粉尘和化学毒物暴露与支气管哮喘患病的影响

调查居住在中国东北的两个城市,年龄≥４０岁的８９８１名男性社区随机样本,检验暴露于粉尘和化学毒物与医生诊断的支气管哮喘患病之间的关系。支气管哮喘的患病率为１．１７％,调整年龄、教育程度、居住面积、吸烟状况及使用煤炉取暖后,接触粉尘和化学毒物的人群患哮喘的调整ＯＲ值分别为３．２８（９５％ＣＩ２．２～５．１）和１．６０（９５％ＣＩ０．９～２．７）。进一步调整分为对照组、仅粉尘暴露、仅化学毒物暴露及粉尘和化学毒物暴露组,支气管哮喘的ＯＲ估计值分别为：仅粉尘暴露３．５７（９５％ＣＩ２．２～６．３）,仅化学毒物暴露１．３５（９５％ＣＩ０．６～３．２）,两者都暴露２．８６（９５％ＣＩ１．５～５．４）。     

天津市女性糖尿病危险因素初步研究

对天津市区居民１２１例女性非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病例进行了１：１配对病例对照研究。经条件Ｌｏｇｉｓｔｉｃ回归模型分析，发现与ＮＩＤＤＭ有关的危险因素是：经济收入高（ＯＲ一３．４８，９５％ＣＩ＝２．０２～５．９８）、糖尿病家族史（ＯＲ＝６．３７，９５％ＣＩ＝２．９２～１３．８９）、既往相关病史（ＯＲ＝６．９２，９５％ＣＩ＝３．２５～１４．７３）、绝经年龄晚（ＯＲ＝３，３９，９５％ＣＩ＝２．１５～５．３５）、嗜甜食（ＯＲ＝３．５６，９５％ＣＩ＝２．２９～５．５４）、肥胖（ＯＲ＝１６．３２，９５％ＣＩ＝６．０２～４４．２３）及ＢＭＩ大（ＯＲ＝２．０８，９５％ＣＩ＝１．５２～２．８５）。同时还发现，体育锻炼（ＯＲ＝０．３６，＝３１．４７，Ｐ＜０．０１）和蔬菜、水果等是保护性因素。     

武汉市前列腺癌的流行病学研究

前列腺癌是欧美国家男性的主要死亡原因，我国还没有全面的发病率和死亡统计资料。为了解我国前列腺癌的流行情况，在武汉市１９９０～１９９２年前列腺癌的发病及死亡报告的基础上，收集了１９９０～１９９５年住院治疗的１０２例前列腺癌现患病例进行了１１配比的病例对照研究。结果显示：武汉市前列腺癌的发病率和死亡率分别为１．３７／１０万和０．７５／１０万，世界人口年平均标化发病率和死亡率分别为１．１０／１０万和０．６６／１０万。泌尿系统病史〔ＯＲ＝５．４２，９５％可信区间（ＣＩ）＝１．５６～１８．８３〕、子女数超过３个（ＯＲ＝２．４３，９５％ＣＩ＝１．１７～５．０２）、青壮年期每周性交超过３次（ＯＲ＝３．３８，９５％ＣＩ＝１．５１～７．５８）、滥用药物（ＯＲ＝４．１１，９５％ＣＩ＝１．６５～１０．２５）、体质指数高（ＯＲ＝２．５８，９５％ＣＩ＝１．３０～５．１１）等是前列腺癌的危险因素，而体力劳动（ＯＲ＝０．３５，９５％ＣＩ＝０．１７～０．７１）、初次遗精年龄晚于１８岁（ＯＲ＝０．２０，９５％ＣＩ＝０．０８～０．５２）等是其保护性因素。     

