中国石棉接触人员癌症死亡队列研究的Meta分析

目的以M eta分析探讨单纯接触温石棉人员癌症是否高发。方法凡满足明确是中国石棉接触人员且为癌症死亡率队列研究的资料均被纳入研究对象,以直接法与随机效应模型法计算主要部位癌症标准化死亡比(SMR)及其95%可信区间(CI),计算Q统计量与Z值检验研究结果异质性及其来源。结果共有13个队列符合入选标准,平均间皮瘤死亡百分比为0.62%,全死因、全癌亡、肺癌的M eta-SMR显著上升(分别为1.51、1.96、4.54),单纯接触温石棉人员肺癌的M eta-SMR也显著上升(4.39),消化系统、喉、乳腺和生殖泌尿系统等其他部位癌症的M eta-SMR未见显著上升。结论单纯温石棉暴露能使作业人员肺癌、间皮瘤显著高发,与其他部位癌症无病因联系。     

单纯接触温石棉人员癌症死亡队列研究的荟萃分析

目的　用荟萃 (meta)分析探讨单纯接触温石棉人员的癌症是否高发。方法　凡满足明确是单纯温石棉暴露且为癌症死亡率队列研究的资料均被纳入研究对象 ,以直接法与随机效应模型法计算主要部位癌症的标准化死亡比 (SMR)及其 95 %可信区间 ,计算Q统计量与Z值检验研究结果异质性及其来源。结果　共有 2 6个队列符合入选标准 ,平均间皮瘤死亡百分比为 0 4 2 % ,全死因、全癌亡、呼吸系统全癌、肺癌和胃癌的meta SMR显著上升 ,分别为 1 2 8、1 2 6、2 2 4、2 2 9与1 2 7。肺癌的meta SMR在纺织 (3 6 4 )、石棉制品加工 (3 0 7)、采选矿 (2 2 4 )和石棉水泥制品加工(1 2 2 )显著升高 ,胃癌的meta SMR在石棉制品加工 (1 4 8)显著升高。其余部位癌症的meta SMR均无显著意义。结论　单纯温石棉暴露能使作业人员肺癌、间皮瘤显著高发 ,与其他部位癌症似无病因联系。     

接触温石棉女工恶性肿瘤死亡的队列研究

目的调查接触温石棉女工的恶性肿瘤死亡率。方法以1960年1月1日至1980年12月31日曾经从事家庭内温石棉手工纺织作业一年以上的女工为调查对象,采用历史性队列流行病学方法进行研究。结果在5681名接触温石棉纺织女工中,有144名死于癌症,其中有74名女工死于肺癌,病死率最高;其次为肝癌,死亡数为27例;占第三位的是胃癌,死亡数为18例。以当地女性年龄组别恶性肿瘤死亡率均值为对照组计算标准化死亡比(SMR),所有除肺癌外的恶性肿瘤与肺癌的SMR分别为1.16(P<0.05)和4.17(P<0.01)。结论接触温石棉的女性纺织工人有明显的肺癌死亡高发倾向。     

接触石棉工人消化系统恶性肿瘤的流行病学调查

为了探讨石棉与消化系统恶性肿瘤关系,采用队列研究方法调查长春石棉厂667名石棉工人33年(1972~2004年)消化系统恶性肿瘤死亡率,石棉工人消化系统全肿瘤、肝癌、胃癌死亡率明显高于居民对照人群,长期接触石棉的工人患消化系统恶性肿瘤,特别是肝癌、胃癌危险性增加。     

手纺石棉女工肿瘤死亡的调查研究

目的：对手纺石棉女工肿瘤发病情况进行研究,方法：采用历史性队列研究方法。结果：发现肿瘤死亡144人,以肺癌居首位（74人,占51．39％）,死亡率各为108．97／10万与56．00／10万,SMR分别为1．16、4．17,均显著高于对照,结论：手纺石棉作业也能使接触人员肺癌高发。     

