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。     

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。     

职业接触粉尘及吸烟对死亡影响的前瞻性队列研究

目的 研究接尘和吸烟对死亡的影响。方法 以1989－1992年广州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岁的接尘工人和无任何粉尘及其他有害物质接触的职工（对照组）61648名为研究对象，进行前瞻性队列研究。结果 （1）队列失访28例，死亡1186例，以恶性肿瘤死亡为主；（2）本队列男性多于女性，年龄35－44岁，主要为工人，中学文化，已婚，率42．2％，饮酒率32．8％；（3）调整相应混杂因素后，全死因、恶性肿瘤和呼吸系疾病死亡接尘者相对危险度（RR）分别为1．24、1．34和1．96，与对照组比较，差异均有显著性（P＜0．01），吸烟者RR分别为1．16、1．37和1．63，与不吸烟者比，前二者差异有显著性（P＜0．01）；既接尘又吸烟者上述相应死因死亡1RR分别为1．48、1．85和3．12，明显高于单纯接尘或单纯吸烟者，差异有显著性（P＜0．01）；（4）接尘对死亡的影响主要表现在职业接触矽尘和木尘。结论 接尘与吸烟均可致死亡危险性增加，并存在协同作用。     

沥青接触工人与癌症关系的Meta分析

目的：研究沥青接触工人与癌症的关系。方法：应用Meta分析方法国内八有关沥青接触工人与癌症关系的队列研究进行定性和定量综合分析。采用固定效应模型和随机效应模型方法对沥青接触工人余死因,全癌死因、肺癌死因、胃癌死因的标化率比率（SRR）进行综合分析。结果：沥青接触工人全癌是其第一位死因,肺癌又居癌症死亡之首,全死因、癌症死因、肺癌死因、胃癌死因综合SRR（95％的可信区间）分别为1．4073（1．2328－1．614）、1．6225（1．4813－1．7770）、1．8905（1．4880－2．4044）、1．1757（0．9614－1．4378）;四个工龄组肺癌死率综合SRR都大于1（P＜0．05）。结论,沥青作业工人在存在癌症、特别是肺癌的高发趋势,沥青是工人肺癌的一个危险因素。     

某化工厂恶性肿瘤死亡的回顾性队列研究

目的：了解职业因素对化工厂工人恶性肿瘤死亡的影响。方法：采用流行病学队列研究方法对该厂接触毒物工人疾病死亡原因进行29年回顾性分析。结果：硫酸、磷肥两车间肝癌死亡明显高于对照组（P＜0．05或0．01）;磷肥车间全癌死亡也明显高于对照组（P＜0．05）。此外,磷肥车间累计接毒工龄15－20年（或年龄40－50岁）全癌死亡、累计接毒工龄20年以上（或年龄50岁以上）肝癌死亡标化相对危险度（SRR）明显高于对照组（P＜0．05或0．01）;硫酸车间累计接毒工龄20年以上（或年龄50岁以上）肝癌死亡SRR也明显高于对照组（P＜0．05或0．01）。结论：本研究表明,某化工厂癌症发生可能与其生产环境中存在的铁金属矿尘、磷矿石粉尘以及氟化物等职业危害因素的综合作用有关。     

温石棉与肺癌关系的巢式病例对照研究

目的探讨单纯接触温石棉与肺癌发病的关系。方法按照巢式病例对照的研究方法，从一个追踪了30年接触温石棉的男性固定队列中，收集所有的肺癌患者作为病例组，按1：4的配对比例在该队列中选取非癌症者作为对照组，配对因素为同性别、年龄相差〈5岁、工龄相差〈5年、吸烟情况一致。结果研究队列中收集到40例肺癌病例，发病水平高于全国平均水平[标化死亡比（SMR）=1．77]。肺癌发病密度由高到低的工种分别是原料工（741．5／10万人年）、梳纺工（424．3／10万人年）、编织工（365．0／10万人年）、维修工（285．5／10万人年），与接触温石棉的浓度高低一致。与低浓度接触组比较，高浓度接触组发生肺癌的相对危险度（OR）为3．7，95％可信区间为2．30～8．16，差异有统计学意义（P〈0．01）。结论单纯温石棉接触能增加工人肺癌发病的危险性。     

