Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)
Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)
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DOI：
10.1136/oemed-2014-102671
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发表时间：
2015-10-01
影响因子：
4.9
通讯作者：
Pinkerton, Lynne E.
中科院分区：
文献类型：
--
作者：
Daniels, Robert D.;Bertke, Stephen;Pinkerton, Lynne E.
目的：在之前研究的美国职业消防员中，研究消防暴露替代物和选择结果之间的暴露-反应关系。方法采用条件logistic回归对8例癌症结局和4例非癌症结局进行分析。发病率密度抽样将每个病例与200名达到年龄的对照进行匹配。在消防任务中累积的天数（暴露天数），运行总数（消防运行）和运行时间（消防小时）被用作暴露替代。采用对数线性、线性、对数二次、幂和受限三次样条一般相对风险模型计算第75和25百分位滞后累积暴露的hr。使用分段常数模型来检查暴露后的时间、暴露时的年龄和日历期间的风险差异。结果19 309名男性消防员中，癌症死亡1333人，癌症发病率2609人。工作时间与肺癌死亡率和发病率之间存在明显的正相关。白血病死亡率和火灾之间也发现了类似的关系。肺癌的相关性在累积暴露中几乎是线性的，而与白血病死亡率的相关性在较高的暴露水平下减弱，在最近的暴露中更强。暴露替代物与结直肠癌和前列腺癌之间明显存在显著的负相关，表明医疗筛查可能增强了健康工人的幸存者效应。结论：肺癌和白血病的死亡风险随着消防员的暴露而适度增加。这些发现进一步证明了消防和癌症之间存在因果关系。然而，小的影响值得谨慎解释。我们计划继续跟踪该队列中疾病和损伤的发生情况。
Objectives To examine exposure-response relationships between surrogates of firefighting exposure and select outcomes among previously studied US career firefighters.Methods Eight cancer and four non-cancer outcomes were examined using conditional logistic regression. Incidence density sampling was used to match each case to 200 controls on attained age. Days accrued in firefighting assignments (exposed-days), run totals (fire-runs) and run times (fire-hours) were used as exposure surrogates. HRs comparing 75th and 25th centiles of lagged cumulative exposures were calculated using loglinear, linear, log-quadratic, power and restricted cubic spline general relative risk models. Piecewise constant models were used to examine risk differences by time since exposure, age at exposure and calendar period.Results Among 19 309 male firefighters eligible for the study, there were 1333 cancer deaths and 2609 cancer incidence cases. Significant positive associations between fire-hours and lung cancer mortality and incidence were evident. A similar relation between leukaemia mortality and fire-runs was also found. The lung cancer associations were nearly linear in cumulative exposure, while the association with leukaemia mortality was attenuated at higher exposure levels and greater for recent exposures. Significant negative associations were evident for the exposure surrogates and colorectal and prostate cancers, suggesting a healthy worker survivor effect possibly enhanced by medical screening.Conclusions Lung cancer and leukaemia mortality risks were modestly increasing with firefighter exposures. These findings add to evidence of a causal association between firefighting and cancer. Nevertheless, small effects merit cautious interpretation. We plan to continue to follow the occurrence of disease and injury in this cohort.