Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models.
Occupational silica exposure and mortality from lung cancer and nonmalignant respiratory disease: G-estimation of structural nested accelerated failure time models.
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DOI：
10.1097/ee9.0000000000000029
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Costello S
中科院分区：
文献类型：
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作者：
Picciotto S;Neophytou AM;Brown DM;Checkoway H;Eisen EA;Costello S
补充数字内容可在文本中找到。已知职业暴露于结晶二氧化硅会增加肺癌和非传染性非恶性呼吸道疾病（NMRD）的风险。然而，二氧化硅暴露和生存时间之间的关联尚未被描述。在暴露于结晶二氧化硅（主要是方石英）的硅藻土工人的纵向队列中，从1942年到2011年，我们应用结构嵌套加速失效时间模型的g-估计来调整可能导致健康工人幸存者偏倚的时变混杂。在分析中使用了一种连续的暴露测量方法来估计禁止接触二氧化硅对生存时间的假设影响。由于禁令是不可行的，敏感性分析研究了执行各种职业接触限值的假设影响。由于二氧化硅暴露，每个工人（所有自然原因）的估计中位寿命损失年数为0.48（95%置信区间= 0.02，1.01）。对于全国农村改良和发展研究死亡，相应的估计数为3.22（0.82，7.75），肺癌死亡为2.21（0.97，3.56）。具体原因的估计是敏感的权重调整竞争事件的使用。肺癌死亡率，往往发生在年轻人，是一个重要的竞争事件的NMRD死亡率。敏感性分析支持主要结果，但估计值更大，并建议严格限制几乎与完全禁止二氧化硅接触一样有效。在这个行业中，工作场所暴露于结晶二氧化硅似乎会显着缩短生存时间，特别是那些死于肺癌或NMRD的人。可能需要更严格的接触限值。
Supplemental Digital Content is available in the text. Occupational exposure to crystalline silica is known to increase risks of both lung cancer and noninfectious nonmalignant respiratory diseases (NMRD). However, associations between silica exposure and survival times have not been described. In a longitudinal cohort of diatomaceous earth workers exposed to crystalline silica (primarily cristobalite) and followed from 1942 to 2011, we applied g-estimation of structural nested accelerated failure time models to adjust for time-varying confounding that could result in healthy worker survivor bias. A continuous measure of exposure was used in analyses estimating the hypothetical effect of banning exposure to silica on survival time. Since a ban is infeasible, sensitivity analyses examined the hypothetical effects of enforcing various Occupational Exposure Limits. The estimated median number of years of life lost per worker (for all natural causes) due to silica exposure was 0.48 (95% confidence interval = 0.02, 1.01). For NMRD deaths, the corresponding estimate was 3.22 (0.82, 7.75) and for lung cancer deaths, 2.21 (0.97, 3.56). Cause-specific estimates were sensitive to the use of weights to adjust for competing events. Lung cancer mortality, which tended to occur at younger ages, was an important competing event for NMRD mortality. Sensitivity analyses supported the main results, but with larger estimates, and suggested that a strict limit would be nearly as effective as a complete ban on silica exposure. Workplace exposure to crystalline silica in this industry appears to shorten survival times significantly, particularly for those who die of lung cancer or NMRD. More stringent exposure limits are probably warranted.