Smoking prevalence and smoking attributable mortality in Italy, 2010

Objective

To provide updated information on smoking prevalence and attributable mortality in Italy.

Method

A representative survey on smoking was conducted in 2010 on a sample of 3020 Italian adults (1453 men and 1567 women). We used SAMMEC software to update smoking attributable mortality in Italy.

Results

In 2010, 21.7% of Italians (23.9% of men and 19.7% of women) described themselves as current smokers. Smoking prevalence was higher in men than in women in all age groups, except for the middle-aged population (45-64 years; 25.6% in men and 25.9% in women). Age-standardized smoking prevalence was higher in men than in women among less educated subjects and in southern Italy. No substantial difference was observed either in educated subjects or in northern and central Italy. Overall, 71,445 deaths in Italy (52,707 men and 18,738 women, 12.5% of total mortality) are attributable to smoking.

Conclusion

The overall smoking prevalence of 21.7% in 2010 is the lowest registered over the last 50 years. Since 1998, smoking related deaths declined by almost 15%. Given that Italy has now reached the final stage of the tobacco epidemic, anti-smoking strategies should focus on support for smoking cessation.     

Emerging epidemic in a growing industry: cigarette smoking among female micro-electronics workers in Taiwan

OBJECTIVE: To explore the emerging tobacco epidemic in female workers in the growing micro-electronics industry of Taiwan. METHODS: Workers were surveyed regarding their smoking status, sociodemographics and work characteristics. In total, 1950 female employees in two large micro-electronics companies in Taiwan completed the survey. RESULTS: Approximately 9.3% of the female employees were occasional or daily smokers at the time of the survey. The prevalence of smoking was higher in those aged 16-19 years (20.9%), those not married (12.9%), those with a high school education or less (11.7%), those employed by Company A (11.7%), shift workers (14.3%), and those who had been in their present employment for 1 year or less (13.6%). Results of multivariate adjusted logistic regression indicated that younger age, lower level of education, shorter periods of employment with the company and shift working were the important factors in determining cigarette smoking among the study participants. The odds ratio of being a daily smoker was similar to that of being a current smoker. Marital status was the only significant variable when comparing former smokers with current smokers. CONCLUSIONS: Smoking prevalence in female workers in the two micro-electronics companies studied was much higher than previous reports have suggested about female smoking prevalence in Taiwan and China. We suggest that smoking is no longer a 'male problem' in Taiwan. Future smoking cessation and prevention programmes should target young working women as well as men.     

Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality

Background: Gamma-glutamyl transferase (GGT), alanine transaminase (ALT), and aspartate transaminase (AST) are widely used as markers of hepatobiliary disorders in occupational health surveillance. Little is known, however, about the prevalence and occupational and non-occupational determinants of elevated levels of these enzymes in specific occupational groups or about the prognostic value of elevated levels with respect to long-term outcomes such as all-cause mortality and vocational disability. Methods: A cohort study was conducted among 8,043 male construction workers aged 25–64 years who had undergone occupational health examinations in 6 centers in southern Germany from 1986 to 1988 and had been followed until 1994. The prevalence of elevated levels of GGT, ALT, and AST, depending on the sociodemographic and medical characteristics determined at the baseline examination and the risk of vocational disability and all-cause mortality in relation to elevated liver enzyme activity at baseline were assessed. Covariates considered in multivariate analysis included age, nationality, occupation, body mass index (BMI), smoking, and alcohol consumption. Results: The baseline prevalence of elevated activity levels of GGT (>28 U/l at 25 °C), ALT (>22 U/l), and AST (>18 U/l) was 32%, 22%, and 12%, respectively. Factors most strongly related to elevated serum activity levels for all three enzymes were self-reported alcohol consumption, diabetes, and hypertension. BMI was strongly associated with elevations in GGT and ALT but not in AST. Elevated levels of AST and GGT were strongly related to early retirement and all-cause mortality. Men with AST levels exceeding 18 U/l had a 2-fold risk of early retirement and a 3 times higher risk of all-cause mortality as compared with men with lower AST levels. No significant association was observed between ALT and either of the long-term outcomes. Conclusions: Our findings suggest that screening for elevated GGT and AST levels, which are a common finding among construction workers, may be a␣powerful tool for the identification of individuals at increased risk of early retirement and preterm mortality and may be helpful in targeting of prevention efforts. Received: 8 December 1997 / Accepted: 28 March 1998     

