接尘、吸烟者死亡危险度比较的前瞻性队列研究

目的 比较接尘、吸烟对死亡的影响。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、中学文化程度、已婚，接尘率16．3％，吸烟率43．7％，饮酒率335%。(2)队列平均随访8年，失访35人，死亡1539人，以恶性肿瘤死亡为主。(3)调整相关混杂因素后，全死因、恶性肿瘤、心脑血管疾病等死亡相对危险度(RR)，接尘者和吸烟者基本一致，但鼻咽癌、呼吸系统疾病死亡RR值，接尘者高于吸烟者，而肺癌、胃癌死亡RR值，吸烟者分别是接尘者的2．2倍和1．5倍；接尘可协同吸烟致死亡危险性明显增加。(4)男性总死因、恶性肿瘤和呼吸系统疾病死亡RR值，矽尘接触者高于吸烟者，心脑血管疾病死亡RR值，木尘接触者也高于吸烟者。(5)人群死亡归因危险度百分比(PARP)吸烟者是接尘者的2．5倍。(6)男吸烟者全死因、恶性肿瘤、肺癌、胃癌的死亡危险随日吸烟量、烟龄的增加而明显递增，冠心病、呼吸系统疾病的死亡危险则分别随日吸烟量、烟龄的增加而增加。结论 接尘、吸烟者死亡RR值基本一致，接尘与吸烟存在协同作用，某些死因死亡危险吸烟者较明显，某些接尘者较明显；吸烟者PARP较接尘者高；吸烟与死亡危险存在明显的剂量效应关系。     

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。     

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。     

上海某冶炼厂铅接触工人肿瘤死亡的回顾性队列研究

目的 了解职业铅接触工人肿瘤死亡情况,探讨职业铅接触与肿瘤的关系。方法 1985年1月1日前在本厂工人1年以上,且1985年1月1日仍存活的男性工人共6971名组成全队列,其中3344名在铅接触车间工作的工人组成的亚队列为接触队列。随访从1985年1月1日至1997年12月31日。以上海市人口的肿瘤死亡率作为标准对照,计算标化死亡比（SMR）;以本厂非接触人群作内对照计算相对危险度（RR）;估计累计接触剂量进行剂量－反应关系分析。结果 全队列6971人共观察87576人年,接触队列3344人共观察41505人年。全队列中,肺癌的SMR（95％CI）为128．0（101．1－159．7）。1965年后入厂的工人肺癌的SMR为463．7（P＜0．01）。有铅接触工作史且工龄超过20年的工人鼻咽癌的SMR＝408．0（P＜0．01）,肺癌的SMR＝156．6（P＜0．01）。肿瘤总计、恶性肿瘤总计、食管癌、胃癌、肝和胆道癌、肺癌和膀胱癌的RR（95％CI）分别为3．25（2．43－3．89）、3．28（2．54－4．32）、3．57（1．08－10．47）、2．93（1．15－4．87）、4．58（2．03－9．97）、8．58（4．82－15．11）、6．66（2．83－13．01）。将累计接触剂量分为高、中、低3个组,中、高组工人恶性肿瘤RR分别为1．62（P＜0．05）和1．70（P＜0．05）,且有随累计接触剂量增加危险性升高的趋势。中、高组工人的肺癌RR分别为2．55（P＜0．05）,和2．31（P＜0．05）。结论 工人肿瘤死亡危险性升高可能与铅接触有关,但还需要在控制其他职业有害因素接触和非职业性有害因素接触的情况下作进一步的研究。     

水泥作业工人的职业暴露和吸烟对肺通气功能和胸部X线影像的影响

目的分析职业暴露和吸烟对水泥作业工人肺通气功能和胸部X线影像的影响。方法对某市参加职业病体检的工人进行不同层次分组作回顾性研究。结果水泥厂工人不接尘组与接尘组比较，接尘组FVC％、FEV1％、FEV1％（％）低于标准值例数及胸片0^＋例数明显高于不接尘组，差异有非常显著性（P〈0．01）；而工期尘肺两者无统计学意义（P〉0．05）。水泥厂接尘工人吸烟组与不吸烟组肺通气功能与胸片的比较，吸烟组FVC％低于标准值例数明显高于不吸烟组，差异有非常显著性（P〈0．01）；吸烟组FEV1％低于标准值例数高于不吸烟组，差异有显著性（P〈0．05），FEV1％（％）低于标准值例数、胸片0^＋、Ⅰ期尘肺例数无统计学意义（P〉0．05）。结论水泥企业的职业暴露和吸烟对工人的肺通气功能影响是明显的，对X线胸部影像改变也是肯定的，肺通气功能变化比X线影像变化敏感。     

