煤矿工人和煤工尘肺患者恶性肿瘤死亡研究

本文采用回顾性队列研究方法,对1972年1月工资在册煤矿接尘工人3516例,煤工尘肺患者1752例和对照组工厂工人4210例,追踪17年。结果表明死亡密度尘肺组2611.1/10万,接尘组503.67/10万,工人对照组最低241.9/10万。三个组恶性肿瘤死因构成占前两位的是肝癌和肺癌,以工厂不接尘工人作参照,煤矿接尘工人全癌、肺癌、胃癌和胃肠癌均不超高,煤工尘肺患者肺癌显著低于工厂工人对照组,全癌、肺癌、胃癌、胃肠癌均无显著性差异;用煤矿所在地居民作对照、接尘组肺癌显著超高,全癌显著低,尘肺组全癌也显著地低,用四川省居民作对照接尘组肺癌显著超高,尘肺组全癌和肺癌显著地低,结合本文结果讨论了诸多因素后,认为煤矿工人与工厂工人比全癌、肺癌、胃癌和胃肠癌不超高,煤工尘肺合并肺癌不高发。     

铜陵有色金属公司730例尘肺患者死因浅析

对７３０例尘肺患者的死因分析表明：尘肺患者首位死因仍为肺结核，但随着年代的推移，癌症和心血管系统疾病死亡逐渐增多，尘肺患者症死亡率明显高于普通人群。癌症死亡者平均接尘工龄高于全死因接尘工龄。故笔者认为，该公司要重视尘肺癌症和老年病的防治，加强癌症与长期吸入粉尘的研究。     

不同类型厂矿接尘工人肺癌病因学研究──矽尘或矽肺与肺癌的关系

为评价游离二氧化硅（简称矽尘或ＳｉＯ２）是否致肺癌？矽肺是否是肺癌前变基础？选择四类接尘厂矿进行队列和队列内病例对照研究。队列对象６８２８５人。有矽肺６４８７例，肺癌３３０例（男３１９，女１１），配对照１３５８例。根据厂矿历年工业卫生记录和近期对已知致癌物监测结果，定量评估了每个对象的接尘水平及每个病例对照的累积接触量。研究对象追访到１９８９年底，死亡６１９２人。与全国居民死亡平均数计算的期望值近似。全死因中癌症是第一死因，但全癌低于国家居民死亡率。分析结果说明：（１）矽尘单独存在时不是肺致癌剂。肺癌不超高，与接尘关系不明显；（２）在６４８７名矽肺队列中，肺癌相对危险度仅比非矽肺高０．２２倍，主要反应在铜铁矿工人中（Ｒ＝２．２），而矽肺患病率最严重的钨矿工人，其肺癌危险度反而随接尘水平上升而下降，再则肺癌死亡率与矽肺期别不呈正比；形态学上观察也不支持肺癌病变与矽肺纤维化病变相关。本研究结果难以支持矽尘或矽肺与肺癌病因学相关的假说。     

徐州矿务集团1003例死亡尘肺病例分析

目的　探讨尘肺发生、发展及死亡规律 ,为其预防提供科学依据。方法　对徐州矿务集团 10 0 3例死亡尘肺病例进行分析。结果　 ( 1)死因构成列前四位的是 :尘肺、肺结核、慢性肺心病、肺癌 ;1990年开始 ,死因构成顺序变化为 :尘肺、慢性肺心病、肺癌、脑血管意外 ,肺结核已不再是导致尘肺患者死亡的主要因素。( 2 )死亡尘肺病例累计死亡百分比变化与接尘工龄长短有关 ,接尘工龄 5～ 2 0年间累计死亡百分比呈快速直线上升。 ( 3 )死亡尘肺病例中不同接尘工种之间平均死亡年龄、发病工龄有显著性差异 (P <0 0 1) ;纯掘进工、纯采煤工的平均死亡年龄和发病工龄短于其他接尘工种。 ( 4)自七十年代以来 ,尘肺患者死亡年龄和病程呈延长趋势。结论　降低生产环境中粉尘浓度、限制接尘时限是预防和控制尘肺病的关键     

广西锡矿工人死因分析

为评价锡矿工人的死亡原因,对广西４个锡矿共７８５５名工人进行队列研究,追访到１９９４年底,共计１７１２５０人年。结果表明,锡矿工人全死因标准化死亡比（ＳＭＲ＝１．０２）略高于全国居民平均水平,死亡超高的疾病主要是肺结核、恶性呼吸系疾病（包括陶工尘肺）、心血管疾病和肝癌。影响工人寿命的主要疾病是恶性肿瘤、憬血管疾病、非恶性呼吸系统病和脑血和疾病。接尘工人非恶性呼吸系统病、脑血管疾病和肺癌死亡均明显高     

接尘与肺癌形态关系的研究

接尘与肺癌形态关系的研究陈卫红陈镜琼近年来，我国的主要死因中，癌症死亡率持续增长，其中肺癌死亡增长最为明显［１］，由于工业的迅速发展，职业因素导致的肿瘤也越来越受到关注，接尘与肺癌关系的研究一直是探讨的热点。为了解厂矿接尘工人肺癌与非接尘工人肺癌在形...     

