstracts and full-text studies were assessed for relevance and eligibility independently by two authors using Covidence. Six studies were included, with cancer being the most commonly reported long-term health hazard possibly associated with cumulative radiation exposure. A 1.85 fold greater prevalence of all cancers and 2.9 fold greater prevalence of breast cancer was reported amongst female orthopaedic surgeons compared to a sex- and age-adjusted population, but the results were not replicated amongst other surgical specialties. Multiple limitations of quantifying health risks of intra-operative radiation exposure were identified, including identifying a dose-effect relationship and confounders such as nulliparity and maternal age. This article highlights the lack of robust evidence regarding the potential hazards of cumulative occupational intra-operative radiation exposure. This study demonstrates the importance of developing standardised national radiation safety protocols for surgical colleges and subspecialties to minimise risks to operating theatre staff.

Health Status and Cancer Related Mortality among Nuclear Plant Workers Exposed to Ionizing Radiation

The investigation of potential adverse health effects of occupational exposures to ionizing radiation, on nuclear plant workers, is an important area of research. In this study, we aimed to calculate the incidence and risk of cancer development and mortality during last five years (2015-2019). 456 nuclear industry workers were included into this study (39 cancer patients and 417 healthy). For this cohort, the cancer mortality has been assessed by data obtained from national health registry excluded for the probability of known causes of death. The associations between cumulative occupational radiation exposures (radon, gamma radiation and long-lived radionuclides) and cancer mortality were calculated. Radon and Gamma exposure was significantly higher among workers who developed cancer [8.4 (0; 3,224.5) vs. 19.7 (0; 128.4), p=0.03] and [12.0 (2.1; 110.0) vs. 24.5 (0; 470.1), p=0.02]. However, no significant association was found between long-lived radionuclides and risk of cancer (p=0.07).

Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts.

Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up.Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking.Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.

Maternal occupational exposure to polycyclic aromatic hydrocarbons and the risk of isolated congenital heart defects among offspring

BackgroundAlthough there is evidence in experimental model systems that exposure to polycyclic aromatic hydrocarbons (PAHs) is linked with congenital heart defects (CHDs), few studies have examined the association in humans. We conducted a case-control study to examine the association between maternal exposure to PAHs and CHDs in offspring using data from the National Birth Defects Prevention Study (NBDPS) (1997–2011). MethodsWe obtained detailed information on maternal occupation during the month before to three months after conception. Expert raters, masked to case-control status, assessed job descriptions to assign categorical levels of exposure. Categories were quantitatively mapped to estimate cumulative exposure to PAHs, incorporating exposure intensity, frequency, work duration, and work hours. Quartiles were generated for cumulative maternal exposure to PAHs. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression for quartiles of PAH exposure and six CHD groupings (e.g. conotruncal) and specific subtypes (e.g. tetralogy of Fallot [ToF]). Final models were adjusted for maternal age, race/ethnicity, education, smoking, anticonvulsant use, folic acid supplementation, and study center. ResultsThere were 4,775 case and 7,734 control infants eligible for the study. The prevalence of occupational exposure to PAHs was 10.2% among both case and control mothers. In adjusted analysis, compared to mothers with no occupational PAH exposure, those in the highest quartile of exposure were more likely to have offspring in the conotruncal heart defects group (OR 1.41; 95% CI 1.00–2.00), and with ToF (OR 1.83; 95% CI 1.21–2.78). ConclusionsWomen in the highest quartile of estimated cumulative occupational PAH exposure during early pregnancy were more likely to have offspring with conotruncal heart defects, specifically ToF, compared to women with no occupational PAH exposure. Other comparisons between PAHs and other CHDs subgroups did not show any statistically precise associations.

Lifetime cumulative exposure to rubber dust, fumes and N-nitrosamines and non-cancer mortality: a 49-year follow-up of UK rubber factory workers

ObjectivesTo examine associations between occupational exposures to rubber dust, rubber fumes and N-nitrosamines and non-cancer mortality.MethodsA cohort of 36 441 males aged 35+ years employed in British rubber factories was...