煤工尘肺死亡的回顾性队列研究

为探索煤工尘肺病人的主要死因以及煤工尘肺与恶性肿瘤死亡之间的关系，采用流行病学回顾性队列研究方法对开滦矿务局１９５２～１９９５年诊断的３２２８例煤工尘肺患者（全部为男性）的结局进行了调查。队列观察从１９７０年１月１日开始，至死亡病例的死亡日期或１９９５年１２月３１日终止，以全国男性人群为参照。用标化死亡比（ＳＭＲ）作为统计指标，并计算９５％可信区间（９５％ＣＩ）。结果：全死因ＳＭＲ较全国人群高１１％（ＳＭＲ＝１．１１，９５％ＣＩ：１．０４～１．１８）。其中肺心病死亡（ＳＭＲ＝５．９７，９５％ＣＩ：５．２３～６．７７）、肺结核死亡（ＳＭＲ＝３．６８，９５％ＣＩ：３．０１～４．４６）均高于全国人群。全癌死亡低于全国人群（ＳＭＲ＝０．８１，９５％ＣＩ：０．７１～０．９２），但肺癌死亡高于全国人群（ＳＭＲ＝１．３６，９５％ＣＩ：１．１０～１．６６）。按不同死亡年代及粉尘种类进一步分析，均发现肺癌高发。结果表明：煤工尘肺病人的全死因死亡比稍高于全国人群，其中，肺心病和肺结核有明显的超额死亡。煤工尘肺病人中肺癌死亡超高。提示：煤工尘肺与肺癌的发生有关。     

低危人群中乳腺癌与人工流产相关关系的研究

探讨人工流产与乳腺癌发病危险性之间的关系。方法研究对象为经产妇。资料以条件Ｌｏｇｉｓ－ｔｉｃ回归模型分析。教育程度，以及初产年龄，采用过人工流产的妇女患乳腺癌的危险性比对照高２．９（ＲＲ＝２．９）倍，９５％ＣＩ为１．４－４．４（９５％ＣＩ＝１．４－４．４）。而在低于３５岁的妇女中，其相对危险度为４．５，９５％ＣＩ为１．９－１０．７（ＲＲ＝４．５，９５％ＣＩ＝１．９－１０．７），高于３５岁的妇女中，     

吸烟,饮酒及高血压与脑出血的关系

采用以医院为基础的配比病例对照研究方法，探讨了吸烟、饮酒及高血压与脑出血的关系。结果表明，吸烟、饮酒及高血压与脑出血联系的ＯＲ（９５％ＣＩ）分别为２．００（１．１８～３．３８）、２．３５（１．３６～４．０７）和１２．７１（７．０１～２３．０５）；吸烟或饮酒与高血压在脑出血发病过程中均呈协同作用；脑出血归因于吸烟、饮酒及高血压的人群归因危险度（９５％ＣＩ）分别为２６．２％（９．４％～４３．１％）、２５．４％（１１．５％～３９．２％）和６９．９％（６０．３％～７９．５％）。     

钢铁工人肺癌的高危工种和病因分析

收集鞍钢所属５家医院１９８７～１９９３年间确诊的全部６１０例肺癌病人,采用巢式病例对照研究,在全体鞍钢（包括退休）工人人事库中随机抽取９５９人为对照,收集其终生职业史和暴露史,计算各种尘、毒的终生累计暴露剂量,进行多变量分析。结果表明暴露组工人肺癌危险性高于非暴露组（ＯＲ＝１４,９５％ＣＩ＝１１～１８）。焦炉工最为严重。职业性危险因子为各种粉尘、多环芒烃和石棉。累积总尘量、累积ＢＡＰ总量、石棉暴露严重程度与肺癌发生危险度均呈剂量反应关系,不同性质粉尘之间ＯＲ值未见显著差异。     

橡胶职业暴露与肺癌关系的前瞻性研究：I标化死亡率分析

目的 将橡胶职业暴露人群肺癌死亡率与普通人群比较，估计其肺癌危险度及肺癌在工种间的聚集性。方法 对某橡胶厂工人进行２３年（１９７３－１９９５年）随访，应用标化死亡率比（ＳＭＲ）分析。结果 男女性工人肺癌死亡率轻度增高，ＳＭＲ分别为１．２２（９５％ＣＩ：０．５８￣２．２４）和１．２６（９５％ＣＩ：０．９０￣１．７１）。肺癌死亡率在不同工种间差别有显著意义（一致性检验Ｐ＝０．００２），表现为硫化、胶鞋     