不同类型厂矿接尘工人肺癌病因学研究

为评价游离二化硅是否致肺癌？矽肺是否是肺癌前变基础？选择四类接尘厂矿进行队列和队列内病例对照研究。队列对象６８２８５人。有矽肺６４８７例，肺癌３３０例，配对照１３５８例。根据厂矿历年工业卫生记录和近期对书籍致癌物监测结果，定量评估了每个对象的接尘水平及每个病例对照的积接触量。研究对象追访到１９８９年底，死亡６１９２人，与全国居民亡平均数计算的期望值近似。全死因中癌症是第一死因，但全癌低于国家居民死     

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.     

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。     

煤矿矿工尘肺与肺癌死亡Poisson回归分析

目的 探讨尘肺与肺癌的关系。方法 对涟邵矿务局3140例尘肺矿工进行回顾性队列分析,计算主要死因的标化死亡比（SMR）,对尘肺与肺癌的关系进行Poisson回归分析。结果 尘肺矿工全死因与肺癌均高于对照人数,其中肺癌高于湖南省人群5倍;Poisson回归分析表明尘肺矿工肺癌与对照组的差别主要在25－44岁组。结论 支持尘肺与肺癌的相关关系。     

Exposures to silica mixed dust and cohort mortality study in tin mines: exposure-response analysis and risk assessment of lung cancer

BACKGROUND: Mineral dusts that contain crystalline silica have been associated directly or indirectly with the development of pneumoconiosis or silicosis, non-malignant respiratory diseases, lung cancer, and other diseases. The health impacts on workers with silica mixed dust exposure in tin mines and dose-response relationships between cumulative dust exposure and the mortality from lung cancer are investigated. METHODS: A cohort of 7,837 workers registered in the employment records in 4 Chinese tin mines between 1972 and 1974 was identified for this study and the mortality follow-up was traced through 1994. Of the cohort, the cause of death was ascertained for 1,061 (97%) of the 1,094 deceased workers. Standardized mortality ratios (SMRs) were calculated for all workers, non-exposed workers, and dust-exposed workers with different exposure levels, silicotics, and non-silicotics based on Chinese national rates. RESULTS: The mortality from all causes in four tin mines was nearly the same as the national mortality. Malignant neoplasm, cerebrovascular disease, and cardiovascular disease accounted for 68.6% of all deaths. Mortality excess from lung cancer, liver cancer, all malignant diseases, and non-malignant respiratory diseases was observed among dust-exposed workers; a 50-fold excess of pneumoconiosis was observed. There was an upward trend for SMRs of lung cancer was noted from no exposure to low, medium, and high exposure levels (SMRs=1.29, 2.65, 2.66, 3.33). The shape of the exposure-response curve for risk of lung cancer at high exposure levels was inconsistent in these four mines. CONCLUSIONS: The findings indicated a positive dose-response relation between exposure to cumulative dust and the mortality of lung cancer. High arsenic content in dust particles, together with crystalline silica, may play an important role in causing increased mortality from lung cancer.     

陶瓷厂矿工人死因队列研究

为评价陶瓷厂矿工人中癌症和其他疾病的死亡率，对江西及湖南的八个陶瓷厂矿共１２９４４人队列进行研究，追访到１９９４年底，共计２７５７０１．８人年，死亡２２９０人，全死因标化死亡率与全国居民平均水平持平，死亡超高的疾病主要是肺结核，非恶性呼吸系疾病，心知管疾病和肝癌。影响工人寿命的主要疾病是恶性肿瘤，心血管疾病，非恶性呼吸系疾病和脑血管疾病。     

