Modeling, estimation and validation of cotton dust and endotoxin exposures in Chinese textile operations

In support of an epidemiological study of cancer incidence among cotton textile workers in Shanghai, PRC, historical estimates of exposure to cotton dust and endotoxin were developed for subjects drawn from a cohort of 267,400 female textile workers. A large dataset of historical cotton dust measurements were available from 56 of the study factories. Using these data, a series of models were developed to estimate cotton dust exposure by year, factory and process. Model estimates were validated by comparing with independently collected measurements gathered over a 15 year period and indicated a low relative bias (< 2%) and relative accuracy (+/- 61%). Endotoxin exposures were estimated using the endotoxin content of cotton dust by major processes obtained in five separate surveys in these factories. The validated exposures were assigned to the 7,242 jobs held by the 3,812 study subjects. Among the exposed workers, the mean cumulative exposure levels were 113.8 mg m(-3)*years for cotton dust and 6,707.7 EU m(-3)*years for endotoxin, respectively. The overall correlation among cotton dust and endotoxin exposures for these subjects was r = 0.58. Using an unusually rich set of historical cotton dust measurements, along with independently collected exposure measurements for validation and conversion to endotoxin levels, validated estimates of cumulative exposure were constructed for this large case-cohort study in the textile industry.