Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.
Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula.
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DOI：
10.1097/ede.0000000000000164
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发表时间：
2014-11
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影响因子：
--
通讯作者：
Richardson DB
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文献类型：
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作者：
Edwards JK;McGrath LJ;Buckley JP;Schubauer-Berigan MK;Cole SR;Richardson DB
传统的回归分析技术用于估计职业氡暴露与肺癌之间的关联，重点是估计累积氡暴露对肺癌的影响，而公共卫生干预措施通常是基于调节氡浓度，而不是工人的累积暴露。此外，估计累积的职业暴露对肺癌的直接影响可能是困难的情况下，容易受到健康工人幸存者偏见。科罗拉多高原铀矿工人队列（N=4,134）在1950年至1964年期间进入研究，并在2005年之前对肺癌死亡率进行了随访。我们使用参数g-公式比较观察到的肺癌死亡率与潜在的肺癌死亡率，在整个随访期间，有3项限制每月氡暴露的政策。在135，275人年的随访中，有617例肺癌死亡。如果不对氡暴露进行干预，估计90岁时的肺癌死亡率为16%。肺癌死亡率降低了所有的干预措施考虑，更大的减少，肺癌死亡率的干预措施，每月氡暴露限值较低。最严格的指导方针，矿山安全和健康管理局的标准0.33工作水平月，降低肺癌死亡率从16%到10%（风险比0.67; 95%置信区间0.61，0.73）。这项工作说明了效用的参数g-公式估计政策的影响，职业暴露，特别是在情况下容易受到健康工人幸存者偏见。
Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer, while public health interventions are typically based on regulating radon concentration rather than workers’ cumulative exposure. Moreover, estimating the direct effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker survivor bias. Workers in the Colorado Plateau Uranium Miners cohort (N=4,134) entered the study between 1950 and 1964 and were followed for lung cancer mortality through 2005. We use the parametric g-formula to compare the observed lung cancer mortality to the potential lung cancer mortality had each of 3 policies to limit monthly radon exposure been in place throughout follow-up. There were 617 lung cancer deaths over 135,275 person-years of follow-up. With no intervention on radon exposure, estimated lung cancer mortality by age 90 was 16%. Lung cancer mortality was reduced for all interventions considered, and larger reductions in lung cancer mortality were seen for interventions with lower monthly radon exposure limits. The most stringent guideline, the Mine Safety and Health Administration standard of 0.33 working level months, reduced lung cancer mortality from 16% to 10% (risk ratio 0.67; 95% confidence interval 0.61, 0.73). This work illustrates the utility of the parametric g-formula for estimating the effects of policies regarding occupational exposures, particularly in situations vulnerable to the healthy worker survivor bias.