Mortality from Circulatory Diseases and other Non-Cancer Outcomes among Nuclear Workers in France, the United Kingdom and the United States (INWORKS).
Mortality from Circulatory Diseases and other Non-Cancer Outcomes among Nuclear Workers in France, the United Kingdom and the United States (INWORKS).
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DOI：
10.1667/rr14608.1
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发表时间：
2017-09
影响因子：
3.4
通讯作者：
Kesminiene A
中科院分区：
文献类型：
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作者：
Gillies M;Richardson DB;Cardis E;Daniels RD;O'Hagan JA;Haylock R;Laurier D;Leuraud K;Moissonnier M;Schubauer-Berigan MK;Thierry-Chef I;Kesminiene A
一些已发表的研究发现，外部辐射剂量与非癌症死亡率之间存在正相关关系，这些研究主要针对暴露于高剂量、高剂量率电离辐射的人群。本研究的目的是确定外部辐射剂量是否与以低剂量率累积暴露于低剂量辐射的大型合并队列核工人的非癌症死亡率相关。这一群体包括来自法国、英国和美国的308297名工人。在组织深度为10mm [Hp(10)]处的平均累积等效剂量为25.2 mSv。总体而言，22%的队列在随访结束时死亡，其中46,029例死亡归因于非癌症结果，其中27,848例死亡归因于循环系统疾病。使用泊松回归研究累积辐射剂量与非癌症死亡率之间的关系。观察到辐射剂量与所有非癌症死亡原因之间存在统计学上显著的关联[每西弗的超额相对风险(ERR/Sv) = 0.19；90% ci: 0.07, 0.30]。这主要是由于辐射剂量与循环系统疾病死亡率之间的相关性（ERR/Sv = 0.22; 90% CI: 0.08, 0.37），非恶性呼吸系统疾病（ERR/Sv = 0.13; 90% CI: - 0.17, 0.47）和消化系统疾病（ERR/Sv = 0.11; 90% CI: - 0.36, 0.69）死亡率的阳性点估计值略小，但不显著。辐射剂量与外因死亡死亡之间相关性的点估计为非显著负相关（ERR = - 0.12; 90% CI: < - 0.60, 0.45）。在循环系统疾病亚型中，观察到脑血管疾病死亡率（ERR/Sv = 0.50; 90% CI: 0.12, 0.94）和缺血性心脏病死亡率（ERR/Sv = 0.18; 90% CI: 0.004, 0.36）与剂量相关。辐射剂量与非癌症死亡率之间关系的估计大体上与原子弹幸存者研究中观察到的结果一致。这项研究的结果可以被解释为提供了进一步的证据，证明外部辐射暴露可能增加非癌症疾病的风险，特别是缺血性心脏病和脑血管疾病。然而，在估计ERR/Sv中观察到异质性，这值得进一步调查。对这些队列的进一步随访，包括内部暴露信息和与生活方式因素相关的其他潜在混杂因素，可能会证明是有益的，因为将进一步阐明可能在低剂量下引起这些非癌症效应的生物学机制。
Positive associations between external radiation dose and non-cancer mortality have been found in a number of published studies, primarily of populations exposed to high-dose, high-dose-rate ionizing radiation. The goal of this study was to determine whether external radiation dose was associated with non-cancer mortality in a large pooled cohort of nuclear workers exposed to low-dose radiation accumulated at low dose rates. The cohort comprised 308,297 workers from France, United Kingdom and United States. The average cumulative equivalent dose at a tissue depth of 10 mm [Hp(10)] was 25.2 mSv. In total, 22% of the cohort were deceased by the end of follow-up, with 46,029 deaths attributed to non-cancer outcomes, including 27,848 deaths attributed to circulatory diseases. Poisson regression was used to investigate the relationship between cumulative radiation dose and non-cancer mortality rates. A statistically significant association between radiation dose and all non-cancer causes of death was observed [excess relative risk per sievert (ERR/Sv) = 0.19; 90% CI: 0.07, 0.30]. This was largely driven by the association between radiation dose and mortality due to circulatory diseases (ERR/Sv = 0.22; 90% CI: 0.08, 0.37), with slightly smaller positive, but nonsignificant, point estimates for mortality due to nonmalignant respiratory disease (ERR/Sv = 0.13; 90% CI: −0.17, 0.47) and digestive disease (ERR/Sv = 0.11; 90% CI: −0.36, 0.69). The point estimate for the association between radiation dose and deaths due to external causes of death was nonsignificantly negative (ERR = −0.12; 90% CI: <−0.60, 0.45). Within circulatory disease subtypes, associations with dose were observed for mortality due to cerebrovascular disease (ERR/Sv = 0.50; 90% CI: 0.12, 0.94) and mortality due to ischemic heart disease (ERR/Sv = 0.18; 90% CI: 0.004, 0.36). The estimates of associations between radiation dose and non-cancer mortality are generally consistent with those observed in atomic bomb survivor studies. The findings of this study could be interpreted as providing further evidence that non-cancer disease risks may be increased by external radiation exposure, particularly for ischemic heart disease and cerebrovascular disease. However, heterogeneity in the estimated ERR/Sv was observed, which warrants further investigation. Further follow-up of these cohorts, with the inclusion of internal exposure information and other potential confounders associated with lifestyle factors, may prove informative, as will further work on elucidating the biological mechanisms that might cause these non-cancer effects at low doses.