Cancer mortality in Chinese chrysotile asbestos miners: exposure-response relationships.
Cancer mortality in Chinese chrysotile asbestos miners: exposure-response relationships.
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DOI：
10.1371/journal.pone.0071899
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Christiani DC
中科院分区：
文献类型：
--
作者：
Wang X;Yano E;Lin S;Yu IT;Lan Y;Tse LA;Qiu H;Christiani DC
这项研究的目的是评估肺癌和其他选定原因与石棉暴露水平之间的关系。对中国某温石棉矿的1539名男工进行了为期26年的跟踪调查。关于生命状况、职业和吸烟的数据是从矿井记录和个人接触者那里收集的。从当地死亡登记处进一步核实了死亡原因和日期。根据转换后的粉尘测量值和特定车间的工作年限，估算了个人累积纤维暴露量（f-yr/ml）。计算了肺癌、胃肠道（GI）癌、所有癌症和非恶性呼吸道疾病（NMRD）的标准化死亡率（SMR），这些疾病按就业年限、估计的累积纤维暴露和吸烟分层。泊松模型拟合，以确定估计的纤维暴露和原因特异性死亡率之间的因果关系，调整年龄和吸烟。肺癌的SMR随着入组研究时的就业年限而增加，与<10年相比，≥10年增加3.5倍，≥20年增加5.3倍。全国改良与发展运动也有类似趋势。吸烟者的各种原因的死亡率高于不吸烟者，但后者也有轻微增加肺癌的SMR。在累积暴露量<20 f-yrs/ml时，未观察到过多的肺癌死亡率。然而，在吸烟者中观察到≥20 f-yrs/ml及以上水平的死亡率显著增加，在非吸烟者中观察到≥100 f-yrs/ml及以上水平的死亡率显著增加。对于匪RD也显示出类似的清晰梯度。多因素分析显示，肺癌和NMRD的疗效关系持续存在。此外，当年龄和吸烟被调整后，GI癌症死亡率显示出明显的梯度。在这一组群中存在明确的风险-反应关系，这意味着温石棉接触与肺癌和非恶性呼吸道疾病之间存在因果关系，并可能与胃肠癌之间存在因果关系，至少对吸烟者而言是如此。
This study was conducted to assess the relationship of mortality from lung cancer and other selected causes to asbestos exposure levels. A cohort of 1539 male workers from a chrysotile mine in China was followed for 26 years. Data on vital status, occupation and smoking were collected from the mine records and individual contacts. Causes and dates of death were further verified from the local death registry. Individual cumulative fibre exposures (f-yr/ml) were estimated based on converted dust measurements and working years at specific workshops. Standardized mortality ratios (SMRs) for lung cancer, gastrointestinal (GI) cancer, all cancers and nonmalignant respiratory diseases (NMRD) stratified by employment years, estimated cumulative fibre exposures, and smoking, were calculated. Poisson models were fitted to determine exposure-response relationships between estimated fibre exposures and cause-specific mortality, adjusting for age and smoking. SMRs for lung cancer increased with employment years at entry to the study, by 3.5-fold in ≥10 years and 5.3-fold in ≥20 years compared with <10 years. A similar trend was seen for NMRD. Smokers had greater mortality from all causes than nonsmokers, but the latter also had slightly increased SMR for lung cancer. No excess lung cancer mortality was observed in cumulative exposures of <20 f-yrs/ml. However, significantly increased mortality was observed in smokers at the levels of ≥20 f-yrs/ml and above, and in nonsmokers at ≥100 f-yrs/ml and above. A similarly clear gradient was also displayed for NMRD. The exposure-response relationships with lung cancer and NMRD persisted in multivariate analysis. Moreover, a clear gradient was shown in GI cancer mortality when age and smoking were adjusted for. There were clear exposure-response relationships in this cohort, which imply a causal link between chrysotile asbestos exposure and lung cancer and nonmalignant respiratory diseases, and possibly to gastrointestinal cancer, at least for smokers.
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