178 Prediction of Optimal Intervals of Radiological Surveillance for Workers at Different Risks of Silicosis - China’s Experience
178 Prediction of Optimal Intervals of Radiological Surveillance for Workers at Different Risks of Silicosis - China’s Experience
复制标题
178 不同矽肺风险工人放射监测最佳间隔预测——中国经验
DOI：
10.1136/oemed-2013-101717.180
复制
发表时间：
2013
影响因子：
4.9
通讯作者：
Chen
中科院分区：
文献类型：
--
作者：
Tse;Chen;Zhang;Yu;Wong;Leung;Kromhout;Meijer;Chen
目的确定不同矽肺危险程度工人的最佳胸片监测间隔时间。方法对中国某铁矿1964~74年接尘工人3492人进行队列调查，随访至2008年12月31日。我们获得了工人的社会人口学、吸烟习惯、疾病史和终生职业史等信息；这些变量被用来根据预测模型开发风险评分系统。预测模型的判别能力取决于受试者工作特征(ROC)曲线下面积。根据OSHA的先例作用(不可接受的风险：>；1/1000)，我们确定了对不同矽肺风险的工人进行放射检查的最佳间隔。结果ROC曲线下面积为0.83(95%CI，0.81~0.86)的最小绝对收缩选择算子(LASSO)Cox模型具有较好的识别性。我们根据得分图表将工人分为3个风险组，发现观察到的概率与预测符合得很好。根据OSHA的先例作用，我们可以确定低风险组(Score<；25)工人最初的放射学监测间隔为11年，然后建议每两年进行一次检查。中级组(24~40分)和高危组(≥40分)的初次检查间隔分别为11年和5年，以后建议每年检查一次。对于矽肺患者，建议进行年度放射监测计划，而不考虑尘肺的阶段。结论本研究首次为不同矽肺风险水平工人的最佳放射学监测间隔提供了科学依据，而在后续研究中的交叉工业验证可能值得探讨。承认肺尘埃沉着病补偿基金委员会，香港。
Objectives To determine the optimal intervals of chest radiographic surveillance for workers at different risks of silicosis. Methods All 3492 workers who were exposed to silica dust during 1964–74 in an iron-ore of China were recruited into this historical cohort study, and followed up till 31/12/2008. We obtained worker’s information on socio-demographics, smoking habits, disease history, and lifetime occupational history; these variables were used to develop a risk score system according to a prediction model. The discriminative ability of prediction model was determined by the area under the receiver operating characteristic (ROC) curve. We determined the optimal interval of radiographic surveillance for workers at different risk of silicosis according to the OSHA’s precedent role (unacceptable risk: >1/1000). Results The model with the best fit was the least absolute shrinkage and selection operator (LASSO) Cox model which showed a good discrimination with an area of 0.83 (95% CI, 0.81–0.86) under the ROC curve. We classified workers into 3 risk groups according to the score chart, and found the observed probabilities matched well to the predictions. According to the OSHA’s precedent role, we can determine that the initial interval of radiographic surveillance for workers in the low risk group (score <25) was 11 years and then a biyearly examination was recommended. The initial examination interval was 11 years and 5 years respectively for workers in the middle (score: 24–40) and high risk group (score ≥40), and a yearly examination was recommended thereafter. For patients with silicosis, an annual radiological surveillance program was recommended regardless of the stage of pneumoconiosis. Conclusions This study is the first to provide scientific evidence on the optimal intervals of radiographic surveillance for workers at different risk levels of silicosis, whilst cross-setting industry validation in subsequent studies may worth exploring. Acknowledgement Pneumoconiosis Compensation Fund Board, Hong Kong.