Estimating the Impact of Changes to Occupational Standards for Silica Exposure on Lung Cancer Mortality.
Estimating the Impact of Changes to Occupational Standards for Silica Exposure on Lung Cancer Mortality.
复制标题
DOI：
10.1097/ede.0000000000000867
复制
发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Steenland K
中科院分区：
文献类型：
--
作者：
Keil AP;Richardson DB;Westreich D;Steenland K
呼吸接触二氧化硅与因恶性和非恶性疾病而死亡的风险有关。230万美国工人接触到二氧化硅。二氧化硅的职业暴露限值来自许多证据，包括观察性研究。观察性研究可能受到健康工人幸存者偏差的影响，这可能导致低估二氧化硅对工人死亡率的影响，进而导致职业接触限值的偏差风险估计。利用来自多个行业的65,999名工人的数据，我们估计了几种假设的职业暴露限值对二氧化硅暴露对肺癌和全因死亡率的影响。我们使用参数g公式，它可以解释健康工人的幸存者偏差。假设我们可以消除职业暴露，我们估计在我们的汇总研究中，到80岁时，每1000名工人的死亡人数将减少20.7人（95%置信区间：14.5,26.8），其中肺癌死亡人数减少3.91人（95%置信区间：1.53,6.30）。限制性较低的干预措施显示，风险降低幅度较小，但仍然很大。我们的研究结果表明，可以进一步加强二氧化硅的职业暴露限值，以降低二氧化硅相关的死亡率，并说明如何改进目前的职业限值风险分析。
Respiratory exposure to silica is associated with the risk of death due to malignant and non-malignant disease. 2.3 million U.S. workers are exposed to silica. Occupational exposure limits for silica are derived from a number of lines of evidence, including observational studies. Observational studies may be subject to healthy worker survivor bias, which could result in underestimates of silica’s impact on worker mortality and, in turn, bias risk estimates for occupational exposure limits. Using data on 65,999 workers pooled across multiple industries, we estimate the impacts of several hypothetical occupational exposure limits on silica exposure on lung cancer and all-cause mortality. We use the parametric g-formula, which can account for healthy worker survivor bias. Assuming we could eliminate occupational exposure, we estimate that there would be 20.7 fewer deaths per 1,000 workers in our pooled study by age 80 (95% confidence interval: 14.5, 26.8), including 3.91 fewer deaths due to lung cancer (95%CI: 1.53, 6.30). Less restrictive interventions demonstrated smaller, but still substantial risk reductions. Our results suggest that occupational exposure limits for silica can be further strengthened to reduce silica-associated mortality and illustrate how current risk analysis for occupational limits can be improved.