Cerebrovascular Diseases Incidence and Mortality in an Extended Mayak Worker Cohort 1948-1982
Cerebrovascular Diseases Incidence and Mortality in an Extended Mayak Worker Cohort 1948-1982
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DOI：
10.1667/rr13680.1
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发表时间：
2014-11-01
影响因子：
3.4
通讯作者：
Grigoryeva, E. S.
中科院分区：
文献类型：
--
作者：
Azizova, T. V.;Haylock, R. G. E.;Grigoryeva, E. S.
脑血管疾病（CVD）的发病率和死亡率[国际疾病分类第9版（ICD-9）编码：430-438]在1948-1982年首次受雇于Mayak生产协会（Mayak PA）的22，377名工人中进行了研究，并随访至2008年底。队列规模比之前的分析增加了19%，随访时间延长了3年。使用更新的剂量测定系统估计辐射剂量：Mayak工人剂量测定系统2008（MWDS-2008）。这是第一次，在对这一队列的分析中，使用了定量吸烟数据。研究队列的工人在职业上长期暴露于外部伽马射线和内部α粒子。男性和女性的外部伽马射线平均（+/-标准差）总剂量分别为0.54 +/- 0.76戈伊（95%百分位数2.21戈伊）和0.44 +/- 0.65戈伊（95%百分位数1.87戈伊）。受内照射监测的31%工人的平均钚身体负荷为男性1.32 +/- 4.87 kBq（95%百分位数4.71 kBq），女性2.21 +/- 13.24 kBq（95%百分位数4.56 kBq）。从结合的钚中吸收到肝脏的平均总α粒子剂量为0.23 +/- 0.77戈伊（95%百分位数为0.89戈伊），男性为0.44 +/- 2.11戈伊（95%百分位数为1.25戈伊）。在调整非辐射因素（性别，年龄，日历期，就业期，设施，吸烟，饮酒），有显着增加的趋势，CVD发病率与总吸收剂量从外部γ射线和总吸收剂量从内部α粒子辐射暴露到肝脏。基于线性剂量反应模型，每戈伊的超额相对风险（ERR/戈伊）分别为0.46（95% CI 0.37，0.57）和0.28（95% CI 0.16，0.42）。调整其他因素（高血压、体重指数、就业时间、吸烟指数和外部照射分析期间内部照射对肝脏的总吸收剂量，反之亦然）对结果影响不大。分类分析表明，与暴露于较低剂量的工人相比，总吸收外部伽马射线剂量大于0.1戈伊的工人的心血管疾病发病率明显较高，与暴露于较低剂量的工人相比，总吸收合并钚的肝脏内部α粒子剂量大于0.01戈伊的工人的心血管疾病发病率也明显较高。CVD发病率的分类分析的结果与外部γ射线剂量的线性剂量反应一致，但内部α粒子剂量的情况不太清楚。与暴露于小于0.01戈伊的剂量的工人相比，首次在肝脏暴露于大于0.1戈伊的内部α粒子剂量的工人中观察到心血管疾病死亡的过度风险。校正非辐射因素后，在1.0戈伊剂量组中，CVD死亡率随α粒子内照射剂量的增加而显著增加，ERR/戈伊= 0.84（95%CI，0.09，1.92）。这些更新的结果为CVD发病率与外部伽马射线剂量呈线性趋势提供了很好的证据。由于使用基于低于检测限的生物测定测量的剂量估计值相关问题的影响，CVD发病率与内部α粒子剂量的趋势不太清楚。(C)2014年，辐射研究学会
Incidence and mortality from cerebrovascular disease (CVD) [International Classification of Diseases 9th revision (ICD-9) codes: 430-438] was studied in a cohort of 22,377 workers first employed at the Mayak Production Association (Mayak PA) in 1948-1982 and followed up to the end of 2008. The cohort size was increased by 19% and follow-up extended by 3 years over the previous analysis. Radiation doses were estimated using an updated dosimetry system: Mayak Worker Dosimetry System 2008 (MWDS-2008). For the first time, in an analysis of this cohort, quantitative smoking data were used. Workers of the study cohort were exposed occupationally to prolonged external gamma rays and internal alpha particles. The mean (+/- standard deviation) total dose from external gamma rays was 0.54 +/- 0.76 Gy (95% percentile 2.21 Gy) for males and 0.44 +/- 0.65 Gy (95% percentile 1.87 Gy) for females. The mean plutonium body burden in the 31% of workers monitored for internal exposure was 1.32 +/- 4.87 kBq (95% percentile 4.71 kBq) for males and 2.21 +/- 13.24 kBq (95% percentile 4.56 kBq) for females. The mean total absorbed alpha-particles dose to the liver from incorporated plutonium was 0.23 +/- 0.77 Gy (95% percentile 0.89 Gy) in males and 0.44 +/- 2.11 Gy (95% percentile 1.25 Gy) in females. After adjusting for nonradiation factors (gender, age, calendar period, employment period, facility, smoking, alcohol consumption), there were significantly increasing trends in CVD incidence associated with total absorbed dose from external gamma rays and total absorbed dose to the liver from internal alpha-particle radiation exposure. Excess relative risks per Gy (ERR/Gy) were 0.46 (95% CI 0.37, 0.57) and 0.28 (95% CI 0.16, 0.42), respectively, based on a linear dose-response model. Adjustments for additional factors (hypertension, body mass index, duration of employment, smoking index and total absorbed dose to the liver from internal exposure during the analysis of external exposure and vice versa) had little effect on the results. The categorical analyses showed that CVD incidence was significantly higher among workers with total absorbed external gamma-ray doses greater than 0.1 Gy compared to those exposed to lower doses and that CVD incidence was also significantly higher among workers with total absorbed internal alpha-particle doses to the liver from incorporated plutonium greater than 0.01 Gy compared to those exposed to lower doses. The results of the categorical analyses of CVD incidence were in good agreement with a linear dose response for external gammaray doses but for internal alpha-particle doses the picture was less clear. For the first time an excess risk of CVD mortality was seen in workers whose livers were exposed to internal alpha-particle doses greater than 0.1 Gy compared to those workers who were exposed to doses of less than 0.01 Gy. A significant increasing trend for CVD mortality with internal alpha-particle dose was revealed in the subcohort of workers exposed at doses,1.0 Gy after having adjusted for nonradiation factors, ERR/Gy = 0.84 (95% CI, 0.09, 1.92). These updated results provide good evidence for a linear trend in risk of CVD incidence with external gamma-ray dose. The trend for CVD incidence with internal alpha-particle dose is less clear due to the impact of issues concerning the use of dose estimates based on below the limit of detection bioassay measurements. (C) 2014 by Radiation Research Society