Jawablah pertanyaan-pertanyaan berikut sesuai dengan kasus yang

dijelaskan.
Animal studies in the late 1990s and early 2000s showed that crystalline silica (quartz)
could promote and induce lung tumors. It was therefore of interest to determine
whether silica-exposed human populations were at an increased risk of lung cancer.
A second hypothesis of interest was whether those who have silicosis, a fibrotic disease
of the lung, were at increased risk of lung cancer. It has been hypothesized that some
aspect of silicosis, such as enzymes released by macrophages that are destroyed in the
silicotic process, induces lung cancer.
In order to investigate these hypotheses, NIOSH investigators sought to find a cohort of
workers exposed primarily to silica. Silica exposure in the workplace principally occurs
among foundry workers, miners, granite workers, and sandblasters.

PERTANYAAN 1.
A. Apa keuntungan dan kelebihan bila menggunakan kelompok pekerja tersebut
sebagai studi penelitian?
B. Apakah studi kasus-kontrol berbasis pada populasi umum mungkin dapat
menjadi alternatif untuk mempelajari hubungan pajanan silika dengan kanker
paru-paru? Mengapa?
Researchers chose to study granite cutters organized in the Granite Cutters Union.
These men worked in granite sheds near quarries and cut granite to make gravestones,
building material, etc. They had historically been exposed to very high levels of silica,
without any potentially confounding exposures. Historical dust levels were
approximately 20-50 million particles per cubic foot (mppcf) through the 1960s, but
were lowered to approximately 35 mppcf thereafter, after it was recognized that high
levels of silica dust caused silicosis. Silicosis, which had been very common among
granite cutters, became muchrarer after dust levels were lowered. The Granite Cutters
Union had records of deaths among its members, but not a list of all its members over
time. Death records went back in time to January 1, 1969, and continued until the early
2000s. The union paid death benefits (the amount determined by duration of union
membership) to families of decedents, so next of kin had a financial incentive to inform
the union of deaths.

PERTANYAAN 2. Berdasarkan informasi diatas:

A. Jenis penelitian apa yang dapat dilakukan dalam situasi seperti diatas?
B. Siapa kelompok tidak terpajannya?
C. Potensi kelemahan apa yang akan ditemukan dalam penelitian ini?
Union records enabled the identification of 2,274 deaths. Last name, date of death, and
the state in which the decedent had worked were available from death records, but
Social Security number was not. Death certificates were obtained for 1,911 of these

individuals (84%), of whom 1,905 were white males. Six men were missing age at
death, and analyses were restricted to 1899 white males for whom age at death was
known. For 90% of the records, the amount of funeral money awarded (corresponding to
length of union membership) was also available.
A proportionate mortality analysis was performed, comparing the granite cutters to the
U.S. population. Deaths were stratified by age and calendar time to avoid confounding
from these variables. The proportion of deaths from lung cancer, out of all deaths, in the
exposed cohort versus the U.S. population was calculated. A proportionate cancer
mortality ratio (PCMR) was also calculated for lung cancer, and a mortality odds ratio
(MOR) was also calculated by treating the data as if they were case-control data.

PERTANYAAN 3.
A. Dengan adanya angka penyebab kematian tidak diketahui sebesar 16%,
apakah penelitian akan tetap dilanjutkan? Mengapa?
B. Bagaimana cara memastikan penebab kematian pada subyek yang tidak
terdapat sertifikat kematian untuk meminimalisir bias?

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