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。     

职业铅接触对男性工人腰椎骨折的影响

目的探讨职业铅接触对男性工人腰椎骨折的影响。方法以上海某蓄电池厂152名男性铅作业工人为研究人群。采用石墨炉原子吸收分光光度法测定血铅（aPb）、尿铅（UPb），应用单光子骨密度仪（SPA-4）测定工人骨蛮度，并做Z评分。拍摄腰椎侧位x线平片，并诊断有无腰椎骨折。结果铅作业工人血铅浓度0．85（0．33-1．90）μmol／L，尿铅浓度4．84（0．46-21．31）μg／g Cr，腰椎骨折发病率为19．7％。工人腰椎骨折发病率随年龄和工龄增长而升高，但差异无统计学意义（P〉0．05）。工人骨密度随血铅、尿铅水平升高而明显下降，差异有统计学意义（P〈0．05）。工人随着体内铅接触水平的升高，腰椎骨折发病率随之明显升高，差异有统计学意义（P〈05）并呈线性相关（r血铅=-0．977，P〈0．05；r尿铅=0．994，P〈0．01）。随着骨量减少，工人腰椎骨折发病率明显升高，差异有统计学意义（P〈0．01）并呈线性相关（r=-0．980，P〈0．01）。结论职业铅接触可能引起职业人群骨密度下降，腰椎骨折发病率增高，腰椎骨折的发生可能与骨量减少有关。     

兵器行业三硝基甲苯作业工人恶性肿瘤的回顾性调查研究

目的：了解兵器行业三硝基甲苯（TNT）作业人员恶性肿瘤的发病情况，为修订慢性TNT中毒诊断标准、制定TNT作业防护管理措施提供依据。方法：对兵器行业8个工厂1970－1995年期间从事TNT作业1年以上的男工恶性肿瘤发病情况进行回顾性队列调查研究。结果：接触组全恶性肿瘤发病率明显高于对照组，相对危险度（RR）为2．32。用全国大中城市1973－1975年和1990－1992年男性居民全恶性肿瘤死亡专率作标准计算标化死亡比（SMR）分别为71．8和179．6，99％CI为71．8－144．2，差异有显著性（P＜0．01），表明TNT作业者全恶性肿瘤死亡率明显高于一般人群。肝癌发病率占全恶性肿瘤发病率的31．92％，死亡率为对照组的3．97倍。用全国大中城市1973－1975年和1990－1992年男性居民肝癌死亡率为标准计算，SMR分别为150．5和381．5和381．6，99％CI为59．3－184．0，差异有显著性（P＜0．01），平均死亡年龄（51．7岁）比对照组（54．1岁）提前2．4岁，比全国大中城市居民（55．6岁）提前3．9岁。肝癌发病与工龄、工种以及接触TNT程度关系密切；饮酒有协同致癌作用。结论：TNT作业男工全恶性肿瘤发病率和死亡率明显高于一般人群，肝癌居首位，其发病与工龄、工种、接触TNT程度关系密切。     

木尘暴露工人死因分析

目的：探讨木尘暴露工人死因的分布情况和木尘对健康的影响。方法：对某木综厂1720名木尘暴露工人进行了15年的回顾性队列研究,并与对照组和当地一般人群进行了比较,结果：木尘暴露工人前5位的死因分别为：癌症,肺心病,脑血管病,外伤中毒和意外,消化系疾病;与对照比较,木尘暴露工人癌症,肺心病,其它心脏病,肝炎和肝硬化,脑血管病及全死因的标化死亡率升高（P＜0．05或P＜0．01）,癌症,肺心病,肝炎肝硬化的SMR升高（P＜0．01）,结论：木尘可能对人体健康存在不良影响。     

Mortality and lead exposure: a retrospective cohort study of Swedish smelter workers.

The study is based on the work histories and mortality data for 3832 male workers first employed before 1967 at a copper smelter in northern Sweden and followed up from 1950 to 1981. From the 3832 workers a lead cohort consisting of 437 workers employed for at least three years at sites with considerable lead exposure during 1950-74 was selected. These workers had regularly had blood lead measurements performed since 1950. Based on the cumulative blood lead dose 1950-74 and peak blood lead values, the cohort was subdivided into high mean, low mean, high peak, and low peak groups. Standardised mortality ratios (SMR) were calculated for the six groups using general and local reference populations. The original cohort of 3832 workers showed considerable excess of deaths for total mortality, malignant neoplasms especially lung and stomach cancer, ischaemic heart diseases, and cerebrovascular diseases when compared with the general population. In the lead cohort where the workers had been subjected to a considerable lead exposure only the raised SMR for lung cancer was sustained (SMR = 162; not significant). No significant differences were found between high lead and low lead exposed smelter workers.     

