耐火材料厂矽尘作业工人肺癌流行病学研究

本文对冶金系统十一个耐火材料厂的矽砖、粘土砖制造工人的肺癌进行了回顾性队列研究。队列由６２６６名男性工人组成，观察期为１９６３年１月１日至１９８５年１２月３１日，在此２３年期间共累积１３０７３０人年。以全国不同地区的十个大、中型钢铁企业的钢坯初轧厂１１４７０名男性职工在１９７１年至１９８５年间的年龄别、死因别死亡率为标准，计算各项死因的标化率比（ＳＭＲ）。矽尘作业人群的肺癌显示超量发生（ＳＲＲ为１     

铁矿工人肺癌回顾性队列研究

对１５个铁矿采矿工人的肺癌进行了回顾性队列研究。队列由１６９５１名１９７１年前入放的男职工组成,观察期从１９８０年至１９８９年,失访７６０人（４．５％）,队列内非接尘人群是接尘人群各群的对照人群。接尘人群及其井下、露天、赤铁矿、磁铁矿各舸矿各组中癌均无明显超量。但接尘人群分为非矽肺和矽肺两群时组,矽肺患者人群的肺癌显示超量。赤铁矿、磁铁矿、井下矿、吴矿各群组都再分为非矽肺和矽肺两群组时,除露天采矿     

焦炉工人肺癌病例对照研究

本文进行了一项队列内病例对照研究，病例来自于１６个焦化厂１５年期间（１９７１年１月１日－１９８５年１２月３１日）死亡的１２９１名焦炉工人中死于肺癌的１４５例患者。按照１：１的配对原则，余下的死亡者中取与病例同一工厂、相同性别和年龄的死亡者做为对照，共匹配成１３９对。通过相对危险度（ＲＲ）和逻辑回归分析，结果表明：焦化厂炼焦工作区的肺癌有超量发生（ＲＲ为２．９８，Ｐ＜０．０１）。并具有职业特片，其Ｒ     

铝电解工人恶性肿瘤流行病学研究

为了解铝电解作业工人恶性肿瘤发病情况，采用回顾性队列研究方法，对某电解铝厂９８９名男性作业工人进行了１０年死因流行病学调查。结果表明，该厂工人的恶性肿瘤发病率较高，其全癌、胃癌和上消化道癌的死亡率超出对照人群。ＳＲＲ分别为１．６１，２．１３和２．６７（均Ｐ＜０．０５）。进一步分析发现，该厂癌症高发主要集中于工作场所含大量沥青烟和３，４－苯并（ａ）芘等毒物的铝电解车间工人。其中１５～、２０～年工龄组和５５～岁年龄组超量明显，ＳＲＲ分别为６．２８，３．７４和１．８７（均Ｐ＜０．０５），而接毒较轻的辅助车间工人癌发率较低。提示铝电解工人的恶性肿瘤高发具有职业性特征。     

铸造工人肺癌死亡队列研究

以三个工厂３ ２７９名铸钢、铸铁工为暴露组, 以同厂１ １７６ 名机加、修机工为非暴露组, 对１９７２ 年１ 月１ 日在册的队列成员进行了回顾性队列研究。观察期自１９７２ 年１ 月１ 日至１９９２ 年１２ 月３１ 日。结果表明, 铸造工肺癌粗死亡率４６－４４／１０ 万, 占恶性肿瘤死亡的３０－１０ ％ , 在恶性肿瘤死亡中居首位。以一般人群作参比标准时, 铸工标化死亡比（Ｓｔａｎｄａｒｒｉｚｅｄ Ｍｏｒｔａｌｉｔｙ Ｒａｔｉｏ, ＳＭＲ） 为１－５６ , １－８３ （ Ｐ＜ ０－０５）。男性尘肺患者肺癌死亡率高于男性非尘肺患者, ＳＭＲ 为２－１５ （χ２ ＝ ６－９２） , 相对危险度（ＲＲ） 为３－４０ （χ２ ＝ ６－９６） , 年龄分层处理后总的相对危险度（Ｒｅｌａｔｉｖｅ Ｒｉｓｋ Ｔｏｔａｌ ＲＲＴ） 为１－６９ （χ２ＭＨ＝ １－１９）。结果表明,该队列铸造工肺癌死亡超量, 尘肺患者尤为明显。     

