A comparison of PMRs and SMRs as estimators of occupational mortality.
A comparison of PMRs and SMRs as estimators of occupational mortality.
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DOI：
10.1097/00001648-199101000-00008
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发表时间：
1991-01-01
期刊：
影响因子：
--
通讯作者：
Silverstein, M A
中科院分区：
文献类型：
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作者：
Park, R M;Maizlish, N A;Silverstein, M A
职业病的标准化死亡率(SMR)被工业人群和普通人群之间的健康差异所混淆。在109个基本没有与工作相关的死亡率的行业队列中，这些选择效应对恶性和非恶性结果都有相当大的影响。在许多队列中，全癌SMR显著低于1.0，肺癌与非恶性疾病受到几乎同样多的选择来源的混淆。在估计职业风险方面，标准化比例死亡率(PMR)(由相对SMR(RSMR)近似)比SMR更容易混淆。PMR似乎平均高估了6%的癌症死亡率，而SMR高估了13%。PMRS低估了16%的非恶性呼吸道疾病，而SMR低估了39%。令人困惑的来源，除了对受雇的健康状况进行选择外，最有可能的是社会阶层。在缺乏内部人口比较的情况下，SMR将无法在许多工业队列中检测到与恶性和非恶性工作相关的死亡率。
Standardized mortality ratios (SMRs) for occupational diseases are confounded by health differences between industrial and general populations. In 109 industrial cohorts largely free of work-related mortality, these selection effects were sizable for both malignant and nonmalignant outcomes. All-cancer SMRs were considerably less than 1.0 for many cohorts, and lung cancer was subject to almost as much selection-derived confounding as nonmalignant disease. Standardized proportional mortality ratios (PMRs) (approximated by relative SMRs (RSMRs] were less confounded than SMRs in estimating occupational risk. PMRs appeared to overestimate cancer mortality on average by 6%, while SMRs underestimated by 13%. PMRs underestimated nonmalignant respiratory disease by 16 percent but SMRs underestimated by 39 percent. The sources of confounding, in addition to selection on health status at hire, most likely include social class. SMRs, in the absence of internal population comparisons, would fail to detect both malignant and nonmalignant work-related mortality in many industrial cohorts.