FLYING HOURS OF AUSTRALIAN COMMERCIAL PILOTS AND RISK OF CUTANEOUS MELANOMA

ABSTRACT Aim To compare occupational flying hours (a surrogate for occupational exposure to radiation) of commercial pilots subsequently diagnosed with melanoma, with those without melanoma. Methods Nested case-control study of de-identified male commercial pilots in Australia 2011-2016, ascertained through the Civil Aviation Safety Authority (CASA). Cases were pilots diagnosed with melanoma 2011-2016; controls were randomly-selected pilots age-matched 1:2 with invasive cases. Total flying hours and hours flown in the last 6 months in 2011, date of birth and state of residence were also obtained. We estimated the association between total flying hours (in tertile groups), and melanoma by odds ratios adjusted for age and state (ORsadj; 95% confidence intervals (CIs)). Results During 2011-2016, 51 pilots developed invasive melanoma and 63, in situ (mean ages 47 and 49 years, respectively). Their median cumulative flying hours in 2011 were 6,108 and 6,900 respectively, compared with 7,500 for 102 control pilots (mean age 48.6). Risk of invasive melanoma did not increase per 1000 total hours flown (ORadj=1.00) nor did risk increase in pilots with highest vs lowest total flying hours (ORadj=1.18, 95% CI 0.44-3.15). Total flying hours were inversely associated with invasive melanoma development in pilots aged &lt; 50 (ORadj=0.37, not significant), and not associated with melanoma on exposed sites. Recent flying hours were not associated with melanoma. Results were unchanged with inclusion of in situ cases. Conclusion Risk of melanoma in Australian commercial pilots is unrelated to cumulative or recent occupational exposure to radiation as indicated by total and recent flying hours.

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia.

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.

Occupational radiation exposure and excess additive risk of cataract incidence in a cohort of US radiologic technologists

ObjectivesPrevious analyses of cataract in radiation-exposed populations have assessed relative risk; radiogenic excess additive risk (EAR), arguably of more public health importance, has not been estimated. Previous analysis of a...

Exposure-response relationships between cumulative occupational shoulder exposures and different diagnoses related to surgery for subacromial impingement syndrome.

The aim was to examine associations between cumulative occupational shoulder exposures and different diagnoses related to surgery for subacromial impingement syndrome (SIS). We re-analysed data from a previous register-based cohort study of the Danish working population (2,374,403 persons) with follow-up 2003-2008. The outcomes were eight different SIS-related diagnosis codes (M19, M75.1-5, and M75.8-9) in combination with SIS-related surgery codes. Occupational shoulder exposures were estimated by combining occupational codes with an expert-rated job exposure matrix. Cumulative exposure estimates were calculated for 10-year time windows and expressed as exposure-years. We used a logistic regression technique equivalent to discrete survival analysis. Exposure-response relationships were found between most occupational shoulder exposures and the different SIS-related diagnosis codes. For arm-elevation-years, M19, M75.1, and M75.4 reached maximum adjusted odds ratio (ORadj) of 2.0-2.4, while the maximum ORadj for M75.3 was 1.6; we found intermediate values for the remaining diagnoses. The relationships were almost similar for repetition-years and shoulder-load-years. For force-years, maximum ORadj of 1.7-1.9 was seen for M19, M75.1, and M75.4, while M75.3 reached a maximum ORadj of 1.3. For HAV-years, M19, M75.1, and M75.4 reached maximum ORadj of 1.5-1.7, while M75.3 reached a maximum ORadj of 1.1. We found associations between all occupational shoulder exposures and the eight different SIS-related diagnoses; exposure-response relationships were found for most diagnoses. The highest risks were seen for M19 (acromioclavicular osteoarthritis), M75.1 (rotator cuff syndrome), and M75.4 (impingement syndrome), and the lowest for M75.3 (calcific tendinitis).