Mortality and lead exposure: a retrospective cohort study of Swedish smelter workers

The study is based on the work histories and mortality data for 3832 male workers first employed before 1967 at a copper smelter in northern Sweden and followed up from 1950 to 1981. From the 3832 workers a lead cohort consisting of 437 workers employed for at least three years at sites with considerable lead exposure during 1950-74 was selected. These workers had regularly had blood lead measurements performed since 1950. Based on the cumulative blood lead dose 1950-74 and peak blood lead values, the cohort was subdivided into high mean, low mean, high peak, and low peak groups. Standardised mortality ratios (SMR) were calculated for the six groups using general and local reference populations. The original cohort of 3832 workers showed considerable excess of deaths for total mortality, malignant neoplasms especially lung and stomach cancer, ischaemic heart diseases, and cerebrovascular diseases when compared with the general population. In the lead cohort where the workers had been subjected to a considerable lead exposure only the raised SMR for lung cancer was sustained (SMR = 162; not significant). No significant differences were found between high lead and low lead exposed smelter workers.     

Cancer mortality in a cohort of male German iron foundry workers

BACKGROUND: Observations of an increased incidence of cancers of the upper aero-digestive tract (pharynx, esophagus, larynx, lung) among workers of local German foundries gave rise to concern about a potentially elevated occupational risk of those cancer sites. The purpose of the study was to examine whether occupational exposure in iron foundries increases the risk of cancer. METHODS: A historical cohort study of 17,708 male German production workers in 37 iron foundries who were first employed in 1950-1985 with a minimum employment period of 1 year was initiated. Employment and occupational histories were collected. Mortality was compared with that of the German general population during 1950-1993 using a new method for computing the SMR when not all causes of death are available (called SMR*). RESULTS: Mortality from all causes was elevated to SMR = 115.4 (95% confidence interval (CI) = 111.9-119.1), as was for total cancer (SMR* = 123.8, CI = 102.1-152.6), especially cancers of the lung (SMR* = 163.9, CI = 123.9-223.0) and liver (SMR* = 322.5, CI = 149.5-844.8), and diseases of the respiratory system (SMR* = 147.6, CI = 100.4-221.5). Non-significant elevations of mortality were also found for cancers of the mouth and pharynx (SMR* = 153.5, CI = 82.3-359.8) and larynx (SMR* = 173.1, CI = 85.5-550.5). Mortality from various causes of death was higher among workers with shorter exposure periods than among long-term employees. The elevated mortality persisted for years and decades after termination of employment. CONCLUSIONS: The results provide further evidence for an increased risk of lung cancer and possibly other cancers of the upper aero-digestive tract among foundry workers. Special attention should be paid to the strongly increased mortality from liver cancer and the mortality pattern among employees having terminated work.     

Mortality in a cohort of asbestos cement workers in Bari

The study describes the mortality of 417 workers employed in a asbestos-cement plant, located in Bari, Puglia, Southern Italy. Follow up started on February 1st 1972. The vital status and cause of death were ascertained at 1995. The mortality experience of the Apulian population was used as comparison. Using 90% confidence limits (CLs), a significant increase in mortality was observed in our cohort from: all causes of death (SMR 118, CL 100-139), pneumoconiosis (SMR 14810, CL 10298-20683), all types of cancer (SMR 139, CL 105-181), lung (SMR 191, CL 126-277), pleural (SMR 1560 CL 431-4081) and peritoneum (SMR 1705, CL 303-5367) malignant neoplasms. In our cohort, the discrepancy between observed and expected mortality for lung and pleural cancer occurred 30 years after the first exposure, after 40 years for all neoplasms and peritoneum cancer. Under the Cox regression model, lung cancer SMR showed a curvilinear trend along time since first exposure, the peak being detected at 35 years. Finally, SMRs from our cohort were compared to a previously described cohort including workers from the same plant compensated for asbestosis by INAIL.     

