Methods of control for smoking in occupational cohort mortality studies

Cohort mortality studies, which compare the observed mortality of a historically exposed cohort to an expected mortality based on figures from a national population, are among the most common and useful types of studies done in occupational epidemiology. Such studies are primarily based on records which lack data on smoking. Hence it is often difficult to determine whether an observed excess of a given smoking-related disease is the result of occupational exposures, an excess consumption of cigarettes among the exposed, or an interaction between the two. The purpose of this paper is to outline the different types of control which may be exercised in cohort mortality studies to control for the effects of smoking. Indirect control, which uses only existing data, may be exercised through (i) analysis of other smoking-related causes of death besides the cause-of-death of primary interest, (ii) use of an internal reference group instead of the national population, (iii) adjustment of the excess risk based on hypothetical smoking habits, or (iv) analysis for a dose-response relationship between occupational exposure and disease. Direct control, which requires interviews, may be exercised through (i) a survey of the smoking habits of currently employed cohort members, (ii) a survey of all cohort members, or (iii) a 'nested' case-referent study within the cohort. The choice of which method to use depends on the cost and the degree of accuracy required by the investigator.