Dust exposure, pneumoconiosis, and mortality of coalminers

General mortality in approximately 25 000 British coalminers over 22 year periods ending in 1980 was 13% lower on average than in English and Welsh men in the same regions of Britain. There were significant within region variations between collieries, and standardised mortality ratios increased during the later years of the follow up, approaching or slightly exceeding 100 in most of the 20 coalmines studied. Age specific comparisons of 22 year survival rates were made in subgroups. Relative risks of death from all non-violent causes for men with the earliest stage of progressive massive fibrosis (PMF category A), compared with risks in miners with no pneumoconiosis (category O), ranged from 1.2 in those aged 55-64 initially to 3.5 for those aged 25-34. Mortality in miners with higher categories of PMF (B or C) was even more severe. Survival rates in men with category 1 simple pneumoconiosis were about 2% to 3% lower than in miners with radiographs classified as category O, but there was no consistent evidence of an increase in mortality with increasing category of simple pneumoconiosis. Mortality from all non-violent causes increased systematically with increases in estimates of exposure to dust before the start of the follow up. That gradient was attributable primarily to deaths certified as due to pneumoconiosis and those recorded as due to bronchitis and emphysema (p less than 0.001). There was some evidence of a dust related increase in deaths from cancers of the digestive system (p approximately equal to 0.05), but none of an association between exposure to coalmine dust and lung cancer. Lung cancer mortality, assessed over 17 year periods, was about 5.5 times higher in smokers than in life long non-smokers. Smokers with no pneumoconiosis had slightly higher lung cancer death rates than smokers with pneumoconiosis. We conclude that miners exposed to excessive amounts of respirable coalmine dust are at increased risk of premature death, either from progressive massive fibrosis or from chronic bronchitis or emphysema.     

Dust exposure, pneumoconiosis, and mortality of coalminers.

General mortality in approximately 25 000 British coalminers over 22 year periods ending in 1980 was 13% lower on average than in English and Welsh men in the same regions of Britain. There were significant within region variations between collieries, and standardised mortality ratios increased during the later years of the follow up, approaching or slightly exceeding 100 in most of the 20 coalmines studied. Age specific comparisons of 22 year survival rates were made in subgroups. Relative risks of death from all non-violent causes for men with the earliest stage of progressive massive fibrosis (PMF category A), compared with risks in miners with no pneumoconiosis (category O), ranged from 1.2 in those aged 55-64 initially to 3.5 for those aged 25-34. Mortality in miners with higher categories of PMF (B or C) was even more severe. Survival rates in men with category 1 simple pneumoconiosis were about 2% to 3% lower than in miners with radiographs classified as category O, but there was no consistent evidence of an increase in mortality with increasing category of simple pneumoconiosis. Mortality from all non-violent causes increased systematically with increases in estimates of exposure to dust before the start of the follow up. That gradient was attributable primarily to deaths certified as due to pneumoconiosis and those recorded as due to bronchitis and emphysema (p less than 0.001). There was some evidence of a dust related increase in deaths from cancers of the digestive system (p approximately equal to 0.05), but none of an association between exposure to coalmine dust and lung cancer. Lung cancer mortality, assessed over 17 year periods, was about 5.5 times higher in smokers than in life long non-smokers. Smokers with no pneumoconiosis had slightly higher lung cancer death rates than smokers with pneumoconiosis. We conclude that miners exposed to excessive amounts of respirable coalmine dust are at increased risk of premature death, either from progressive massive fibrosis or from chronic bronchitis or emphysema.     

锡矿作业工人粉尘接触和队列死因分析

[目的]评价混合性粉尘接触对锡矿作业工人健康的影响及累积粉尘接触与主要引起工人死亡疾病的关系。[方法]建立广西4个锡矿1972~1974年在册且工作一年以上工人的研究队列,以全国城市居民年龄别死亡率为参照,标化死亡比(SMR)作为统计指标。[结果]队列共计7837人,至1994年底,共计165156.7人年,死亡1094人。影响锡矿工人健康的主要疾病按累积死亡率从高到低排序分别是:肿瘤(5.3%)、脑血管疾病(2.4%)、心血管系统疾病(1.9%)和呼吸系统疾病(1.7%),这4种疾病引起的死亡占总数的80.7%,恶性肿瘤以肺癌和肝癌最多,分别占总死亡数的12.6%和10.9%。全死因标化死亡比(SMR=0.94)接近全国平均水平,而鼻咽癌、肝癌、肺癌、白血病、尘肺和脑血管疾病的SMR较高,分别为3.41、1.97、2.49、2.31、33.89和1.15。队列中接尘工人4629名,研究发现矿尘接触导致死亡率上升,与粉尘接触存在明确剂量反应关系的疾病主要是尘肺、肺癌和肺结核。[结论]混合性粉尘明显影响工人健康,累积粉尘接触与肺癌死亡存在剂量-反应关系,可能与粉尘中高含量的砷和游离二氧化硅有关。     

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.     

