MORTALITY AND OCCUPATIONAL EXPOSURE TO RADIATION - 1ST ANALYSIS OF THE NATIONAL-REGISTRY-FOR-RADIATION-WORKERS
MORTALITY AND OCCUPATIONAL EXPOSURE TO RADIATION - 1ST ANALYSIS OF THE NATIONAL-REGISTRY-FOR-RADIATION-WORKERS
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DOI：
10.1136/bmj.304.6821.220
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发表时间：
1992-01-25
影响因子：
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通讯作者：
SILK, TJ
中科院分区：
文献类型：
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作者：
KENDALL, GM;MUIRHEAD, CR;SILK, TJ
目的-研究放射工作人员的死因特异性死亡率，特别是致命肿瘤和辐射暴露水平之间的关系。设计-队列研究。设置-英国。受试者-核工业主要场所的95 217名放射工作人员。主要结果测量-死因。结果-大多数标准化死亡率低于100：83例未滞后，85例所有原因滞后10年; 84例未滞后，86例所有癌症滞后; 80例所有已知的其他原因，表明“健康工人效应”。“肺癌的赤字（75个未滞后，76个滞后）在0.1%的水平上是显著的。甲状腺癌的标准化死亡率显著升高（214例未滞后，303例滞后），但没有证据表明外部记录的辐射剂量有任何趋势。所有癌症的外照射剂量和死亡率弱相关（p = 0.10），多发性骨髓瘤的相关性更强（p = 0.06）;对于白血病，不包括慢性淋巴瘤，趋势是显著的（p = 0.03;所有检验均为单侧）。从这些数据中得出的所有癌症的终生风险中心估计值为10.0%/Sv（90%置信区间< 0至24%），白血病为0.76%/Sv（0.07至2.4%）（不包括慢性淋巴性白血病）。这两个数值分别是国际辐射防护委员会建议的风险估计值的2.5倍和1.9倍，但90%的置信区间很大，而委员会的风险系数正好在这个范围内。所有癌症剂量的正趋势（风险估计值是由此得出的）并不显著。在辅助分析中，白血病（慢性淋巴细胞白血病除外）之间的正相关性显著且稳健。这项研究表明，辐射暴露和前列腺癌之间没有关联。结论-有证据表明，辐射暴露和癌症死亡率之间的关联，特别是白血病（不包括慢性淋巴细胞白血病）和多发性骨髓瘤，虽然这些疾病的死亡率在研究人群总体低于一般人群。本研究的中心风险估计值高于国际放射防护委员会对白血病（不包括慢性淋巴白血病）和所有恶性肿瘤的最新估计值。然而，委员会的风险估计完全在这项研究的90%置信区间内。对各州的分析表明，风险估计低于委员会的建议，当美国的数据与我们的分析相结合时，总体风险接近委员会的估计。国家放射工作人员登记处的第一次分析没有提供足够的证据来证明为辐射防护目的而修订风险估计是合理的。
Objective - To study cause specific mortality of radiation workers with particular reference to associations between fatal neoplasms and level of exposure to radiation.Design - Cohort study.Setting - United Kingdom.Subjects - 95 217 radiation workers at major sites of the nuclear industry.Main outcome measure - Cause of death.Results - Most standardised mortality ratios were below 100: 83 unlagged, 85 with a 10 year lag for all causes; 84 unlagged, 86 lagged for all cancers; and 80 for all known other causes, indicating a "healthy worker effect." The deficit of lung cancer (75 unlagged, 76 lagged) was significant at the 0.1% level. Standardised mortality ratios were significantly raised (214 unlagged, 303 lagged) for thyroid cancer, but there was no evidence for any trend with external recorded radiation dose. Dose of external radiation and mortality from all cancers were weakly correlated (p = 0.10), and multiple myeloma was more strongly correlated (p = 0.06); for leukaemia, excluding chronic lymphatic, the trend was significant (p = 0.03; all tests one tailed). The central estimates of lifetime risk derived from these data were 10.0% per Sv (90% confidence interval < 0 to 24%) for all cancers and 0.76% per Sv (0.07 to 2.4%) for leukaemia (excluding chronic lymphatic leukaemia). These are, respectively, 2.5 times and 1.9 times the risk estimates recommended by the International Commission on Radiological Protection, but 90% confidence intervals are large and the commission's risk factors fall well within the range. The positive trend with dose for all cancers, from which the risk estimate was derived, was not significant. The positive association between leukaemia (except chronic lymphatic leukaemia) was significant and robust in subsidiary analyses. This study showed no association between radiation exposure and prostatic cancer.Conclusion - There is evidence for an association between radiation exposure and mortality from cancer, in particular leukaemia (excluding chronic lymphatic leukaemia) and multiple myeloma, although mortality from these diseases in the study population overall was below that in the general population. The central estimates of risk from this study lie above the most recent estimates of the International Commission on Radiological Protection for leukaemia (excluding chronic lymphatic leukaemia) and for all malignancies. However, the commission's risk estimates are well within the 90% confidence intervals from this study. Analysis of States indicated lower risk estimates than the commission recommends, and when the American data are combined with our analysis the overall risks are close to those estimated by the commission. This first analysis of the National Registry for Radiation Workers does not provide sufficient evidence to justify a revision in risk estimates for radiological protection purposes.