Smoking behavior in trucking industry workers

BACKGROUND: In retrospective occupational studies, the degree of confounding by smoking depends on variation in smoking among job-related exposure groups. We assessed the relationship between job title and smoking behavior as part of a study on occupational exposures and lung cancer. METHODS: A questionnaire on smoking was mailed to a sample of 11,986 trucking industry workers. Company records were used to gather other relevant information. RESULTS: The response rate was 40.5%. Among white males, the age-adjusted prevalence of ever smoking was highest among longhaul truck drivers (67%) and lowest among clerks (44%). Smoking rates among workers with other job titles were similar. CONCLUSIONS: Our results will be used to adjust for the differences in smoking among job-related exposure groups when assessing the association between particulate matter exposure and lung cancer mortality. Our study also suggests that an assessment of methods to control for smoking should be considered in the design of retrospective occupational health studies.     

Lung cancer mortality in a french cohort of hard-metal workers

A cohort mortality study was carried out among workers of a plant producing hard metals using cobalt as a binder. This study was aimed at assessing possible lung cancer risks in relation with cobalt exposure. Seven hundred nine male workers with at least 1 year of employment were included in the cohort and followed for mortality from 1956 to 1989. Job histories were provided by the administration of the plant, whereas smoking habits were collected from medical records and by interview. The causes of deaths were ascertained from hospital and general practitioner records. The observed numbers of deaths (obs) were compared with the expected based on national rates with adjustment for age, sex, and calendar time (standardized mortality ratio; SMR). The overall mortality did not differ from that expected (obs = 75, SMR = 1.05), whereas mortality due to lung cancer was in significant excess (obs = 10, SMR = 2.13). This excess was higher among workers employed in the areas with the highest exposure (obs = 6, SMR = 5.03). No trend was observed, however, with duration of employment or time since first employment. Smoking data were available for 81% of the workers and 69% of the deceased and showed that smoking alone does not account for these lung cancer excesses, yet, because of the small numbers involved, no firm conclusion should be drawn from this study.     

Lung cancer mortality in a Dutch cohort of asphalt workers: evaluation of possible confounding by smoking

BACKGROUND: Using data from a Dutch cohort of workers in road construction and asphalt mixing companies, this article describes possible confounding of the association between exposure to bitumen fume and lung cancer mortality by smoking. METHODS: A retrospective cohort of 3,714 workers with at least one season of employment was identified. Semi-quantitative exposure to bitumen fume was assessed by a job-exposure matrix. Information on smoking habits was available for a sub-cohort of 1,138 workers, who underwent medical examinations by the occupational health services in the past. RESULTS: Smoking habits differed between occupational title groups and there was a positive association between cumulative exposure and smoking. Internal analyses using the non-exposed subjects as reference category, showed a positive association between semi-quantitative bitumen fume exposure and lung cancer risk. After adjusting for differences in smoking habits, all relative risks were reduced, but a weak positive association could still be observed. CONCLUSION: Confounding by smoking on the association between exposure to bitumen fume and lung cancer mortality is possible, although the positive trend (not statistically significant) for lung cancer mortality remained. Only a nested case-control study may allow proper treatment of potential (residual) confounding by smoking in this population.     

General mortality and respiratory cancer among a cohort of male chemical workers in California.