冶金行业矽肺患者肺癌流行病学研究

对全国冶金系统４７个厂矿１９８０年１月１日以前确诊并生存的４３７２例矽肺患者的肺癌进行了回顾性队列研究，观察期从１９８０年１月１日至１９８９年１２月３１日共１０年。研究结果表明：矽肺患者的全死因、全癌（主要为肺癌）、慢支－肺炎－肺心病和肺结核显著超出全国对照组。全癌中以肺癌为主，ＳＭＲｓ为２３７。当将矽肺人群分成包括铁矿、烧结、耐火、冶炼和铸造等不同作业类型后，除铸造（ＳＭＲｓ＝１５７，Ｐ＞０．０１）外所有作业类型的肺癌均显著超出全国对照组（ＳＭＲｓ均在２００以上，Ｐ＜０．０１）。肺癌的这种超出未显示出同矽尘的累计接尘年数和Ｌａｔｅｎｃｙ有相关趋势，且不论是吸烟（ＳＭＲｓ＝２５７，Ｐ＜０．０１）或非吸烟组（ＳＭＲｓ＝２０９，Ｐ＜０．０１）同全国对照组比较均有极显著超出。     

冶金系统13个耐火材料厂矽肺患者死亡的流行病学研究

本文对冶金系统１３个火材料厂１９８０年１月１日以前确诊并生存的男性矽肺患者１２８４例进行了队列研究来观察１０年（１９８０．１￣１９８９．１２）期间矽肺队列成员的职业变动情况、死亡情况及死亡原因。研究结果表明：耐火行业矽肺患者的平均寿命比煤矿短，比铁矿长、与陶瓷行业近似。矽肺确诊越早其死亡年龄越小，全癌为矽肺患者的首位死因，其次为慢性支气管肺炎，肺心病，肺结核和脑血管病，全癌中以肺癌的死亡率为最高。     

木尘与肺癌关系的队列研究

为进一步探讨木尘与肺癌的关系，我们进行了回顾性队列研究，暴露组为成都某木综厂工龄１年以上的接触木尘职工２３６２（男１７０７，女６５５）人，观察期１５年（１９７８年１月１日～１９９２年１２月３１日），观察了３３６７９人年。非暴露组为当地某煤矿工龄１年以上的男性职工２５８７人，观察期２１年（１９７２年１月１日～１９９２年１２月３１日），观察了５４０４０人年。结果显示：接触木尘职工肺癌的标化死亡率（ＳＭＲ）为７４．６２／１０５（ＲＲ＝４．０８，Ｐ＜０．０１），与当地居民死亡率比较，接尘职工的ＳＭＲ为２１８．６（９５％ＣＩ：１．４１～３．２３，Ｐ＜０．０１）。肺癌标准化死亡比例比（ＳＰＭＲ）为３４９．０，差异有非常显著意义（Ｐ＜０．０１）。提示：木尘可能与肺癌有关。     

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。     

火力发电厂职工死亡率10年随访调查

为查明电厂职工死亡率和肿瘤死亡率是否受生产性危害因素的影响，用回顾性队列调查方法对两个热电厂进行了流行病学调查。分别按当地居民全死因死亡率和恶性肿瘤死亡率计算队列预期死亡人数和标化死亡比（ＳＭＲ），按统计工种分组，比较电厂内部各组恶性肿瘤死亡ＳＭＲ。结果表明：两个火力发电厂职工死亡率显著低于当地居民（健康工人效应，队列全死因死亡ＳＭＲ＝０．６３，Ｐ＜０．０５），而队列肿瘤死亡率稍低于当地居民，无统计学意义（ＳＭＲ＝０．８８，Ｐ＞０．０５），但突破了健康工人效应。电厂内部各组肿瘤死亡率以锅炉组最高，锅炉组标化相对危险度（ＳＲＲ）是燃料组的４．５９倍。提示：电厂职工肿瘤死亡率稍有增高，尤其锅炉职工肿瘤死亡率有超量趋势。这种超量趋势可能由于仅使用普通居民为参比人群而被遗漏。     

