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Occupational Exposure to Solvents and Gender-Related Risk of Systemic Sclerosis: a Metaanalysis of Case-Control Studies
ADRIEN KETTANEH, OUBAIDA AL MOUFTI, KIET P. TIEV, CATHERINE CHAYET, CÉCILE TOLÉDANO, BÉNÉDICTE FABRE, LAURENCE FARDET, and JEAN CABANE ABSTRACT. Objective. In 2001 a metaanalysis reported an excess risk of systemic sclerosis (SSc) related to solvents exposure. The magnitude of risk varied among studies and sources of heterogeneity have not been investigated due to a lack of statistical power. We conducted a new metaanalysis to identify features associated with the magnitude of SSc risk in patients exposed to solvents. Methods. We searched 4 databases (Medline, Pascal, Pascal Biomed, Francis). Inclusion criteria were: case-control study, occupational exposure to solvents (OES) assessed by questionnaire and summarized to "any solvent" or "any organic solvent," SSc defined by the American College of Rheumatology or the consultant's criteria. The quality of studies within this metaanalysis was scored according to the Newcastle-Ottawa scale. Odds ratios (OR) were adjusted for the "publication bias" and validated by a sensitivity analysis. Subgroup analyses investigated the effect of gender, quality of studies, and the type of controls. Results. Among 11 studies (1291 patients and 3435 controls), 9 involved a majority of women (76.2 to 100%), while 2 involved men only. The risk of SSc associated with OES was variable among studies (p for heterogeneity = 0.01) and overrepresentation of higher OR values in smaller studies (p = 0.003) suggested "publication bias." SSc was associated with OES (OR 2.4; 95% CI 1.7–3.4; p < 0.0001), including after adjusting for bias (OR 1.8; 95% CI 1.2–2.5; p = 0.002). The relative risk was higher (p = 0.03) in men (OR 3.0; 95% CI 1.9–4.6; p < 0.0001) than in women (OR 1.8; 95% CI 1.5–2.1; p < 0.0001). Conclusion. Whereas SSc affects women predominantly, among subjects with occupational exposure to solvents, men are at higher risk than women for the disease. (First Release Nov 15 2006; J Rheumatol 2007;34:97–103) Key Indexing Terms:
METAANALYSIS From the Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique/Hôpitaux de Paris; Université Pierre et Marie Curie-Paris, Paris, France. A. Kettaneh, MD; O. Al Moufti, MD; K.P. Tiev, MD; C. Chayet, MPH; C. Tolédano, MD; B. Fabre, MD; L. Fardet, MD; J. Cabane, MD. Address reprint requests to Dr. A. Kettaneh, Department of Internal Medicine, Hôpital Saint-Antoine, 75012 Paris, France. E-mail: adrien.kettaneh@sat.ap-hop-paris.fr Accepted for publication August 11, 2006. |
