A critical review of the epidemiologic literature on health effects of occupational exposure to vinyl chloride.

We have attempted to critically review and summarise the collective epidemiologic evidence concerning the association of occupational vinyl-chloride exposure with human health outcomes, including cancer, liver cirrhosis, cardiovascular disease, nonmalignant respiratory disease and acroosteolysis. Based on data from individual reports, qualitative and, where possible, quantitative summaries are presented. With respect to cancer, which has been extensively studied, angiosarcoma of the liver is the only malignancy causally related to vinyl-chloride exposure. Hypothesised associations between vinyl chloride and cancers of other sites, namely lung, brain and lymphohaematopoietic system, are not consistently supported by the available data. Similarly, the epidemiologic data relating vinyl chloride to nonmalignant disease, while quantitatively limited and qualitatively suboptimal, do not support a causal association for any of the studied disorders. In summary, a comprehensive review of the relevant epidemiologic literature revealed that occupational vinyl-chloride exposure has not been conclusively or causally linked to any adverse health outcome, with the exception of angiosarcoma of the liver.