Silicosis and lung cancer in U.S. metal miners

The association between silicosis and lung cancer mortality was estimated in 9,912 (369 silicotics and 9,543 nonsilicotics) white male metal miners. These miners were examined by the U.S. Public Health Service during 1959-1961 and were followed through 1975. Miners were excluded from this study if they were employed in a mine during 1959-1961 that used diesel equipment underground. The ores that were mined consisted of copper, lead-zinc, iron, mercury, lead silver, gold and gold-silver, tungsten, and molybenum. The standardized mortality ratio (SMR, U.S. white male rates) for lung cancer was 1.73 (95% CI: .94-2.90) in silicotics and 1.18 (95% CI: .98-1.42) in nonsilicotics. Additionally, SMRs were higher in silicotics than in nonsilicotics, even in most subgroups stratified by cigarette smoking habit, type of ore mined, years of service in an underground job, radon exposure group, or year of hire. When lung cancer mortality between silicotics and nonsilicotics was compared, the age-adjusted rate ratio (95% CI) was 1.56 (.91-2.68), and the age- and smoking-adjusted rate ratio was 1.96 (.98-3.67). Corresponding figures for miners who were employed in mines with low levels of radon exposure were 1.90 (.98-3.67) and 2.59 (1.44-4.68), respectively. These findings indicate that lung cancer mortality risk was increased in silicotics, and this probably did not result from chance or bias. However, confounding from radon exposure could not be ruled out. The findings indicate that further follow-up of this cohort is needed.     

Nonmalignant respiratory disease among hematite mine workers in China

The mortality risk of nonmalignant respiratory disease among hematite workers in the Longyan and Taochong mines of China was investigated in a retrospective cohort study covering the period 1970-1982. The cohort was limited to men and consisted of 5406 underground miners, of whom 1335 (25%) were diagnosed as having silicosis. Among those with silicosis, 560 (42%) were diagnosed as having silicotuberculosis. Among the 490 underground miners who died, 278 (57%) died of nonmalignant respiratory disease. The relative risk for death due to nonmalignant respiratory disease for stage III silicotics compared to nonsilicotics was almost 100-fold. High dust exposure was associated with a statistically significant increase in risk of death due to nonmalignant respiratory disease (relative risk 5.3). The relative risk associated with jobs with high dust exposure before the introduction of industrial hygiene controls was 7.7, and the corresponding value for after their introduction was 2.3. There is a need for continued close monitoring of industrial hygiene in these mines.     

Mortality from lung cancer among copper miners.

A cohort mortality study of lung cancer in 7088 copper miners was made from 1 January 1969 to 31 December 1988. There was an excess of deaths from lung cancer in the copper miners. The standardised mortality ratio (SMR) was 147 (p < 0.01). The SMR increased with calendar period. There was a higher risk of deaths from lung cancer in the miners employed in the 1950s. Age at the start of exposure had no effect on the risk of lung cancer. The risk of death from lung cancer increased with the duration of exposure and the time since first exposure. The SMR for lung cancer was 173 in underground miners and 193 for drilling miners (both p < 0.01). These data show that exposure to dust is associated with an excess of deaths from lung cancer in copper miners whereas exposure to radiation does not seem to carry such risk.     

