职业接尘及吸烟致呼吸系统疾病死亡危险度比较的队列研究

目的 比较接尘、吸烟对呼吸系统疾病死亡的影响.方法 在1989年至1992年广州建立职业健康监护档案的基础上对30岁以上、职业接触粉尘和无粉尘接触的80 987名工人进行前瞻性队列研究.结果 （1）队列平均年龄43.5岁,职业性粉尘接触率16.3%,吸烟率43.7%,饮酒率33.5%.（2）队列平均随访8年,35人失访,失访率0.04%,总死亡1 593人中,219人死于肺癌,90人死于非恶性肿瘤性呼吸系统疾病.（3）调整相关因素后,相对于不吸烟者,吸烟者肺癌死亡相对危险度（RR）为3.32,是粉尘接触者相对于无粉尘接触者肺癌死亡RR（1.53）的2.2倍.粉尘接触者非恶性肿瘤性呼吸系统疾病死亡RR为2.41,是吸烟者（1.89）的1.28倍.尤其是矽尘接触者,其非恶性肿瘤性呼吸系统疾病死亡RR为5.72,是吸烟者的3.03倍.既接触粉尘又吸烟,呼吸系统疾病死亡RR增加更明显.（4）男性吸烟者呼吸系统疾病死亡危险分别随日吸烟量、烟龄的增加而增加.结论 职业接触粉尘和吸烟均可引致超额的呼吸系统疾病死亡,两者存在协同作用.吸烟致肺癌死亡RR高于接尘,而致非恶性肿瘤性呼吸系统疾病死亡RR则低于接尘.吸烟与呼吸系统疾病死亡危险存在明显的剂量-效应关系.     

职业接触粉尘与死亡相关的前瞻性队列研究

目的探讨职业接触粉尘对死亡的影响,为现代职业卫生政策法规的制定以及相关工作提供科学依据。方法以1989～1992年广州市实施并建立的职工职业健康监护档案为基础资料,选年龄≥30岁的80987名接尘和无接尘职工为研究对象,进行前瞻性队列研究。结果(1)队列平均43．5岁,主要为工人,中学文化,已婚,接尘率16．3％,吸烟率43．7％,饮酒率33．5％;(2)队列平均随访8年,失访35例,死亡1539人,以恶性肿瘤死亡为主。接尘、无接尘全死因粗死亡率分别为男380．14／10万和314．56／10万,女95．72／10万和98．33／10万。(3)调整相关混杂因素后,接尘者全死因、恶性肿瘤、呼吸系统疾病死亡相对危险度(RR)分别为1．24、1、34和2．41,其中男性矽尘接触者分别为1．57、1．61和5、72,男接尘者肺癌和鼻咽癌死亡相对危险度分别为1、67和1．81,与无接尘者比,RR的增加均有显著性意义。(4)调整相关混杂因素后,接尘者全死因、恶性肿瘤死亡归因危险度百分比(AR％)和人群归因危险度百分比(PAR％)分别为19．5％、3．8％、25．4％和5．3％。结论职业接触粉尘可致全死因死亡尤其是恶性肿瘤和呼吸系统疾病死亡危险性增加。     

职业接触粉尘及吸烟对死亡影响的前瞻性队列研究

目的 研究接尘和吸烟对死亡的影响。方法 以1989－1992年广州实施并建立的职工职业健康监护档案为基础资料，选年龄≥30岁的接尘工人和无任何粉尘及其他有害物质接触的职工（对照组）61648名为研究对象，进行前瞻性队列研究。结果 （1）队列失访28例，死亡1186例，以恶性肿瘤死亡为主；（2）本队列男性多于女性，年龄35－44岁，主要为工人，中学文化，已婚，率42．2％，饮酒率32．8％；（3）调整相应混杂因素后，全死因、恶性肿瘤和呼吸系疾病死亡接尘者相对危险度（RR）分别为1．24、1．34和1．96，与对照组比较，差异均有显著性（P＜0．01），吸烟者RR分别为1．16、1．37和1．63，与不吸烟者比，前二者差异有显著性（P＜0．01）；既接尘又吸烟者上述相应死因死亡1RR分别为1．48、1．85和3．12，明显高于单纯接尘或单纯吸烟者，差异有显著性（P＜0．01）；（4）接尘对死亡的影响主要表现在职业接触矽尘和木尘。结论 接尘与吸烟均可致死亡危险性增加，并存在协同作用。     