四川省抽样人群中高血压危险因素研究

根据四川省１９９１年度高血压抽样调查资料，采用病例－对照的研究方法，结合条件Ｌｏｇｉｓｔｉｃ回归模型，分析了高血压的危险因素。结果表明，影响高血压的主要危险因素是：体重指数（ＯＲ＝１．６６１，９５％ＣＩ：１．５２９～１．８０４）、高血压家族史（ＯＲ＝１．２５８，９５％ＣＩ：１．１６４～１．３６０）、脉率（ＯＲ＝１．５３９，９５％ＣＩ：１．２４９～１．８９８）、卫生知识水平（ＯＲ＝１．０５８，９５％ＣＩ：１．０２９～１．０８８）和每日酒精摄入量（ＯＲ＝１．１９０，９５％ＣＩ：１．０４２～１．３５９）。从本次调查资料，我们未发现吸烟与高血压有关联。     

本溪市大气污染与死亡率的关系

本溪市１９９３年和１９９４年两年总死亡率经年龄调整后为６９１．３／１０万。比较了７个大气监测点周围各街道死亡率后、发现大气污染水平与总死亡率及３种慢性病之间都有显著相关;ＴＳＰ每增加１００μｇ／ｍ３,总死亡率增加８％（ＯＲ的９５％ＣＩ＝１．０２～１．１４）;对慢性阻塞性肺疾患（ＣＯＰＤ）、心血管病（ＣＨＤ）和脑血管病（ＣＶＤ）死亡专率分别增加２４％（ＯＲ的９５％ＣＩ＝１．０４～１．４４）、２４％（ＯＲ的９５％ＣＩ＝１．０８～１．４１）和８％（ＯＲ的９５％ＣＩ＝１．００～１．１５）     

Risk of lung cancer from exposure to dusts and fibers in Leningrad Province, Russia

BACKGROUND: Exposures to several dusts and fibers (DFs) have been established or suggested as etiologic factors for lung cancer. METHODS: To investigate lung cancer risk in relation to exposure to DFs, we identified 540 pathologically-diagnosed lung cancer cases and 582 controls from the 1993-1998 autopsy records of the 88 hospitals of Leningrad Province, Russia. Lifetime job-specific exposure measurements were available for 15 organic, 15 man-made and 28 natural-inorganic agents. RESULTS: In male workers, increased risks were found for linen dust (OR = 3.68, 95% CI 1.00-13.6, adjusted for age, smoking and residence), and unspecified DFs (OR = 1.44, 95% CI 1.07-1.94). Small non-significant excess risks were observed for quartz dust (OR = 1.27; 95% CI 0.83-1.93) and man-made vitreous fibers (MMVFs) (OR = 1.82, 95% CI 0.88-3.75). In female subjects, risks were non-significantly associated with paper dust (OR = 1.77, 95% CI 0.74-4.20), and unspecified DFs (OR = 1.52, 95% CI 0.77-3.03). CONCLUSIONS: The study showed increased lung cancer risk for selected categories of DFs.     