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。     

汽车铸造作业工人队列死因研究

目的 分析危害汽车铸造作业工人健康的主要疾病,探讨铸造作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,以某汽车铸造厂1980年在册的3529名职工为研究对象,从1980年随访至2005年底,以全国城市居民年龄别死亡率均值为参照,用标化死亡比(SMR)作为统计指标,并计算95%可信区间.结果 随访至2005年底,共计84 999人年,共死亡265人,死亡率3.12‰,累积死亡率为7.51%.铸工队列全死因SMR为0.96(95%CI:0.85～1.08)与全国平均水平持平,随着年龄增长,全死因SMR呈现升高趋势,50岁以上组工人的SMR均大于1.影响铸造工人寿命的主要疾病按累积死亡率从高到低排序分别是:恶性肿瘤(3.43%)、意外伤害(1.16%)、脑血管疾病(1.08%)、心血管疾病(0.79%).恶性肿瘤占总死亡原因的45.7%.铸造工人中死亡率明显升高的疾病有恶性肿瘤(SMR=7.87)、意外伤害(SMR=2.70)、心血管疾病(SMR=2.68)、消化系统疾病(SMR=2.79).一线作业工人恶性肿瘤死亡是辅助丁人的1.95倍(RR=1.95,P<0.05).结论 铸造作业中粉尘等职业危害因素明显影响工人的健康,恶性肿瘤死亡明显增加,应加强防护.     

石棉接触与胃癌发病的关系探讨

为探讨石棉接触与胃癌发病的关系 ,应用历史前瞻性队列研究方法回顾调查青岛石棉厂 530名石棉接触工人2 2年期间 (1 977～ 1 999年 )胃癌死亡率 ,发现胃癌死亡率(440 96/1 0万 ,男性 1 4 85 44/1 0万 )高出当地居民 1 7 54倍(SMR440 1 4 ,P <0 0 1 ) ,高出当地男性居民 42 35倍(SMR787 4,P <0 0 1 )。结论提出长期接触石棉工人患胃癌危险性增加。     

某木材厂恶性肿瘤的流行病学研究

采用回顾性队列研究,调查了某木材厂3059人.分析发现该厂家具车间中,1955年以前开始接触木尘的木工胃癌标化死亡比升高具有显著性(SMR=2.36,P<0.05).由于样本较小,本研究不能确定接触木尘与胃癌的关系.但它提示,木工中胃癌高发的原因,值得进一步探讨.     

手纺温石棉女工肿瘤死亡的41年队列研究

采用历史性队列研究方法对手纺温石棉女工肿瘤死亡情况进行了研究 ,以寿命表法计算人年数 ,以观察人群人年数为基数计算死亡率 ,并以当地女性年龄别死亡率均值为对照计算标准化死亡比 (SMR)、相对危险度 (RR)和特异危险度 (AR)及其 95%可信区间 (CI)。调查发现 ,在对 1960～ 1980年间手纺温石棉 1年以上的 5681名女工 ,追访至 2 0 0 0年底 ,共死亡 858例 ,以肿瘤死亡为主 (2 13例 ,占 2 4 83 % ) ,其中又以肺癌居首位 (87例 ,占 40 85% ) ,死亡率分别为 12 7 47 10万与 52 0 6 10万 ,SMR各为 1 3 5(1 18～ 1 54)、3 88(3 14～ 4 79) ,AR各为 3 3 0 7 10万与 3 8 64 10万 ,均显著高于对照 (P <0 0 5或P <0 0 1)。结果提示 ,手纺温石棉作业能使接触人员肺癌高发 ,与“闪石理论”、“矿物油暴露理论”和吸烟无关 ,而是由于手纺作业更易产生长度大于 10 μm的石棉纤维所致     

Meta-analysis of studies of occupational exposure to vinyl chloride in relation to cancer mortality

