Meta-analysis of mortality and cancer incidence among workers in the synthetic rubber-producing industry
Meta-analysis of mortality and cancer incidence among workers in the synthetic rubber-producing industry
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DOI：
10.1093/aje/kwj252
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发表时间：
2006-09-01
影响因子：
5
通讯作者：
Abrams, K. R.
中科院分区：
文献类型：
--
作者：
Alder, N.;Fenty, J.;Abrams, K. R.
合成橡胶的生产涉及接触几种潜在有害的化学物质。作者对橡胶生产行业工人的队列研究进行了系统回顾和荟萃分析。数据来自几个数据库的计算机化文献检索，从成立到2003年12月。检查了已识别文章的参考文献列表中的其他相关文章。作者对对数标准化死亡率比（SMR）/标准化发病率比进行了随机效应荟萃分析。通过对队列人口统计学因素和研究质量指标进行亚组分析和荟萃回归，探讨研究结果之间的异质性。作者确定了36篇已发表的文章，报告了31个不同队列组的信息。全因死亡率（28个队列）的荟萃SMR为0.86（95%置信区间（CI）：0.82，0.91），所有恶性肿瘤（27个队列）的荟萃SMR为0.94（95% CI：0.89，1.01）。观察到这些终点和大多数疾病特异性结局的异质性。观察到糖尿病的统计学显著过量（荟萃SMR = 1.36，95% CI：1.17，1.59）（5个队列）和白血病（荟萃SMR = 1.21，95% CI：1.03，1.43）（16个队列），后者尤其是专门从事非轮胎制造业的人（meta SMR = 1.70，95%CI：1.14，2.54）（4个队列）。以前的叙述性审查中强调的过度情况没有得到证实。这些结果的解释是复杂的大量无法解释的异质性，在特定的死亡率结果的小过度可能已被掩盖的健康工人的影响。
Production of synthetic rubber involves exposure to several potentially harmful chemicals. The authors carried out a systematic review and meta-analysis of cohort studies of workers in the rubber-producing industry. Data were obtained from computerized literature searches of several databases from their inception through December 2003. The reference lists of identified articles were inspected for further relevant articles. The authors conducted random-effects meta-analyses of log standardized mortality ratios (SMRs)/standardized incidence ratios. Heterogeneity between study results was explored through subgroup analyses and meta-regression on cohort demographic factors and study quality indicators. The authors identified, 36 published articles reporting information on 31 different cohort groups. The meta-SMR was 0.86 (95% confidence interval (CI): 0.82, 0.91) for all-cause mortality (28 cohorts) and 0.94 (95% CI: 0.89, 1.01) for all malignant neoplasms (27 cohorts). Heterogeneity was observed for these endpoints and for the majority of disease-specific outcomes. Statistically significant excesses were observed for diabetes (meta-SMR = 1.36, 95% CI: 1.17, 1.59) (five cohorts) and leukemia (meta-SMR = 1.21, 95% CI: 1.03, 1.43) (16 cohorts), the latter particularly for persons working exclusively in nontire manufacturing (meta-SMR = 1.70, 95%CI: 1.14,2.54) (four cohorts). Excesses highlighted in previous narrative reviews were not substantiated. Interpretation of these results is complicated by substantial unexplainable heterogeneity; small excesses in specific mortality outcomes may have been disguised by the healthy worker effect.