Study of lung cancer histologic types, occupation, and smoking in Missouri

A case-control study of lung cancer was conducted to evaluate the relationship between lung cancer histologic types and occupation, adjusted for smoking. A total of 4,431 white male cases and 11,326 cancer controls, diagnosed between 1980 and 1985, were identified through the Missouri Cancer Registry. For all histologic types combined, excess risk was observed among many a priori suspected high-risk occupations. Lung cancer was elevated among men employed as insulators (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 0.7, 137.8), carpenters (OR = 1.3; 95% CI = 1.0, 1.7), painters, plasterers, and wallpaper hangers (OR = 2.0; 95% CI = 1.2,3.3), structural metal workers (OR = 1.9; 95% CI = 0.6,6.0), mechanics and repairers (OR = 1.3; 95% CI = 1.0,1.7), motor vehicle drivers (OR = 1.5; 95% CI = 1.2,1.8), police and firefighters (OR = 1.6; 95% CI = 1.1,2.3), and food service personnel (OR = 1.8; 95% CI = 1.0,3.5). A deficit of lung cancer was observed among farmers (OR = 0.9; 95% CI = 0.7,1.0). Adenocarcinoma of the lung was elevated among carpenters (OR = 1.6; 95% CI = 1.0,2.5) and cabinet and furniture makers (OR = 2.0; 95% CI = 0.4,8.1), which is interesting because of the previous reports of excess adenocarcinoma of the nasal cavity associated with wood dust exposure. Adenocarcinomas were also elevated among plumbers (OR = 2.0; 95% CI = 1.0,3.8) and printers (OR = 1.8; 95% CI = 0.7,4.2). Electricians were at slightly increased risk for adenocarcinoma (OR = 1.5; 95% CI = 0.7,2.8) and "other" or mixed cell types of lung cancer (OR = 1.5; 95% CI = 0.8,2.9) but at decreased risk for small cell (OR = 0.8; 95% CI = 0.3,2.0) and squamous cell (OR = 0.8; 95% CI = 0.4,1.6) tumors. Among welders, adenocarcinoma (OR = 1.7; 95% CI = 0.7,3.8) and squamous cell (OR = 1.7; 95% CI = 0.9,3.3) cancers were elevated, but small cell and "other" lung cancers were not. Despite the limitations of the Cancer Registry data, some interesting associations were observed that merit further study, particularly the association between lung adenocarcinoma and occupational exposure to wood and wood dust.     

Lung cancer in motor exhaust-related occupations

The association between employment in motor exhaust-related occupations and the risk for lung cancer was examined in 2,291 male cases of lung cancer and 2,570 controls in data pooled from three U.S. case control studies carried out by the National Cancer Institute between 1976 and 1983. Most analyses were limited to subjects providing direct, in-person interviews, including 1,444 cases and 1,893 controls. For those providing direct interviews and employed 10 years or more in motor exhaust-related (MER) occupations, the age, smoking, and study area adjusted odds ratio (OR) for lung cancer was 1.5 (95% CI = 1.2-1.9). Risk was elevated for truck drivers (OR = 1.5; 95% CI = 1.1-1.9) and for other MER occupations (OR = 1.4; 95% CI = 1.1-2.0). The odds ratios associated with MER employment of 10+ years were 1.6 (95% CI = 1.2-2.1) for whites and 1.4 (95% CI = 0.9-2.1) for nonwhites; 1.2 (95% CI = 0.7-2.0) [corrected] for those with possible exposure to other recognized or reported lung carcinogens; and 1.6 (95% CI 1.2-2.1) for those without such exposure. The 50% excess risk for lung cancer associated with employment in motor exhaust-related occupations could not be explained by greater use of cigarettes or by other occupational exposures among these workers.     

中国非吸烟女性肺癌危险因素的病例-对照研究

目的探讨中国非吸烟女性患肺癌的危险因素。方法应用1∶2配对的病例对照方法,收集2001年9月~2004年2月在北京、上海和成都指定医院经病理诊断确诊的非吸烟女性新发肺癌住院病例157例,按照性别、年龄(±2岁)、不吸烟等配对因素选取医院对照和人群对照。利用统一调查表对调查对象进行面对面问卷调查,收集病例和对照有关危险因素的暴露史等情况。通过单因素分析和多因素条件Logistic回归分析筛选肺癌的主要危险因素。结果单因素分析发现28个暴露因素与非吸烟女性肺癌发生有关。多因素分析发现,被动吸烟指数≥50人年(OR=1·77,95%CI为1·07~2·92)、经常吃动物内脏(OR=1·85,95%CI为1·06~3·22)、职业接触粉尘(OR=2·47,95%CI为1·21~5·03)和工作场所通风不良(OR=4·02,95%CI为1·74~9·29)为非吸烟女性肺癌发生的危险因素;常吃蔬菜(OR=0·26,95%CI为0·12~0·59)、经常服用维生素(OR=0·53,95%CI为0·30~0·93)、结婚后家庭人均月收入≥500元(OR=0·50,95%CI为0·28~0·91)和初次生育年龄在24~30岁之间(OR=0·53,95%CI为0·32~0·90)为非吸烟女性肺癌发生的保护因素。趋势性检验发现,被动吸烟与非吸烟女性发生肺癌的相对危险度之间存在一定剂量反应关系。结论被动吸烟、职业接触粉尘、经常吃动物内脏和工作场所通风不良会增加非吸烟女性患肺癌的危险性。常吃蔬菜和经常服用维生素等因素可以降低非吸烟女性发生肺癌的危险性。     