Cohort mortality and nested case-control studies were conducted involving 2,901 men employed 1 year or more between 1940 and 1986 at any of four California facilities of a major chemical company. Employees experienced fewer deaths from each of the major causes than were expected based on U.S., California, and local county mortality rates. Respiratory cancer was significantly elevated in one socioeconomic category comprised of operators (SMR = 157, 95% CI = 109-220). The 34 cases who died from respiratory cancer and 136 matched controls, all of whom were operators, were included in a nested case-control study. Departments in which subjects had worked were grouped into 13 work assignment or product categories by an industrial hygienist without knowledge of case-control status. Smoking habits and other occupational exposures were ascertained by telephone interview from subjects or surrogate-responders. As expected, current cigarette smoking was strongly related to respiratory cancer. After adjustment for smoking, cases were significantly more likely than controls to have ever worked in one of the 13 work areas (supervision, services, and business support). However, no dose-response relationship was evident with duration of employment in this work area and the departments involved were associated with plant security and not chemical production. Results were similar when a 15-year latency period was assumed. These findings suggest that the excess of respiratory cancer mortality among operators was most likely due to differences in cigarette smoking or other factors not ascertained, rather than to a specific occupational exposure.     

Timing of retirement and mortality - A cohort study of Swedish construction workers

Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes – to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health – the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners – excluding those with diagnoses normally connected to increased mortality – was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.     

Smoking attributable hospital treatment, treatment costs and smoking attributable mortality in the Czech Republic in 2002

OBJECTIVES: The main objective of this work is to quantify the number of hospitalizations caused by smoking, estimate the costs of hospital treatment and to estimate contribution of smoking to mortality in the Czech Republic (CR) in 2002. METHODS: The estimate of the proportion by which smoking contributed to hospitalizations and to mortality in the CR was computed using the method of smoking-attributable fractions (SAF). The SAF was computed from relative risks established in the American study Cancer Prevention Study II and from estimates of the prevalence of smoking in the CR from a nationwide study conducted in 2002. RESULTS: In 2002, based on data provided by the General Health Insurance Company, there were 145,336 hospitalizations, and the total cost of hospital treatment was estimated as 4.727,612 (in thousands) CZK. The total number of deaths caused by smoking was 20,550 (95% CI: 18,851-22,262), 14,525 in men and 6,025 in women. Deaths caused by smoking represented 19% of the total nationwide mortality for 2002. Earlier estimates were published by Peto and Lopez for 1995 (22,300 deaths caused by smoking) and 2000 (17,746 deaths). The estimate arrived by authors using the SAF method for 2002 corresponds quite well with that by Peto and Lopez for 2000. CONCLUSIONS: The high morbidity and mortality rate related to smoking is directly connected to high prevalence of smoking in the Czech Republic. An effective tobacco control policy, including restrictive measures on availability of tobacco products combined with preventive programmes and smoking cessation programmes, could contribute to the reduction of smoking and save lives and treatment costs caused by smoking.     

职业有害因素接触或(和)吸烟对死亡的影响——广州165 660名职工队列的前瞻性研究

目的研究职业有害因素接触或(和)吸烟对死亡的影响.方法利用1989～1992年广州市实施职业健康监护系统建立的165660名年龄≥30岁的工厂职工和司机的个体健康档案为基础资料,填入光学扫描直读表(ICR)并建立基线数据库,随访至1998年12月31日,了解队列中职工生存状态和死亡原因,计算RR(95%CI),绘制产生职业有害因素接触或吸烟的累积生存曲线.结果(1)165 660名队列职工,平均年龄(42.0±6.3)岁,30～49岁占87%;37.3%的职工接触职业有害因素,工厂男职工吸烟率为70.8%,男司机吸烟率为54.8%,全部女职工吸烟率不足2.0%;(2)平均随访时间为(7 6±1.1)年,共随访1 252 168人年,总死亡人数为2 437人,有51名死因不明(占2.1%),总死亡率为194.6/10万人年;(3)调整相关因素后,职业有害因素接触对总死亡、中风和其他原因的死亡,其RR(95%CI)分别为1.11(1.02～1.20)、1.30(1.01～1.68)和1.27(1.06～1.51);吸烟对男职工总死亡、恶性肿瘤和肺癌死亡,其RR(95% CI)分别为1.23(1.11～1.35)、1.34(1.16～1.54)和2.51(1.81～3.48);职业有害因素接触并吸烟者,总死亡和恶性肿瘤死亡的RR(95% CI)增至1.32(1.16～1.51)和1.35(1.12～1.62);(4)调整相关因素后的总死亡、恶性肿瘤死亡、肺癌和胃癌死亡的RR随吸烟总量(包年)的增加而明显增高,差异有显著性(P<0.01).结论职业有害因素接触对死亡有影响,吸烟对死亡的影响比职业有害因素接触的影响更大,职业有害因素接触并吸烟对死亡的影响非常大.     