OBJECTIVE: A meta-analysis was made of studies addressing occupational exposure to vinyl chloride in relation to cancer mortality. METHODS: Two recently updated multicenter cohort studies and six smaller studies were identified. For selected neoplasms, standardized mortality ratios (SMR) and 95% confidence intervals (95% CI) were abstracted (or calculated from raw data). In cases of lack of heterogeneity (P-value > or = 0.01), meta-analyses were conducted using a random-effects model. RESULTS: With SMR values ranging from 1.63 to 57.1, all six studies for which these ratios could be obtained suggested an increased risk of liver cancer. For four of these studies, excesses persisted when known cases of angiosarcoma of the liver (ASL) were excluded. The meta-SMR for liver cancers other than ASL (based on the 2 large cohorts) was 1.35 (95% CI 1.04-1.77). The meta-SMR for lung cancer was 0.90 (95% CI 0.77-1.00, based on 5 studies), although higher SMR values were reported in early studies. The meta-SMR for brain cancer, based on 5 studies, was 1.26 (95% CI 0.98-1.62). For soft tissue sarcomas, the meta-SMR based on 4 studies was 2.52 (95% CI 1.56-4.07). The meta-SMR for lymphatic and hematopoietic neoplasms in the 2 large studies was 0.90 (95% CI 0.75-1.01), although 3 of the smaller studies reported significant excesses. CONCLUSIONS: Apart from the known risk of ASL, workers exposed to vinyl chloride may experience an increased risk of hepatocellular carcinoma and soft-tissue sarcoma; however, these results may have been influenced by the underdiagnosis of true ASL. Increased mortality from lung and brain cancers and from lymphatic and hematopoietic neoplasms cannot be excluded; mortality from other neoplasms does not appear to be increased.     

Asbestos and kidney cancer: the evidence supports a causal association

The role of asbestos in the etiology of lung cancer and of mesothelioma of the pleura and peritoneum has been well documented. The evidence for a causal association between asbestos and other human cancers is not as extensive but suggests that asbestos may be carcinogenic at several different sites. This paper is concerned specifically with a possible causal association between asbestos and human kidney cancer. A review of the evidence to date indicates that only three human studies have sufficient statistical power to detect an excess mortality from kidney cancer among workers exposed to asbestos. All three were occupational cohort studies, and two of these gave strong direct evidence for such an excess; a study of U.S. insulators (kidney cancer SMR = 2.22, 90% CI 1.44-3.30), and a study of U.S. asbestos products company workers (kidney cancer SMR = 2.76, 90% CI 1.29-5.18). The third study, of Italian shipyard workers, reported excess mortality from "cancers of the kidney, urinary bladder, and other urinary organs" (SMR = 1.98, 90% CI 1.42-2.70). Further support for a causal association includes studies finding asbestos fibers in human kidneys and urine, as well as reports of kidney tumors in two animal bioassays. It is concluded that asbestos should be regarded as a probable cause of human kidney cancer.     

Mortality among Rocketdyne workers who tested rocket engines, 1948-1999

OBJECTIVE: The objective of this study was to evaluate potential health risks associated with testing rocket engines. METHODS: A retrospective cohort mortality study was conducted of 8372 Rocketdyne workers employed 1948 to 1999 at the Santa Susana Field Laboratory (SSFL). Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for all workers, including those employed at specific test areas where particular fuels, solvents, and chemicals were used. Dose-response trends were evaluated using Cox proportional hazards models. RESULTS: SMRs for all cancers were close to population expectations among SSFL workers overall (SMR = 0.89; CI = 0.82-0.96) and test stand mechanics in particular (n = 1651; SMR = 1.00; CI = 0.86-1.16), including those likely exposed to hydrazines (n = 315; SMR = 1.09; CI = 0.75-1.52) or trichloroethylene (TCE) (n = 1111; SMR = 1.00; CI = 0.83-1.19). Nonsignificant associations were seen between kidney cancer and TCE, lung cancer and hydrazines, and stomach cancer and years worked as a test stand mechanic. No trends over exposure categories were statistically significant. CONCLUSION: Work at the SSFL rocket engine test facility or as a test stand mechanic was not associated with a significant increase in cancer mortality overall or for any specific cancer.     