Occupation and lung cancer risk among women in Northern China

Lifetime occupational histories were obtained in a case-control study of 965 female lung cancer patients and 959 controls selected from the general population in Shenyang and Harbin, People's Republic of China, where most women have worked outside the home. After adjusting for smoking, we found a significantly increased risk of lung cancer associated with employment involving the manufacture of transportation equipment (OR = 1.6, 95% CI = 1.0, 2.6), in particular the manufacturing of automobiles (OR = 3.0, 95% CI = 1.4, 6.4). Metal smelting and treatment workers were at an increased risk of lung cancer (OR = 1.5, 95% CI = 1.0, 2.1); the highest risks were observed among metal surfacers (OR = 3.1, 95% CI = 1.1, 9.0) and currently employed foundry workers (OR = 13.0, 95% CI = 1.7, 99.4). On the other hand, about a 50% decreased risk of lung cancer was observed among those employed in textile industries or as leaders of state and party organizations. Based on self-reports, exposures to coal dust and smoke from burning fuel at the workplace were also significant risk factors. The findings were similar when the analyses were confined to nonsmokers and were comparable across the major cell types of lung cancer. © 1993 Wiley-Liss, Inc.     

Occupation and gastric cancer in Spain

The association between occupational exposure and stomach cancer was investigated in a multicenter case-referent study conducted in Spain on 354 histologically confirmed cases and 354 hospital referents, matched by age, gender, and residence. An increased risk of gastric cancer was found for coal mining workers [odds ratio (OR) 11.8], but the number of workers was small, and therefore the 95% confidence interval (95% CI) was wide (95% CI 1.36-103). An increased risk was observed for wood and furniture workers (OR 1.76), construction workers (OR 1.68), and glass and ceramic workers (OR 2.18), but none of these risks were statistically significant. According to an occupation-exposure linkage system an increased risk was found for occupations associated with exposure to silica and mineral dust (OR 1.80, 95% CI 0.90-3.59). All of the OR estimates were adjusted for the confounding factors socioprofessional status and dietary habits. The possibility of a causal association between stomach cancer and coal and mineral dust is supported by the results.     

Nested case-control study of lung cancer among pulp and paper workers in relation to exposure to dusts

BACKGROUND: Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96-153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95-270) among workers engaged in paper production. METHODS: A nested case-control design within a cohort of pulp and paper workers was applied. Seventy-nine lung cancer cases and 237 "healthy" controls were selected from the cohort of 10,460 workers employed during the years 1968-1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression. RESULTS: Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0-fold risk (95% CI:1.3-12.6), and a dose-response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9-4.9), but without dose-response relationship. CONCLUSIONS: Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis.     