Reevaluation of lung cancer risk in the acrylonitrile cohort study of the National Cancer Institute and the National Institute for Occupational Safety and Health

OBJECTIVES: The present study provides additional analyses of data obtained earlier on lung cancer risk among workers with acrylonitrile exposure. METHODS: The original authors provided the data. For total mortality and the cancer sites of a priori interest (lung, stomach, brain, breast, prostate, and the lymphatic and hematopoietic systems), standardized mortality ratios (SMR) and 95% confidence intervals (95% CI) were computed, the total United States and surrounding counties being used as standard populations. Regional rate-based SMR values were also computed between lung cancer and cumulative acrylonitrile exposure. RESULTS: Except for lung cancer, the external comparisons corroborated the earlier internal comparisons (no increased cancer mortality risk). For lung cancer, the external comparisons revealed death deficits for the unexposed workers (SMR 0.68, 95% CI 0.5-0.9) and all categories of acrylonitrile-exposed workers. The SMR obtained using external rates and the most exposed group (SMR 0.92. 95% CI 0.6-1.4) differed from the corresponding relative risk (RR) of the internal rates (RR 1.5, 95% CI 0.9-2.4). CONCLUSIONS: The analysis of the present study provides little evidence that acrylonitrile exposure increases the mortality risk of cancers of a priori interest, including lung cancer. The lung cancer findings of the external comparison differed from the earlier findings of the internal comparisons. Selection bias (as the healthy worker effect) was probably not responsible. Additional follow-up and analyses, especially of the unexposed workers with low lung cancer rates, may help elucidate the internal and external comparison differences. Results from both comparisons should be presented when the relative risks differ markedly, as both have advantages and disadvantages.     

Epidemiologic study of cancer mortality among Israeli asphalt workers

BACKGROUND: We describe the results of a cancer mortality study among asphalt workers in Israel. METHODS: Personal identifiers and employment histories of 2,176 workers were extracted from company records. RESULTS: Mortality from all malignant neoplasms was significantly reduced in the whole cohort (SMR 0.68, 95% confidence interval (CI) 0.56-0.83). SMR for lung cancer was elevated in workers exposed to bitumen (SMR 1.05, 95% CI 0.62-1.66). No significant elevation or reduction in mortality was observed in relation to a specific site. SMRs for lung cancer was higher among ever exposed to bitumen than among unexposed. There was no association between lung cancer risk and estimated exposure to bitumen fume, and no dose-response was apparent. CONCLUSIONS: While the results of this cohort study indicate a slightly increased SMR for lung cancer, it did not produce evidence of a causal link between lung cancer and exposure to bitumen fume.     

Epidemiologic study of workers exposed to vinyl chloride in Porto Marghera: mortality update

The investigation describes mortality of vinyl chloride exposed workers in the Montedison-Enichem plant located in Porto Marghera, near Venice, Italy. A total of 1658 workers employed from start of production (1950), present in 1956 or successively hired until 1985, were followed up between 01.01.1973 and 31.07.1999, for a total of 41.037 person years at risk: 248 deaths were observed. Mortality from all causes compared with regional population was lower than expected, (SMR 0.75; 90% CI 0.68-0.83) and from all malignant neoplasms similar to expected (SMR 0.94; 90% CI 0.81-1.09). SMR for primary liver cancer was significantly increased (SMR 2.78 90% CI 1.86-4.14). In the first year since leaving employment observed mortality was significantly above the null value for all causes (SMR 2.76; 90% CI 1.94-3.91), all malignant neoplasms (SMR 1.89; 90% CI 0.97-3.92) and cardiovascular diseases (SMR 2.37; 90% CI 1.13-4.95). Mortality rates for liver angiosarcoma (6 cases) increased with latency (trend test x 2 (1df) = 25.20 p < 0.001) and cumulative exposure (trend test x 2 (1df) = 61.00 p < 0.001), there were no cases with duration of employment less than 12 years, latency less than 10 years and for cumulative exposure less than 2.379 ppm-years. Mortality rates for hepatocellular carcinoma (12 cases) and liver cirrhosis (20 cases) showed a similar pattern for cumulative exposure. Observed mortality from lung cancer was higher than expected among those workers whose only job title was bagger. In the analysis accounting for latency, age and calendar period the RR for only bagger was 2.31 (90% CI 1.15-4.61). Mortality pattern for all causes, all malignancies and cardiovascular disease increased by time since employment, as expected in presence of a particularly strong Healthy Worker Effect (HWE). These results and the increased SMR values during the first year since leaving employment indicate that workers were selected into employment on the basis of good health conditions and early selective removal of weaker ones followed. The study results confirm the causal relationship between VCM exposure and liver angiosarcoma, and add supplementary evidence in favour of a causal explanation of the excess risk for hepatocellular carcinoma and liver cirrhosis as well as lung cancer among only baggers.     