鞍钢焦炉工人肺癌进一步研究

本文对鞍钢焦炉工人的肺癌,在前期回顾性队列研究基础上,作了进一步研究。队列由焦化厂4171名男性工人组成,以1971～1985年为观察期,在此15年期间共积累57153人年。与鞍钢初轧厂男职工人群比较,焦化厂炼焦工作区中焦炉和非焦炉工人的肺癌SRR分别为4.88(P<0.01)和0.50(P>0.05)。炉顶和炉侧工人的肺癌SRR分别为5.74(P<0.01)和3.52(P<0.01)。该区工人的肺癌超出量,以炉顶、炉侧、非焦炉的顺序,呈现梯度(SRR为5.74>3.52>0.50),并与相应场所空气中平均苯溶物浓度相一致。其它工作区工人的肺癌无明显超出。     

Is silicosis required for silica-associated lung cancer?

BACKGROUND: Abundant epidemiologic and experimental evidence supports the 1997 International Agency for Research on Cancer classification of crystalline silica as a human lung carcinogen. Nonetheless, there remains uncertainty about whether excessive lung cancer occurs exclusively among workers with silicosis. METHODS: A review was performed of published occupational epidemiologic literature directly pertinent to the interrelations among silica exposure, silicosis, and lung cancer. RESULTS: The association between silica and lung cancer is generally, but not uniformly, stronger among silicotics than nonsilicotics. However, the existing literature is ambiguous due to incomplete or biased ascertainment of silicosis, inadequate exposure assessment, and the inherently strong correlation between silica exposure and silicosis which hinders efforts to disentangle unique contributions to lung cancer risk. CONCLUSIONS: Until more conclusive epidemiologic findings become available, population-based or individually-based risk assessments should treat silicosis and lung cancer as distinct entities whose cause/effect relations are not necessarily linked.     

Mortality experience of haematite mine workers in China

The mortality risk of iron ore (haematite) miners between 1970 and 1982 was investigated in a retrospective cohort study of workers from two mines, Longyan and Taochong, in China. The cohort was limited to men and consisted of 5406 underground miners and 1038 unexposed surface workers. Among the 490 underground miners who died, 205 (42%) died of silicosis and silicotuberculosis and 98 (20%) of cancer, including 29 cases (5.9%) of lung cancer. The study found an excess risk of non-malignant respiratory disease and of lung cancer among haematite miners. The standardised mortality ratio for lung cancer compared with nationwide male population rates was significantly raised (SMR = 3.7), especially for those miners who were first employed underground before mechanical ventilation and wet drilling were introduced (SMR = 4.8); with jobs involving heavy exposure to dust, radon, and radon daughters (SMR = 4.2); with a history of silicosis (SMR = 5.3); and with silicotuberculosis (SMR = 6.6). No excess risk of lung cancer was observed in unexposed workers (SMR = 1.2). Among current smokers, the risk of lung cancer increased with the level of exposure to dust. The mortality from all cancer, stomach, liver, and oesophageal cancer was not raised among underground miners. An excess risk of lung cancer among underground mine workers which could not be attributed solely to tobacco use was associated with working conditions underground, especially with exposure to dust and radon gas and with the presence of non-malignant respiratory disease. Because of an overlap of exposures to dust and radon daughters, the independent effects of these factors could not be evaluated.     

焦化厂工人的癌症死亡率研究

本研究是对不同地区的10个焦化厂进行的癌症回顾性队列研究。这些工厂合成一个队列,共15,951名男职工,以1971～1981年为观察期,为期11年,共累积167,804人年。与焦化厂同时进行调查的10个钢坯初轧厂共11,004名男职工为对照人群,焦化厂中每个工作区人群分别与其比较,计算癌症标化率比(SRR)。 11年期间焦化厂共死亡825人,全死因和全部癌症的SRR分别为1.32(P<0.01)和1.45(P<0.01),肺癌为2.50(P<0.01)。焦炉工人的肺癌显示明显超出量,SRR为5.20(P<0.01),其中炉顶和炉侧分别为6.91(P<0.01)和4.20(P<0.01)。炉顶、炉侧和非焦炉作业工人的肺癌危险性呈现梯度。即:0.91>4.20>2.72。焦炉工人的肺癌SRR随就业至观察终点间隔(Latency)年数增长而增加。