The Diesel Exhaust in Miners study: a nested case-control study of lung cancer and diesel exhaust.
The Diesel Exhaust in Miners study: a nested case-control study of lung cancer and diesel exhaust.
复制标题
DOI：
10.1093/jnci/djs034
复制
发表时间：
2012-06-06
期刊：
影响因子：
--
通讯作者：
Attfield MD
中科院分区：
文献类型：
--
作者：
Silverman DT;Samanic CM;Lubin JH;Blair AE;Stewart PA;Vermeulen R;Coble JB;Rothman N;Schleiff PL;Travis WD;Ziegler RG;Wacholder S;Attfield MD
大多数关于柴油机废气暴露与肺癌之间关系的研究表明，风险适度但一致地增加。然而，据我们所知，迄今为止还没有研究有定量数据的历史柴油暴露加上足够的样本量，以评估柴油废气和肺癌之间的因果关系。我们的目的是评估量化估计暴露于柴油机废气和肺癌死亡率之间的关系，调整吸烟和其他潜在的混杂因素。我们在8个非金属采矿设施的12315名工人中进行了一项巢式病例对照研究，其中包括198名肺癌死亡者和562名发病密度抽样对照受试者。对于每个病例受试者，我们从病例受试者死亡前存活的所有工人中选择最多4名对照受试者，在采矿设施、性别、种族/民族和出生年份（5年内）上单独匹配。我们估计柴油废气暴露，代表可吸入元素碳（REC），按工作和年，为每个主题，在每个采矿设施的广泛的回顾性暴露评估的基础上。我们进行了分类和连续回归分析，调整了吸烟和其他潜在的混杂变量（例如，肺癌高危职业的就业史和呼吸系统疾病史），以估计比值比（OR）和95%置信区间（CI）。分析均为无滞后和滞后分析，以排除近期暴露，例如死亡日期（病例受试者）/参考日期（对照受试者）前15年内发生的暴露。所有统计学检验均为双侧检验。我们观察到随着累积REC和平均REC强度的增加，肺癌风险呈统计学显著增加趋势。滞后15年的累积REC在肺癌风险总体上产生了统计学显著的正梯度（P趋势= .001）;在严重暴露的工人中，（即，高于上四分位数中位数[REC ≥ 1005 μg/m3-y]），风险约为3倍（OR = 3.20，95% CI = 1.33 ~ 7.69）。在从不吸烟者中，15年滞后累积REC三分位数小于8、8至小于304和304 μg/m3-y或以上的工人的比值比分别为1.0、1.47（95%CI = 0.29至7.50）和7.30（95%CI = 1.46至36.57）。我们还观察到吸烟和15年滞后累积REC之间的相互作用（P相互作用= 0.086），使得这些暴露中的每一个的影响在存在高水平的另一个时被减弱。我们的研究结果提供了进一步的证据，表明柴油废气暴露可能导致人类肺癌，并可能代表潜在的公共卫生负担。
Most studies of the association between diesel exhaust exposure and lung cancer suggest a modest, but consistent, increased risk. However, to our knowledge, no study to date has had quantitative data on historical diesel exposure coupled with adequate sample size to evaluate the exposure–response relationship between diesel exhaust and lung cancer. Our purpose was to evaluate the relationship between quantitative estimates of exposure to diesel exhaust and lung cancer mortality after adjustment for smoking and other potential confounders. We conducted a nested case–control study in a cohort of 12 315 workers in eight non-metal mining facilities, which included 198 lung cancer deaths and 562 incidence density–sampled control subjects. For each case subject, we selected up to four control subjects, individually matched on mining facility, sex, race/ethnicity, and birth year (within 5 years), from all workers who were alive before the day the case subject died. We estimated diesel exhaust exposure, represented by respirable elemental carbon (REC), by job and year, for each subject, based on an extensive retrospective exposure assessment at each mining facility. We conducted both categorical and continuous regression analyses adjusted for cigarette smoking and other potential confounding variables (eg, history of employment in high-risk occupations for lung cancer and a history of respiratory disease) to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Analyses were both unlagged and lagged to exclude recent exposure such as that occurring in the 15 years directly before the date of death (case subjects)/reference date (control subjects). All statistical tests were two-sided. We observed statistically significant increasing trends in lung cancer risk with increasing cumulative REC and average REC intensity. Cumulative REC, lagged 15 years, yielded a statistically significant positive gradient in lung cancer risk overall (P trend = .001); among heavily exposed workers (ie, above the median of the top quartile [REC ≥ 1005 μg/m3-y]), risk was approximately three times greater (OR = 3.20, 95% CI = 1.33 to 7.69) than that among workers in the lowest quartile of exposure. Among never smokers, odd ratios were 1.0, 1.47 (95% CI = 0.29 to 7.50), and 7.30 (95% CI = 1.46 to 36.57) for workers with 15-year lagged cumulative REC tertiles of less than 8, 8 to less than 304, and 304 μg/m3-y or more, respectively. We also observed an interaction between smoking and 15-year lagged cumulative REC (P interaction = .086) such that the effect of each of these exposures was attenuated in the presence of high levels of the other. Our findings provide further evidence that diesel exhaust exposure may cause lung cancer in humans and may represent a potential public health burden.
登录
查看更多内容
影响因子：
5.4
作者：
EMMELIN, A;NYSTROM, L;WALL, S
通讯作者：
WALL, S
影响因子：
12.7
作者：
STEENLAND, NK;SILVERMAN, DT;HORNUNG, RW
通讯作者：
HORNUNG, RW
卡车行业工人的肺癌和车辆排气。
影响因子：
10.4
作者：
Garshick, Eric;Laden, Francine;Hart, Jaime E.;Rosner, Bernard;Davis, Mary E.;Eisen, Ellen A.;Smith, Thomas J.
通讯作者：
Smith, Thomas J.
影响因子：
5.4
作者：
Bhatia, R;Lopipero, P;Smith, AH
通讯作者：
Smith, AH
影响因子：
9.7
作者：
Courter, Lauren A.;Luch, Andreas;Baird, William M.
通讯作者：
Baird, William M.