景德镇瓷厂工人死因分析

目的 探索危害陶瓷工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,对景德镇3个瓷厂1972年到1974年在册且工作一年以上所有陶瓷工人建立队列,随访至2003年底.队列中对死者均查询死因,陶工尘肺由当地疾病控制中心诊断小组确诊,肺癌均收集医院诊断病例.以全国城市居民年龄别死亡率为参照计算标化死亡比(SMR).结果 队列成员共4957名,随访至2003年底,共计130 783.6人年,死亡1636人,死亡率为1250.9/10万,累计死亡率为33.1%.影响陶瓷工人寿命的主要疾病按累计死亡率从高到低排序分别是:恶性肿瘤、心血管疾病、呼吸系统疾病、传染性疾病.与全国平均水平比较,陶瓷工人全死因死亡率基本持平,标化死亡比为1.01,死亡率明显升高的疾病有呼吸系统疾病(SMR=1.30)、陶工尘肺(SMR=36.35)、传染性疾病(SMR=5.08)和肺结核(SMR=4.06).陶瓷粉尘对工人寿命的影响十分明显,接尘工人多种疾病的死亡率均高于非接尘组,除陶工尘肺外,接尘组肺癌(RR=1.9,95%CI:1.2～3.1)、呼吸系统疾病(RR=2.4,95%CI:1.8～3.2)、肺结核(RR=1.6,95%CI:1.2～2.1)明显高于非接尘组,差异有统计学意义.研究还发现全死因、肠癌、肺癌、呼吸系统疾病、肺结核危险度均随接尘严重程度而明显增加,呈现接触一反应关系.结论 陶瓷行业主要职业危害为粉尘,卫生工作重点应是控尘和预防肺结核.     

劳动卫生

飞行负荷对民航飞行人员血脂水平的影响；通化钢铁公司职业病发病情况分析及防治方法；铅作业工人热应激蛋白70水平的分析；井下煤矿工人肠易激综合征患病现状分析；铁矿工人队列死因研究；职业接尘及吸烟致呼吸系统疾病死亡危险度比较的队列研究。     

滑石粉尘对陶瓷工人的健康效应

目的：探讨滑石粉尘对陶瓷工人呼吸系统疾病发生发展的影响。方法：采用历史前瞻性队列研究，全体队列成员按是否接触矽尘和滑石尘分为不接尘组，矽尘组和滑石尘矽尘组，运用优势比（Odds Ratios,OR)方法作计算分析。结果：滑石尘矽尘组工人的非恶性呼吸道疾病（如尘肺）和肺心病的死亡危险度与矽尘组类似，但其癌症的死亡危险度，特别是肺癌死亡比不接尘组明显超高，OR＝4．73，P＜0．01）。结论：认为颗粒型滑石可能是瓷厂工人中致肺癌因子，滑石粉尘对矽肺发病也有明显的促进作用。     

我国北方两卷烟厂职工死亡回顾性调查

为分析烟草尘对卷烟厂职工恶性肿瘤、呼吸系疾病死亡专率的影响，采用回顾性队列研究的方法，对河南、黑龙江两省某两卷烟厂１９８２～１９９４年间在册的职工进行恶性肿瘤、呼吸系疾病死因分析。以队列成员中的非暴露于烟草尘组为内对照，比较两组间的各死因死亡专率的差异。结果表明：男、女职工暴露组的恶性肿瘤、呼吸系疾病死亡专率均显著高于非暴露组。按接触烟草水平分为非接触组、低剂量接触组和高剂量接触组分析发现：恶性肿瘤、呼吸系疾病死亡与其暴露烟草尘水平可能存在剂量－效应关系。提示：接触烟草尘可能是恶性肿瘤、呼吸系疾病死亡的危险因素。吸烟和接触烟草尘的协同作用分析表明：吸烟和接触烟草尘对恶性肿瘤、呼吸系疾病可能存在协同作用。     