Mortality of copper cadmium alloy workers with special reference to lung cancer and non-malignant diseases of the respiratory system, 1946-92.

OBJECTIVES--To identify and quantify any relations between occupational exposure to cadmium oxide fume and mortalities from lung cancer and from chronic non-malignant diseases of the respiratory system. METHODS--The mortality experience of 347 copper cadmium alloy workers, 624 workers employed in the vicinity of copper cadmium alloy work (vicinity workers), and 521 iron and brass foundry workers (all men) was investigated for the period 1946-92. All subjects were first employed in these types of work in the period 1922-78 and for a minimum period of one year at one of two participating factories. Two analytical approaches were used, indirect standardisation and Poisson regression. RESULTS--Compared with the general population of England and Wales, mortality from lung cancer among copper cadmium alloy workers was close to expectation (observed deaths 18, expected deaths 17.8, standardised mortality ratio (SMR) 101, 95% confidence interval (95% CI) 60 to 159). A significant excess was shown for lung cancer among vicinity workers but not among iron and brass foundry workers (vicinity workers: observed 55, expected 34.3, SMR 160, 95% CI 121 to 209, P < 0.01; iron and brass foundry workers: observed 19, expected 17.8, SMR 107, 95% CI 64 to 167). Increased SMRs for non-malignant diseases of the respiratory system were shown for each of the three groups (alloy workers: observed 54, expected 23.5, SMR 230, 95% CI 172 to 300, P < 0.001; vicinity workers: observed 71, expected 43.0, SMR 165, 95% CI 129 to 208, P < 0.001; iron and brass foundry workers: observed 34, expected 17.1, SMR 199, 95% CI 137 to 278, P < 0.01). Work histories of the copper cadmium alloy workers were combined with independent assessments of cadmium exposures over time to develop individual estimates of cumulative exposure to cadmium; this being a time dependent variable. Poisson regression was used to investigate risks of lung cancer and risks of chronic non-malignant diseases of the respiratory system in relation to three levels of cumulative cadmium exposure (< 1600, 1600-4799, > or = 4800 micrograms.m-3.y). After adjustment for age, year of starting alloy work, factory, and time from starting alloy work, there was a significant positive trend (P < 0.01) between cumulative exposure to cadmium and risks of mortality from chronic non-malignant diseases of the respiratory system. Relative to a risk of unity for the lowest exposure category, risks were 4.54 (95% CI 1.96 to 10.51) for the middle exposure category and 4.74 (95% CI 1.81 to 12.43) for the highest exposure category. There was a non-significant negative trend between cumulative cadmium exposure and risks of mortality from lung cancer. Relative to a risk of unity for the lowest exposure category, risks were 0.85 (95% CI 0.27 to 2.68) for the middle exposure category and 0.81 (95% CI 0.18 to 3.73) for the highest exposure category. Similar findings were obtained when adjustment was made for age only. CONCLUSIONS--The findings are consistent with the hypothesis that exposure to cadmium oxide fume increases risks of mortality from chronic non-malignant diseases of the respiratory system. The findings do not support the hypothesis that exposure to cadmium oxide fume increases risks of mortality for lung cancer.     

铁合金作业工人癌症的流行病学研究

本文对吉林，重庆等６个铁合金厂１９８０年１月份工资在册的４８３１名男性铁合金作业工人以同铁俣金厂在地理位置上近的四个钢坯初轧厂同期５２６０名工人做对照进行了为期１０年（１９８０年１月１日－１９８９年１２月３１日）的回顾性队列研究。