Mortality among Ontario members of the International Union of Bricklayers and Allied Craftworkers

BACKGROUND: Dust exposed workers may be at increased risk of pneumoconiosis, stomach cancer, lung cancer, and obstructive lung disease. Bricklayers may experience high exposures to silica and inorganic dusts. The aim of this study was to examine the mortality pattern of bricklayers to identify occupational associations with mortality. METHODS: A cohort of 10,953 workers was assembled from records of the International Union of Bricklayers and Allied Craftworkers (IUBAC). Mortality was ascertained by linkage to the Canadian Mortality Registry at Statistics Canada. Standardized Mortality Ratios (SMRs) were computed using Ontario general population mortality rates as the reference. RESULTS: Twenty or more years from first membership, SMRs for lung (158; 130-190) and stomach (235; 140-370) cancers were significantly elevated. There were four deaths from pneumoconiosis, but non-malignant respiratory mortality SMRs were not increased. CONCLUSIONS: Bricklayers and Allied Craftworkers are at risk from diseases associated with heavy exposure to inorganic dust: lung cancer, stomach cancer, and pneumoconiosis. Dust control as well as education and training of these workers to protect themselves against inhalation hazards is necessary.     

Mortality of a cohort of U.S. workers employed in the crushed stone industry, 1940-1980

The mortality of 3,246 males who had been employed 1 or more years during 1940-1980 at 20 crushed stone operations was evaluated for possible association between employment and death from lung cancer, pneumoconiosis, and other respiratory diseases. Four deaths were attributed to pneumoconiosis. Based on available work histories, at least two of these deaths were probably due to dust exposures in the crushed stone industry. Mortality attributed to pneumoconiosis and other nonmalignant respiratory diseases, including chronic obstructive lung disease, was significantly increased overall (SMR: 1.98; 95%CI: 1.21-3.05), and especially so for a subcohort of crushed stone workers that processed granite (SMR: 7.26; 95%CI: 1.97-18.59). With regard to lung cancer, overall SMRs were elevated (although not statistically significant). Analyzed by rock type, there was a significantly elevated lung cancer SMR among granite workers with at least 20 years latency (SMR: 3.35; 95%CI: 1.34-6.90). Although not definitive, results of this study are consistent with the hypothesis that exposure to respirable silica dust is a risk factor for lung cancer.     

Dust exposure and mortality in chrysotile mining, 1910-75.

We report a further follow-up of a birth cohort of 11 379 workers exposed to chrysotile. The cohort consisted of 10 939 men and 440 women, born 1891-1920, who had worked for at least a month in the mines and mills of Asbestos and Thetford Mines in Quebec. For all subjects, length of service and estimates of accumulated dust exposure were obtained, with a smoking history for the vast majority. Three methods of analysis, two based on the "man-years" methods, the other a "case-and-multiple-controls" approach, gave results consistent with one another and with previous analyses. By the end of 1975, 4463 men and 84 women had died. Among men, the overall excess mortality, 1926-75 was 2% at Asbestos and 10% at Thetford Mines, much the dustier region. The women, mostly employed at Asbestos, had a standardised mortality ratio (SMR) all causes, 1936-75) of 0.90. Analysis of deaths 20 years or more after first employment showed that in men with short service (less than five years) there was no discernible correlation with dust exposure. Among men employed at least 20 years, there were clear excesses in those exposed to the heaviest dust concentrations. Reanalysis in terms of exposure to age 45 showed definite and consistent trends for SMRs for total mortality, for lung cancer, and for pneumoconiosis to be higher the heavier the exposure. The response to increasing dose was effectively linear for lung cancer and for pneumoconiosis. Lung cancer deaths occurred in non-smokers, and showed a greater increase of incidence with increasing exposure than did lung cancer in smokers, but there was insufficient evidence to distinguish between multiplicative and additive risk models. There were no excess deaths from laryngeal cancer, but a clear association with smoking. Ten men and one woman died from pleural mesothelioma. If the only subjects studied had been the 1904 men with at least 20 years' employment in the lower dust concentrations, averaging 6.6 million particles per cubic foot (or about 20 fibres/cc), excess mortality would not have been considered statistically significant, except for pneumoconiosis. The inability of such a large epidemiological survey to detect increased risk at what, today, are considered unacceptable dust concentrations, and the consequent importance of exposure-response models are therefore emphasised.     

煤工肺癌及其他肿瘤的流行病学调查研究

采用回顾性队列调查法,对海勃湾矿务局(以下简称海局)尘肺工人肺癌、全肿瘤进行了调查。结果表明:海局尘肺工人肺癌与当地人群肺癌死亡率比较,P<0.005,RR=56.1,AR=225.2,SMR=8.07,P<0.01。海局与当地全肿瘤死亡率分别为599.4/10万与62.5/10万,P<0.005。海局尘肺工人肺癌、全肿瘤均明显高于当地人群。在煤矿接尘18年以上,如果发生肺癌,应视为职业病。