上海市区男性吸烟与恶性肿瘤死亡的前瞻性研究

目的 探讨上海市区中老年男性吸烟与恶性肿瘤死亡关系,以及随访期间研究对象吸烟情况的改变对这种关系的影响。方法 自1986年1月至1989年9月调查上海市区45～64岁男性居民18244人,每年上门随访一次;用Cox比例风险模型计算相对危险度(RR)。结果 至2002年度随访结束,全队列共随访235762人年,人均随访12.9年。在此期间共死亡3365例,其中恶性肿瘤死亡1381例。基线调查时吸烟者相对于不吸烟者总死亡RR值为1.49,去除随访期间吸烟情况有变化的对象后,一直吸烟者相对于一直不吸烟者的总死亡RR值增至1.78;相应的恶性肿瘤死亡RR值由2.05增至2.58,肺癌死亡RR值由6.40增至8.77。基线调查时吸烟者年龄标化总死亡率及标化恶性肿瘤死亡率为1695.6/10万人年和782.0/10万人年,去除随访期间吸烟情况有变化的对象后,一直吸烟者相应的标化死亡率增至2353.7/10万人年和1144.6/10万人年。结论 吸烟是上海市区中老年男性总死亡及恶性肿瘤死亡的重要危险因素。不考虑随访期间研究对象吸烟状况的改变会低估吸烟对健康的危害性。     

西安市1 268名军队老年男性吸烟相关死亡18年随访研究

目的 探讨军队老年男性不同吸烟状态与烟草相关死亡的关系.方法 选择队列设计,采用多元Cox比例风险模型计算RR值和95%CI.研究对象为西安市22个军队干休所的全部男性离休干部,共计1 268人.观察终点指标为全死因和烟草相关死亡.结果 截止2005年6月30日,共观察18 766.28人·a,平均随访14.80人·a.死亡491人,748人存活,29人失访.多元Cox模型分析显示,既往吸烟者与不吸烟者比较,相对危险度(95%CI)分别为总死亡1.24(1.01～1.53)、慢性阻塞性肺病1.91(1.06～3.46)、肺癌2.91(1.36～6.23)、冠心病1.15(0.68～1.93).与吸烟者比较,戒烟者总死亡和肺癌死亡的危险性分别下降66.67%和14.98%.结论 吸烟为该队列老年男性死亡的主要危险因素,戒烟可以降低总死亡和肺癌死亡的危险性.     

温石棉与肺癌——二十七年追踪研究

目的 探讨单纯接触温石棉的工人恶性肿瘤,尤其肺癌是否超高。方法 采用固定队列研究方法。研究队列为515例男性石棉工人,人列条件为1972年1月1日工资在册,工龄满1年,没有明显心肺疾患者。对照队列为650例不接尘男性工人,其余条件同研究队。追踪27年（1972－1998）。结果 （1）研究队列全癌死亡50例（SMR＝144）,其中肺癌22例（SMR＝652）;．对照队列全癌死亡1例（SMR＝34）,肺癌3例（SMR＝89）。两队列间全癌和肺癌差异均有显著性（P＜0．05）。（2）不接触石棉的吸烟者肺癌RR为2．6,不吸烟的石棉接触者肺癌RR为12．2,而接触石棉的吸烟者RR高达32．1。吸烟和石棉暴露协同指数为2．2。（3）研究队列发生胸膜间皮瘤2例。结论 单纯暴露于温石棉的工人肺癌显著超高。     

Asbestos exposure and cancer mortality among petroleum refinery workers: a Poisson regression analysis of updated data