钢铁工人比例死亡比研究

为探讨钢铁工人的死亡原因，分析职业危害因素与死因的关系，用比例死亡比方法对唐山钢铁公司1984～1996年12年间死亡的1088例工人的死因进行了一般死因和癌死因分析，并接接触粉尘和高温分别进行了分析。参照人群为河北省1990～1992年死亡抽样调查的男性居民。在一般死因比例死亡比分析中，钢铁工人的心脏病（PMR＝1．51，P＜0．01）和泌尿生殖系统疾病（PMR＝1．85，P＜0．05）死亡危险明显超过参照人群。在癌比例死亡比分析中，白血病（PCMR＝1．92，P＜0．05）和肺癌（PCMR＝1．98，P＜0．01）的死亡危险明显超过参照人群。接接触的危险因素分析表明，接触高温和粉尘工人肺癌死亡超高；接触粉尘者呼吸系统疾病死亡超高。提示，钢铁工人心脏病、肺癌和白血病的超额死亡与钢铁工业的职业危害有关。     

氯乙烯作业工人恶性肿瘤流行病学调查研究

目的 为了解氯乙烯作业工人恶性肿瘤发病情况。方法 采用回顾前瞻性观察法,对921名氯乙烯作业工人进行了40年死因流行病学调查。结果 男性接触组肝癌死亡率明显高于对照组。RR为2．16（P＜0．05）;接触组恶性肿瘤、肝癌的死亡也显著高于1994年全国城市居民恶性肿瘤的死亡率及1995年全国城市居民肝癌的死亡水平。SMR分别为1．8、29（P＜0．05）。在恶性肿瘤分类构成中,接触组肝癌居首位。结论 氯乙烯作业工人肝癌高发具有职业性特征。     

吸烟对氧化铝厂接尘作业工人肺通气功能的影响

目的研究吸烟对氧化铝厂接尘作业工人肺通气功能的影响。方法采用横断面整群抽样,对某氧化铝厂作业工人进行问卷调查和肺通气功能检查：结果1．吸烟与粉尘的联合作用：吸烟32人与对照组比较,肺通气功能差异无显著性（P〉0．05）,长期接尘可引起接尘工人肺功能的下降,早期表现为小气道阻力增如,而舌发展为阻塞性改变,与对照组比较．差异有非常显著性（P〈0．01）,其比值比为3．25,而既吸烟又接尘则使接尘工人肺功能的下降更明显（P〈0．01）,与对照组比较,其比值比为5．56。2．重度叹蛔组接尘工人肺功能异常检出率高干不吸烟组和轻吸烟组,差异有显著意义（P〈0．01）结论吸悃与接尘在对氧化铝厂接尘作业工人肺功能影响方面具有协同作用。     

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。     

Mortality analyses for rungsten miners]

OBJECTIVE: To investigate the mortality from main causes of death in 6 tungsten miners and explore the effects of cumulative dust exposure on standardized mortality ratios (SMRs) from main causes. METHODS: A cohort of 18027 workers registered in the employment record from 6 tungsten mines located in Hunan and Jiangxi province and working for at least 1 year was identified for this study. SMRs were calculated based on Chinese national mortality. Trend analysis was used to analyze the effect of cumulative dust exposure on SMRs of main causes of death. RESULTS: The cohort was followed up from 1972 to 2003 with an accumulative of 470 722.21 person-years. A total of 6135 workers died, and the mortality was 13.03 per thousand. Cardiovascular disease, respiratory disease, malignant neoplasm and pulmonary tuberculosis accounted for 79.32% of all death. The mortalities of all-causes, pneumoconiosis, pulmonary tuberculosis, nasopharyngeal carcinoma, infectious disease, respiratory disease, cardiovascular disease and liver cancer were found to be significantly higher than the national average level. Positive dose-response relationship between SMRs and cumulative dust exposure was observed in all-causes, pneumoconiosis, pulmonary tuberculosis, respiratory disease, cardiovascular disease (P < 0.01). CONCLUSION: The mortality from main causes of death for the dust-exposed workers are higher than that for non dust-exposed workers. Positive dose-response relationships are observed between cumulative dust exposure and SMRs from all-causes, respiratory disease (including silicosis), pulmonary tuberculosis and cardiovascular disease.     

Combined effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease in gold miners

A sample of 2209 white South African gold miners aged 45-54 between 1968-71, who started mining exposure during 1936-43, was investigated from 1968-71 to 30 December 1986. The effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease (COLD) was assessed. The relative risk (RR) for dust exposure before 1950 was estimated as 2.5 (95% confidence interval (CI) 1.5-4.2), for 10 units of 1000 particle-years. The combined effect of dust exposure before 1950 and years of cigarette smoking on mortality from COLD was best estimated by the multiplicative model, indicating that the two exposures act synergistically. All those that died of the disease were smokers. According to the estimates of attributable risk about 5% of the deaths from COLD were from the effect of dust, 34% were from smoking, and 59% were from the combined effect of dust and smoking. In conclusion, the results indicate that workers exposed to silica dust who smoke are at higher risk of dying from COLD than smokers not exposed to silica dust, as the two exposures act synergistically in causing COLD.     

