Response to Kottek and Kilpatrick, ‘Estimating Occupational Exposure to Asbestos in Australia’

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We thank Drs. Kottek and Kilpatrick (2016) for their comments on our article (van Oyen et al., 2015). Kottek and Kilpatrick express concerns about low cumulative asbestos exposure estimates in some job titles, which they attribute to underestimation of the frequency and duration of peak exposures. We agree that exposure reconstructions should ‘make sense’ and we appreciate the opportunity to provide further insight into AsbJEM in response to the raised concerns.

A general population job-exposure matrix (JEM), like AsbJEM, is designed to assign exposure levels to a wide range of jobs, based on their typical tasks and work conditions. By assigning exposures in a standardised and cost-effective way, avoiding potential recall and reporting bias, JEMs provide a useful instrument for epidemiological studies (Kromhout and Vermeulen, 2001; Peters et al., 2011). On the flip-side, a JEM assignment will not cover the full range of exposure levels for all workers who performed that job. This element is a well-recognised limitation of general population JEMs, since exposure levels are known to differ between individuals with the same job (Kromhout et al., 1993). We therefore take the opportunity to emphasize once more that caution needs to be taken when applying JEMs, and users need to be aware of both their strengths and limitations, as with any other exposure assessment method. That being said, we also consider AsbJEM to be an instrument to support identification of possible exposure to asbestos in individual Australian workers with a full job history, together with other available information sources.