The authors investigated the relationship between asbestos exposure and respiratory cancer mortality among maintenance workers and other blue-collar workers at an Italian oil refinery. The cohort contained 931 men, 29,511 person-years, and 489 deaths. Poisson regression analysis using white-collar workers as an internal referent group provided relative risk estimates (RRs) for main causes of death, adjusted for age, age at hiring, calendar period, length of exposure, and latency. Among maintenance workers, RRs for all tumors (RR = 1.50), digestive system cancers (RR = 1.41), lung cancers (RR = 1.53), and nonmalignant respiratory diseases (RR = 1.71) were significantly increased (p < 0.05); no significant excess was found for all causes and among maintenance (RR = 1.12) and other blue-collar workers (RR = 1.01). Results confirm the increased risk of death from respiratory diseases and cancer among maintenance workers exposed to asbestos, whereas other smoking-related diseases (circulatory system) were not statistically different among groups.     

Asbestos Exposure and Cancer Mortality among Petroleum Refinery Workers: A Poisson Regression Analysis of Updated Data

The authors investigated the relationship between asbestos exposure and respiratory cancer mortality among maintenance workers and other blue-collar workers at an Italian oil refinery. The cohort contained 931 men, 29,511 person-years, and 489 deaths. Poisson regression analysis using white-collar workers as an internal referent group provided relative risk estimates (RRs) for main causes of death, adjusted for age, age at hiring, calendar period, length of exposure, and latency. Among maintenance workers, RRs for all tumors (RR = 1.50), digestive system cancers (RR = 1.41), lung cancers (RR = 1.53), and nonmalignant respiratory diseases (RR = 1.71) were significantly increased (p 0.05); no significant excess was found for all causes and among maintenance (RR = 1.12) and other blue-collar workers (RR - 1.01). Results confirm the increased risk of death from respiratory diseases and cancer among maintenance workers exposed to asbestos, whereas other smoking-related diseases (circulatory system) were not statistically different among groups.     

铁矿工人队列死因研究

目的 探索危害铁矿作业工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 用流行病学队列研究方法,对武钢大冶铁矿7 469名职工从1972年开始随访30余年,以全国城市居民年龄别死亡率为参照,用标化死亡比（SMR）作为统计指标,并计算95%可信区间.结果 自1972年至2003年底,共计199 108.0人年,死亡1 752人,累积死亡率为23.5%.影响铁矿工人寿命的主要疾病按累积死亡率从高到低排序分别是：肿瘤（7.8%）、脑血管疾病（3.9%）、心血管系疾病（3.4%）和呼吸系疾病（2.9%）,恶性肿瘤以肺癌和肝癌最多,分别占总死亡数的10%和7.4%.全死因SMR为1.06,高于全国平均水平.死亡率明显升高的疾病有鼻咽癌、肝癌、肺癌、尘肺和意外事故,SMR分别为1.84、1.51、1.83、14.94和1.25.队列中接尘工人与非接尘工人比较,接尘工人全死因、胃癌、肺癌、呼吸系统疾病、心血管疾病和意外事故的累积死亡率明显升高（相对危险度分别为1.35、1.83、1.61、2.27、1.34和1.69）.结论 以粉尘为主的职业有害因素明显影响铁矿工人健康和寿命.     

Radiological findings as predictors of mortality in Quebec asbestos workers.