Different measures of asbestos exposure in estimating risk of lung cancer and mesothelioma among construction workers

To analyze occupation, expert-evaluated cumulative exposure, and radiographic abnormalities as indicators of asbestos-related cancer risk we followed 16,696 male construction workers for cancer in 1990-2000. We calculated standardized incidence ratios (SIR) in comparison to the Finnish population and relative risks (RR) in a multivariate analysis in comparison to the internal low-exposure category of each indicator. Overall, the risk was increased for mesothelioma (SIR 2.0, 95% CI = 1.0-3.3), but not for lung cancer (SIR 1.1, 95% CI = 0.9-1.2). Radiographic lung fibrosis indicated a 2-fold and a high value of the exposure index a 3-fold RR of lung cancer, while there was no risk among those with pleural plaques. The risk of lung cancer was the highest in insulators (RR 3.7, 95% CI = 1.4-9.9). Occupation, expert-evaluated cumulative exposure, and lung fibrosis are useful indicators of lung cancer risk among construction workers.     

Nested case-control study of lung cancer in four Chinese tin mines

Objectives: To evaluate the relation between occupational dust exposure and lung cancer in tin mines. This is an update of a previous study of miners with high exposure to dust at four tin mines in southern China.

Methods: A nested case-control study of 130 male lung cancer cases and 627 controls was initiated from a cohort study of 7855 subjects employed at least 1 year between 1972 and 1974 in four tin mines in China. Three of the tin mines were in Dachang and one was in Limu. Cumulative total exposure to dust and cumulative exposure to arsenic were calculated for each person based on industrial hygiene records. Measurements of arsenic, polycyclic aromatic hydrocarbons (PAHs), and radon in the work sites were also evaluated. Odds ratios (ORs), standard statistic analysis and logistic regression were used for analyses.

Results: Increased risk of lung cancer was related to cumulative exposure to dust, duration of exposure, cumulative exposure to arsenic, and tobacco smoking. The risk ratios for low, medium, and high cumulative exposure to dust were 2.1 (95% confidence interval (95% CI) 1.1 to 3.8), 1.7 (95% CI 0.9 to 3.1), and 2.8 (95% CI 1.6 to 5.0) respectively after adjustment for smoking. The risk for lung cancer among workers with short, medium, and long exposure to dust were 1.9 (95% CI 1.0 to 3.5), 2.3 (95% CI 1.3 to 4.1), and 2.3 (95% CI 1.2 to 4.2) respectively after adjusting for smoking. Several sets of risk factors for lung cancer were compared, and the best predictive model included tobacco smoking (OR=1.6, 95% CI 1.1 to 2.4) and cumulative exposure to arsenic (ORs for different groups from low to high exposure were 2.1 (95% CI 1.1 to 3.9); 2.1 (95% CI 1.1 to 3.9); 1.8 (95% CI 1.0 to 3.6); and 3.6 (95% CI 1.8 5 to 7.3)). No excess of lung cancer was found among silicotic subjects in the Limu tin mine although there was a high prevelance of silicosis. Exposures to radon were low in the four tin mines and no carcinogenic PAHs were detected.

Conclusions: These findings provide little support for the hypothesis that respirable crystalline silica induces lung cancer. Ore dust in work sites acts as a carrier, the exposure to arsenic and tobacco smoking play a more important part in carcinogenesis of lung cancer in tin miners. Silicosis seems not to be related to the increased risk of lung cancer.

     

Wood dust exposure and the association with lung cancer risk

BACKGROUND: Wood dust was designated as a human carcinogen based on increased sinus and nasal cancer rates among exposed workers. However, data on an association with lung cancer have been inconclusive. METHODS: Self-reported wood dust exposure was compared between 1,368 lung cancer patients and 1,192 cancer-free adults, in a lung cancer case-control study. Epidemiological information was collected through a detailed personal interview. RESULTS: Using several definitions of wood dust exposure we consistently observed statistically significant elevated adjusted risk estimates; for example, the adjusted odds ratio (OR) for combined wood dust related occupations and industries was 3.15 (95% confidence intervals (CI) 1.45-6.86) and for an overall summary exposure measure it was 1.60 (95% CI 1.19-2.14). The association was maintained when stratified by histopathological type. Among those exposed to cigarette smoke and wood dust, 21% of the cases were attributable to biologic interaction. CONCLUSIONS: Wood dust exposure is a potential risk factor for lung cancer.