Objectives The association between asbestos exposure and asbestosis in high-exposed industrial cohorts is well-known, but there is a lack of knowledge about the exposure–response relationship for asbestosis in a general working population setting. We examined the exposure–response relationship between occupational asbestos exposure and asbestosis in asbestos-exposed workers of the Danish general working population.

Methods We followed all asbestos-exposed workers from 1979 to 2015 and identified incident cases of asbestosis using the Danish National Patient Register. Individual asbestos exposure was estimated with a quantitative job exposure matrix (SYN-JEM) from 1976 onwards and back-extrapolated to age 16 for those exposed in 1976. Exposure–response relations for cumulative exposure and other exposure metrics were analyzed using a discrete time hazard model and adjusted for potential confounders.

Results The range of cumulative exposure in the population was 0.001 to 18 fibers per milliliter-year (f/ml-year). We found increasing incidence rate ratios (IRR) of asbestosis with increasing cumulative asbestos exposure with a fully adjusted IRR per 1 f/ml-years of 1.18 [95% confidence interval (CI) 1.15– -1.22]. The IRR was 1.94 (95% CI 1.53–2.47) in the highest compared to the lowest exposure tertile. We similarly observed increasing risk with increasing cumulative exposure in the inception population.

Conclusions This study found exposure–response relations between cumulative asbestos exposure and incident asbestosis in the Danish general working population with mainly low-level exposed occupations, but there is some uncertainty regarding the exposure levels.

Key terms asbestos; asbestosis; cohort study; exposure; exposure–response; interstitial lung disease; job exposure matrix; occupational exposure; occupational exposure; register study; working population

• Supplementary material