Combined effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease in gold miners.

A sample of 2209 white South African gold miners aged 45-54 between 1968-71, who started mining exposure during 1936-43, was investigated from 1968-71 to 30 December 1986. The effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease (COLD) was assessed. The relative risk (RR) for dust exposure before 1950 was estimated as 2.5 (95% confidence interval (CI) 1.5-4.2), for 10 units of 1000 particle-years. The combined effect of dust exposure before 1950 and years of cigarette smoking on mortality from COLD was best estimated by the multiplicative model, indicating that the two exposures act synergistically. All those that died of the disease were smokers. According to the estimates of attributable risk about 5% of the deaths from COLD were from the effect of dust, 34% were from smoking, and 59% were from the combined effect of dust and smoking. In conclusion, the results indicate that workers exposed to silica dust who smoke are at higher risk of dying from COLD than smokers not exposed to silica dust, as the two exposures act synergistically in causing COLD.     

油田固井水泥粉尘对作业工人健康危害的调查研究

[目的]了解固井水泥粉尘对作业工人健康危害情况。[方法]对油田固井水泥加工和使用现场进行劳动卫生学调查,为接尘工人进行内科、眼科、耳鼻喉科体检,并进行高仟伏拍片、心电图、肺功能及血清NO、MDA、SOD、GSH-Px的含量及活性测定。[结果]作业场所粉尘浓度严重超标,接尘工人呼吸系统刺激症状、眼结膜炎、眼翼状胬肉、咽喉充血、鼻甲充血的检出率明显高于对照(P<0.01),接尘工人血清NO水平、MDA含量升高,抗氧化酶SOD、GSH-Px下降,与对照组比较,差异均有统计学意义(P<0.01)。[结论]固井水泥粉尘对作业工人健康危害严重。     

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.     

Environmental mycological study and respiratory disease investigation in tussah silk processing workers

This study presents the results of an investigation of respiratory symptoms, pulmonary function and chest X-ray examinations, and analysis of antibodies to fungi of 197 tussah silk-processing workers and 40 control workers. An industrial hygiene survey and environmental mycological studies were also conducted. The dust concentrations in tussah silk processing workshops were less than 5.1 mg/m(3) on average, with a maximum of 7.8 mg/m(3) below the national health limit of 10 mg/m(3). Most dusts in all tussah silk processing workshops contained less than 1.2% silica. Numbers of isolated fungi in tussah silk processing workshops [755-6,544 cfu/m(3) (colony forming unit/m(3)), were significantly higher than those in control environments (63-472 cfu/m(3)). The prevalences of respiratory symptoms in tussah silk processing workers were higher than those in control workers. The prevalences of respiratory symptoms in exposed male non-smoking workers were 44.4% with chronic cough, and 38.9% with chronic phlegm respectively, which were significantly higher than those (12.5%, 12.5% respectively) in male non-smoking control workers (p<0.05). The prevalences in exposed male smoking workers were 42.9% with dyspnea, and 38.1% with chest tightness respectively, which were significantly higher than those (16.7%, 8.3% respectively) in male smoking control workers (p<0.01). The prevalences of respiratory symptoms in exposed female workers were 25.3% with chronic cough, 38.0% with chronic phlegm, 31.0% with dyspnea, and 29.1% with chest tightness respectively, which were significantly higher than those (10.0%, 10.0%, 10.0%, 5.0% respectively) in female control workers (p<0.01). Fifteen exposed workers often suffered from fever. Five X-rays were abnormal and four cases had nodular or patchy shadows. The prevalences of pulmonary function abnormalities in the exposed female group were significantly higher than those in control groups (p<0.01). The OD(450 nm) values for antibodies to fungi in tussah silk processing workers were significantly higher than those of control workers (p<0.05). The positive rates of anti-fungal antibodies in tussah silk-processing workers were also significantly higher than those of control workers (p<0.01). The results suggested that fungi might be one of the main allergens in respiratory diseases in the tussah silk processing workers.     

A 24 year cohort study of mortality in slate workers in North Wales

AIM: To study mortality in slate workers in North Wales. METHODS: A cohort study, with a contemporaneous control group (quasi-experimental study) with follow-up from 1975 to 1998. The date and cause of death in those who had died were identified from the Office of National Statistics. RESULTS: Seven hundred twenty six slate workers and 529 age matched controls took part in the survey. We found a clear excess of death rate among slate workers compared with controls, having adjusted for age and smoking habit. This was largely restricted to those ages less than 75. Hazard ratio for all deaths was 1.24 [95% Confidence Interval (CI)=1.04-1.47, P=0.015]. The excess was mainly due to respiratory disease and pneumoconiosis. The hazard ratio for respiratory deaths was 1.85 (95% CI=1.21-2.82). CONCLUSION: It is likely that the excess deaths in the exposed group was due to exposure to slate dust. The accuracy of pneumoconiosis as a cause of death is questionable, but we lack radiographs close to death to confirm it.