A cohort mortality study of construction workers

This report presents a mortality study among the 17,344 members of the Construction Workers' Health Insurance Society of Mie Prefecture in Japan. The study period was between 1973 and 1993. During this period, 480 members died. Age-specific mortality rates of Mie Prefecture were used as comparison standards. Significantly elevated standardized mortality ratio (SMR) and proportionate mortality ratio (PMR) were observed for “accidents and adverse effects.” In addition, the PMRs of all cancers and “cancers of trachea, bronchus and lung” were also significantly elevated. The job classifications were reorganized into three groups, according to the frequency of asbestos exposure the workers experienced on the construction sites. The asbestos exposure was based on job classifications among 7,411 workers who had completed a self-administered survey questionnaire. In the frequent-exposure group, the PMR was significantly elevated for all cancers. In the medium-exposure group, the SMRs were significantly elevated for all cancers and “cancer of trachea, bronchus and lung.” The PMR was significantly elevated for “cancer of trachea, bronchus and lung.” In the less-exposure group, the PMR was significantly elevated for “accidents and adverse effects.” This study provided support for the hypothesis that working in the construction industry might be associated with high risks for asbestos-associated cancers and accidental deaths. Am. J. Ind. Med. 32:35-41, 1997. © 1997 Wiley-Liss, Inc.     

北京市成年人吸烟及被动吸烟情况分析

目的 了解北京市成年人群吸烟和被动吸烟情况。方法 于2008年10-11月采用多阶段分层随机整群抽样方法对北京市18～79岁的常住居民22206人,进行问卷调查。结果 全人群的吸烟率为33.2%,现在吸烟率为29.0%,男女性现在吸烟率分别为54.0%和2.9%,郊区与城区现在吸烟率分别为28.6%和25.6%;吸烟者以吸机制卷烟为主,人均吸烟量为14.7支/d,41.7%的人每天至少吸20支;吸第1支烟平均年龄为18.5岁,开始每天吸烟平均年龄为20.4岁;全市吸烟者戒烟率为15.4%,>50%吸烟者在2000年之后戒烟;43.4%的非吸烟者或戒烟者暴露于二手烟,其中40%的人每天被动吸烟,主要场所是家庭和工作场所。结论 北京市成年人吸烟状况严重,控烟下降不明显。     

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。     

Mortality attributable to cigarette smoking in a cohort study in Japan

We conducted this study to estimate the association and population attributable risk (PAR) of smoking with all-cause and cause-specific mortality based on a general prospective cohort study in Japan. A total of 8,129 subjects (3,996 males and 4,133 females) aged 40 or over were analyzed. The follow-up period was from 1986 to 2003. Smoking habit was classified into three categories of never smoker, former smoker, and current smoker. The Cox proportional hazard model was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). We also estimated the PAR of smoking, and calculated the 95% CI of PAR based on the bootstrap procedure. A total of 112,151 person-years were counted for 8,129 subjects over an average of 13.7 years of follow-up. The results showed that smoking increased the risk of dying from all cancers, cardiovascular, and respiratory diseases in both sexes. For all causes of death, smokers had a HR of 1.30 (95% CI: 1.09, 1.54), PAR of 13.1% (95% CI: 7.6, 22.3) in males, and HR of 1.81 (95% CI: 1.43, 2.29), and PAR of 6.1% (95% CI: 3.1, 9.3) in females compared to never smokers. These results confirm an increased risk of mortality from all causes, as well as from all cancers, cardiovascular disease, and respiratory disease in relation to smoking habit. Smoking is responsible for a considerable proportion of deaths due to all causes as well as cause-specific deaths. Population-based antismoking programs should be implemented to reduce such avoidable deaths.     