Historical cohort study of a New Zealand foundry and heavy engineering plant

OBJECTIVES: To investigate the mortality of workers who had been exposed to asbestos, machining fluids and foundry work in a foundry and heavy engineering plant in the railway rolling stock manufacturing industry in New Zealand. METHODS: Historical cohort study design. RESULTS: For the total workforce of 3522 men employed between 1945 and 1991, follow up was 90% of person-years to 31 December 1991. Significantly increased standardised mortality ratios (SMRs) were found for all causes of death combined (SMR 1.07; 95% confidence interval (95% CI) 1.01 to 1.14), all malignancies (SMR 1.15; 95% CI 1.01 to 1.31), circulatory (SMR 1.16; 95% CI 1.07 to 1.27) and musculoskeletal diseases (SMR 3.06; 95% CI 1.39 to 5.84), all digestive cancers (SMR 1.29; 95% CI 1.04 to 1.59), all respiratory cancers (SMR 1.34; 95% CI 1.08 to 1.65), cancer of the oesophagus (SMR 1.97; 95% CI 1.01 to 3.45), and mesothelioma of the pleura (SMR 6.58; 95% CI 1.24 to 19.49). Three deaths from pleural mesothelioma were recorded, with latency times of 51, 53, and 57 years. There were no dose-response relations between exposure to asbestos, machining fluids or foundry work, or by duration of employment in the plant, and any cause of death. CONCLUSIONS: This study found small increases in risk for several causes of death among foundry and heavy engineering workers; however, these increases were small and the possible effects of smoking and other lifestyle factors could not be excluded. There was evidence of asbestos related disease in those involved in engineering work in the past.

 

     

Mortality among pulp and paper workers in Berlin, New Hampshire

Cause specific mortality was analysed among 883 white male workers from a paper company in Berlin, New Hampshire. Subjects were assigned to different exposure groups on the basis of their having worked in the pulp mill, the paper mill, or elsewhere in the paper company. A standardised mortality ratio (SMR) analysis was used to compare death rates for each of the exposure groups with United States national rates. For all the subjects, deaths due to all causes, all malignant neoplasms, and lung cancer were close to the number expected and excesses were noted for cancers of the digestive system and leukaemia. Among pulp mill workers, the number of cancers of the digestive system was raised and the SMR for pancreatic cancer was especially high (SMR = 305, 95% CI = 98-712). Among paper mill workers, more deaths were due to leukaemia and cancers of the digestive system than expected. These results are consistent with the findings from other studies that employment in pulp and paper mills is associated with excess mortality due to digestive and lymphopoietic cancers.     

Cancer and other causes of death among a cohort of dry cleaners

Mortality among 5365 members of a dry cleaning union in St. Louis, Missouri, was less than expected for all causes combined (SMR = 0.9) but slightly raised for cancer (SMR = 1.2). Among the cancers, statistically significant excesses occurred for oesophagus (SMR = 2.1) and cervix (SMR = 1.7) and non-significant excesses for larynx (SMR = 1.6), lung (SMR = 1.3), bladder (SMR = 1.7), thyroid (SMR = 3.3), lymphosarcoma and reticulosarcoma (SMR = 1.7), and Hodgkin's disease (SMR = 2.1). Mortality from emphysema was also significantly raised (SMR = 2.0). Eleven of the 13 deaths from oesophageal cancer occurred among black men. The risk of this cancer showed a significant association with estimated cumulative exposure to dry cleaning solvents (rising to 2.8-fold in the highest category) but not with level or duration of exposure. Mortality from kidney cancer was not excessive as reported in other studies. Excesses for emphysema and cancers of the larynx, lung, oesophagus, bladder, and cervix may be related to socioeconomic status, tobacco, or alcohol use. Although the number of deaths was small, the greatest risk for cancers of the lymphatic and haematopoietic system (fourfold) occurred among workers likely to have held jobs where exposures were the heaviest. Small numbers and limited information on exposure to specific substances complicates interpretation of this association but is unlikely to be due to confounding by tobacco use. It was not possible to identify workers exposed to specific dry cleaning solvents but mortality among those entering the union after 1960, when use of perchloroethylene was predominant, was similar to those entering before 1960.