Two cohorts of chrysotile miners and millers in Quebec were selected to study the extent to which chest radiographs taken while still employed predict mortality. The paper presents mainly findings in much the larger cohort, which consisted of 4559 men (two-thirds past workers) whose latest radiograph had been assessed by one of six experienced readers into what became the UICC/Cincinnati (U/C) classification; by the end of 1975 there had been 1543 deaths in this cohort. The findings were generally confirmed in the other cohort, comprising 988 current male workers, who had been examined in 1967-8 by questionnaires on respiratory symptoms and smoking and by lung function tests, and for whom all six readers had assessed their 1966 radiographs into the U/C classification; 130 men had died by the end of 1975. Men with any radiographic abnormality, heavy dust exposure, or a history of cigarette smoking had relative risks (RRs) of total mortality greater than unity. Death from pneumoconiosis was associated with small parenchymal opacities, usually irregular, of profusion l/l or more, and with heavy dust exposure but not with smoking. Most who died from lung cancer had smoked cigarettes, or had been heavily exposed to dust, or both. Small parenchymal opacities were present in most but not all the excess deaths due to lung cancer. Deaths from other malignant diseases showed no consistent dust or x-ray patterns. RRs of deaths from most other causes were raised for certain radiographic features. Failures in forecasting mortality were primarily due to deaths in which asbestos-related disease was not the primary cause but may have been a contributing factor. The main findings validated the U/C classification convincingly, particulary as the films had been taken as routine and were of modest quality. Despite objective rules for the reading and the fact that all six readers were contributing to the development of the classification, there was inevitably some observer variation. The importance of radiographic technique and the need for careful control of the reading is evident. Our results provide support for the use of the chest radiograph for surveillance of asbestos workers, and for environmental monitoring. Its protective value for individual workers, however, is limited to the extent that radiological progression continues after withdrawal from exposure, and by the carcinogenic risk associated with dust already retained.     

矽肺对肺癌及总死亡影响的回顾性队列研究

目的 利用香港矽肺患者队列的资料进行分析,探讨矽尘、矽肺与肺癌的关系.方法 选择1981年1月1日至1998年12月31日期间在香港尘肺诊所登记的2789例男性矽肺病例为研究对象,取用同时期一般男性人群作为对照.用人年的方法估计各死因的标化死亡比(SMR),用Axelson's法间接调整吸烟的混杂影响.矽尘与肺癌的剂量-效应关系采用多因素p-spline平滑法模型来拟合最佳风险模型.结果 该组研究队列人数为2789,共观察24 992.6人年,失访率仅为2.9%.该队列主要工种为建筑工人(5 1.09%)和地下沉箱操作工人(37.54%).队列总死亡人数为853人,平均死亡年龄为(63.8±10.27)岁,整个队列中86例死于肺癌.全死因及全癌的SMR均明显上升,首位死因是呼吸道疾病,肺癌的5MR明显增加(SMR:1.69,95%CI:1.35～2.09).去除年龄、时期和吸烟的混杂因素的影响,矽肺对肺癌的相对危险度下降到1.12(95%CI:0.89～1.38).间接调整吸烟的混杂影响后建筑工人及地下沉箱工人肺癌的相对危险度分别为1.09(95%CI:0.82～1.42)和1.56(0.98～2.36).多因素p-spline平滑法风险模型分析显示,肺癌与累积呼吸性矽尘总量或平均矽尘浓度的关系无剂量-效应关系.结论 队列研究未发现接触矽尘或矽肺能增加肺癌死亡的危险,平滑法模型拟合的风险模型并不支持矽尘与肺癌死亡之间存在剂量-效应关系.     

Individual asbestos exposure: smoking and mortality--a cohort study in the asbestos cement industry.

A historical prospective cohort study comprised all persons employed from 1950 to 1981 for at least three years in the oldest asbestos cement factory in the world. From 2816 persons eligible for the study, record based estimates and measurements of dust and fibres and histories of smoking based on interviews were used to calculate individual exposures over time. After observation of 51,218 person-years and registration of 540 deaths, underlying causes of death for this cohort were compared with those for the regional population on the basis of death certificates. Deaths from lung cancer in asbestos cement workers were higher (standard mortality ratio (SMR) 1.7), but after adjustment for age and sex specific smoking habits this was not significant (SMR 1.04). The study had a probability of greater than 92% of detecting a smoking adjusted SMR of 1.5 or more. Using the best available evidence (including necropsy records) 52 deaths were assigned to lung cancer and five to mesothelioma. Life table analyses confirmed the predominant influence of smoking on lung cancer. Mesothelioma was associated with the use of crocidolite in pipe production. From present working conditions with much lower concentrations of chrysotile and no crocidolite no more occupational cancers are expected in the asbestos cement industry.