Cigarette smoking and acute myocardial infarction

To make a further quantitative assessment of the relationship between cigarette smoking and the risk of myocardial infarction, a multicentric case-control study was conducted in Italy between September 1988 and June 1989 within the framework of the GISSI-2 trial. Ninety hospitals in various Italian Regions participated. 916 cases of acute myocardial infarction with no history of ischaemic heart disease and 1106 controls admitted to hospital for acute conditions not related to known or suspected risk factors for ischaemic heart disease were studied. Relative risks (RR) and 95% confidence intervals (CI) of myocardial infarction according to various measures of tobacco smoking, were adjusted for identified potential confounding factors using multiple logistic regression. Compared to lifelong non-smokers, the RR was 1.3 (95% CI 1.0 to 1.9) for ex-smokers, 2.0 (95% CI 1.4 to 2.9) for current smokers of less than 15 cigarettes per day, 3.1 (95% CI 2.2 to 4.2) for 15–24 cigarettes per day and 4.9 (95% CI 3.4 to 7.1) for 25 or more cigarettes per day. No trend in risk was evident for the duration, the RR being around 3 for subsequent categories. There was a significant interaction between smoking and age. Below the age 45, smokers of 25 or more cigarettes per day had a 33 times higher risk than non-smokers, compared to 7.5 at in the age group 45–54, 4.4 between the ages 55–64 and 2.5 at the age of 65 or over. The risk estimates were higher in women (RR for 25 cigarettes per day =10.1), in subjects in the lowest cholesterol tertile (RR=11.9), with no history of diabetes (RR=6.8), hypertension (RR=9.5), no family history ischaemic heart disease (RR=9.1) and low body mass index (RR=9.3). The importance of smoking is confirmed as a cause of acute myocardial infarction: about 50% of all nonfatal infarctions in this Italian population could be attributable to cigarette smoking. The relative risks for smokers were higher at a younger age, in women and in subjects with a low baseline risk for other risk factors.GISSI-EFRIM (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto — Epidemiologia dei Fattori di Rischio dell'Infarto Miocardico) Scientific Advisory Board: G.A. Feruglio, M. G. Franzosi, C. La Vecchia, A. P. Maggioni, A. Maseri & . Tognoni Participating Clinical Centers: Alba (S. Boscarino), Assti (M. Alciati), Avellino (G. Amoroso), Bari Di Venere (N. D'Amato), Barletta (M.A. Messina), Belluno (A. Darold & A. De Blasi), Biella (A. Pagliarini), Bolzano (C. Romeo), Bozzolo (E. Franzi), Brindisi (C. Andriulo), Broni (B. Albonico), Cagliari (M. Sias), Casale Monferrato (M. Pezzana), Casarano (S. Ciricugno), Caserta (R. Di Sarno), Castel San Giovanni (D. Bozzarelli), Castellammare di Stabia (R. Longobardi), Cento (L. Orselli), Chiari (C. Gentilini), Colleferro (E. Venturini), Copertino (A. Calcagnile), Crotone (R. Lumare), Desio (G. Lacuitti), Fidenza (S. Callegari), Foligno (A. Mattioli), Gallarate (G. Filippini), Genova Galliera (G. Scarsi), Grosseto (A. Cresti), Guastalla (V. Manicardi), Legnago (P. Todesco), Leno (A. Lanzini), Lodi (C. Pezzi), Lugo (T. Tognoli & M. Gobbi), Magenta (G. Ventura & R. Turato), Mantova (A. Lzzo & G.P. Guerra), Matera (A. Rizzi), Menaggio (S. Silvani), Messina Policlinico (G. Di Tano), Mestre (G. Gasparini), Milano Niguarda II Divisione (C. Corsini), Milano Policlinico (M. Marconi), Miranao (A. Zanocco), Monza (F. Achilli), Napoli Cardarelli (F. Piantadosi, R. Giuliano, G. Sepe & S. Pezzella), Novi Ligure (L. Fasciolo), Nuoro (G. Tupponi), Palermo Cervello (A. Ledda), Palermo Benfratelli (R.G. La Malfa), Palermo 'Villa Sofia' (A. Pizzuto), Perugia (S. Brando), Pescia (L. Lacopetti), Piombino (S. Bechi), Pisa (U. Conti), Pistoia (F. Fantoni), Putignano (A. Marco), Riccione (F. Brighi & A. Benati), Rieti (S. Orazi), Rimini (F. Bologna & D. Santoro), Roma Nuova ITOR (M. Rocchi), Roma S. Pietro (P. Giuliani), Roma Policlinico (P. De Paolis), Saluzzo (P. Allemanno & S. Reinaud), San Dona di Piave (P. Della Valentina), Sassuolo (G. Fontana & P. Orlandi), Savigliano (V. Cravero), Savona (A. Ganadolfo), Sciacca (C. Catalano), Sondrio (M. Marieni), Termoli (M. Esposito), Torino Maria Vittoria (L. Faccio & L. Mussano), Trapani (G.B. Biondo), Treviso (F. Perissinotto), Udine (C. Fresco), Vasto (E. Bottari) & Voghera (G. Ferrari)     

