Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)
Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)
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DOI：
10.1136/oemed-2013-101662
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发表时间：
2014-06-01
影响因子：
4.9
通讯作者：
Pinkerton, Lynne E.
中科院分区：
文献类型：
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作者：
Daniels, Robert D.;Kubale, Travis L.;Pinkerton, Lynne E.
目的 调查自 1950 年起并跟踪至 2009 年的 29 993 名美国职业消防员的死亡率模式和癌症发病率。方法以美国人口为参考，通过生命表方法评估死亡率和癌症发病率。确定了 92 种死亡原因和 41 种癌症发病率分组的标准化死亡率 (SMR) 和发病率 (SIR) 比率。分析重点关注 15 个先验结果。进行敏感性分析以检查是否存在显着偏倚。结果 死亡率和发病率分析的风险人年总计分别为 858 938 和 403 152。全因死亡率符合预期（SMR = 0.99，95% CI 0.97 至 1.01，n = 12 028）。癌症死亡率（SMR = 1.14，95% CI 1.10 至 1.18，n = 3285）和发病率（SIR = 1.09，95% CI 1.06 至 1.12，n = 4461）过高，主要包括消化道癌症（SMR = 1.26，95% CI 1.18 至 1.34，n = 928；SIR = 1.17，95% CI 1.10 至 1.25，n = 930）和呼吸道癌症（SMR = 1.10，95% CI 1.04 至 1.17，n = 1096；SIR = 1.16，95% CI 1.08 至 1.24，n = 813）癌症。与之前的报告一致，在几种实体癌中观察到适度的升高；然而，缺乏淋巴癌或造血系统癌症过多的证据。这项研究首次报告了美国消防员中恶性间皮瘤过多的情况（SMR= 2.00，95% CI 1.03 至 3.49，n = 12；SIR = 2.29，95% CI 1.60 至 3.19，n = 35）。在不同的假设和分析技术下，结果显得稳健。结论我们的结果提供了消防与癌症之间关系的证据。鉴于石棉暴露是已知的消防危害，恶性间皮瘤过多的新发现值得注意。
Objectives To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009.Methods Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias.Results Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR = 0.99, 95% CI 0.97 to 1.01, n = 12 028). There was excess cancer mortality (SMR = 1.14, 95% CI 1.10 to 1.18, n = 3285) and incidence (SIR = 1.09, 95% CI 1.06 to 1.12, n = 4461) comprised mainly of digestive (SMR = 1.26, 95% CI 1.18 to 1.34, n = 928; SIR = 1.17, 95% CI 1.10 to 1.25, n = 930) and respiratory (SMR= 1.10, 95% CI 1.04 to 1.17, n = 1096; SIR = 1.16, 95% CI 1.08 to 1.24, n = 813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR= 2.00, 95% CI 1.03 to 3.49, n = 12; SIR = 2.29, 95% CI 1.60 to 3.19, n = 35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques.Conclusions Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.