江苏省部分地区医生、教师和公务员吸烟和被动吸烟调查

目的了解江苏省医生、教师和公务员三类人群吸烟和被动吸烟状况。方法于2008年对江苏省5个城市的4731名医生、教师和公务员的吸烟和被动吸烟情况进行了问卷调查。结果三类人群总的吸烟率和现在吸烟率分别为30．1％和24．4％,男性吸烟率和现在吸烟率分别为53．1％和43．1％,戒烟率、成功戒烟率和被动吸烟率分别为20．1％、11．5％和43．4％。在调整地区、性别等因素后,以医生为参照,公务员吸烟、现在吸烟和被动吸烟的OR值（95％CI）分别为1．33（1．12～1．64）、1．36（1．12～1．65）和1．76（1．47～2．12）。教师被动吸烟风险低于医生,OR值（95％CI）为0．60（0．51～0．70）。结论公务员吸烟率、现在吸烟率、戒烟率和被动吸烟率均高于医生和教师,并且不受地区、性别、年龄、学历和工作年限的影响。     

Exposure to high concentrations of nitrosamines and cancer mortality among a cohort of rubber workers

OBJECTIVES—To examine if the occurrence of different cancers was increased among rubber workers, as the highest known exposures of humans to nitrosamines have occurred in the rubber industry.
METHODS—A cohort of 8933 rubber workers (hired after 1 January 1950, still active or retired on 1 January 1981 and employed for at least 1 year in one of five study factories) was followed up for mortality from 1 January 1981 to 31 December 1991. Work histories were reconstructed with routinely documented cost centre codes, which allowed identification by employment in specific work areas. For each cost centre code time and factory specific, semi-quantitative exposures to nitrosamines (three levels: low, medium, high) and other compounds were estimated by industrial hygienists. Rate ratios for medium (RR_m) and high (RR_h) exposures and 95% confidence intervals (95% CIs) were calculated with Cox's proportional hazards models with the low exposure as reference.
RESULTS—Exposure to nitrosamines was significantly associated with an increased mortality from cancers of the oesophagus (13 deaths: RR_m 1.7, 95% CI 0.3 to 10.3; RR_h 7.3, 95% CI 1.9 to 27.8) and of the oral cavity and pharynx (17 deaths: RR_m 0.8, 95% CI 0.2 to 4.1; RR_h 3.9, 95% CI 1.4 to 11.1). A non-significant trend of increasing mortality with exposure to higher concentrations of nitrosamines was found for mortality from cancer of the prostate (26 deaths: RR_m 1.4, 95% CI 0.5 to 3.8; RR_h 2.2, 95% CI 0.9 to 5.6), and the brain (six deaths: RR_m 3.9, 95% CI 0.3 to 42.6; RR_h 6.0, 95% CI 0.6 to 57.6). No association was found between exposure to nitrosamines and cancer of the stomach (RR_m 0.8, 95% CI 0.4 to 1.8; RR_h 1.2, 95% CI 0.5 to 2.5) or lung (RR_m 1.0, 95% CI 0.6 to 1.5; RR_h 1.0, 95% CI 0.7 to 1.6).
CONCLUSIONS—Exposure to high concentrations of nitrosamines is associated with increased mortality from cancers of the oesophagus, oral cavity, and pharynx, but not with increased mortality from cancers of the stomach or lung.


Keywords: nitrosamines; cancer mortality; rubber industry