Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: A systematic review and modelling paper
Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: A systematic review and modelling paper
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DOI：
10.1101/2023.05.31.23290725
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发表时间：
2023-06
期刊：
影响因子：
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通讯作者：
P. Howlett;Hader Mousa;Bibie Said;A. Mbuya;O. Kon;S. Mpagama;J. Feary
中科院分区：
文献类型：
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作者：
P. Howlett;Hader Mousa;Bibie Said;A. Mbuya;O. Kon;S. Mpagama;J. Feary
据估计，4400万个体和小规模矿工（ASM）主要分布在发展中经济体，面临着呼吸道疾病的重大职业风险。我们的目的是审查研究，描述矽肺和结核病的患病率和可吸入结晶二氧化硅（RCS）暴露的ASM和使用背景证据，试图了解暴露和疾病的结果之间的关系。方法检索PubMed、Web of Science、Scopus和Embase中2023年3月24日之前发表的研究。进行了系统性综述和叙述性综合，并评估了偏倚风险。Logistic和Poisson回归模型与预定义的参数被用来估计矽肺患病率和结核病发病率在不同分布的累积二氧化硅暴露。结果：我们确定了18个合格的研究，13个不同的人群在10个国家。矽肺患病率范围为11%至37%，尽管五项研究中有四项报告的平均采矿时间中位数<6年。结核病流行率很高;微生物学证实的疾病为1.8%至12%，临床疾病为3.0%至17%。平均RCS强度非常高（范围为0.19-89.5 mg/m3），呼吸道症状常见。我们的模型表明，RCS的降低导致矽肺和结核病的减少，在较高的平均暴露量下效果更大。讨论在这篇综述的研究中，矽肺和结核病的患病率很高。我们的模型表明，减少RCS对呼吸系统健康的最大益处是那些接触最多的人。个体和小型金矿面临着很高的职业性呼吸道疾病负担，可以通过低成本和有效地减少RCS来减轻这种负担。
Background An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases. We aimed to review studies that describe silicosis and tuberculosis prevalence and respirable crystalline silica (RCS) exposures among ASM and use background evidence to attempt to understand the relationship between exposures and disease outcomes. Methods We searched PubMed, Web of Science, Scopus and Embase for studies published before the 24th March 2023. A systematic review and narrative synthesis was performed and risk of bias assessed. Logistic and Poisson regression models with predefined parameters were used to estimate silicosis prevalence and tuberculosis incidence at different distributions of cumulative silica exposure. Results We identified 18 eligible studies of 13 distinct populations in 10 countries. Silicosis prevalence ranged from 11 to 37%, despite four of five studies reporting an average median duration of mining of <6 years. Tuberculosis prevalence was high; microbiologically confirmed disease ranged from 1.8 to 12% and clinical disease 3.0 to 17%. Average RCS intensity was very high (range 0.19-89.5 mg/m3) and respiratory symptoms were common. Our modelling demonstrated decreases in RCS result in reductions in silicosis and tuberculosis, with greater effects at higher mean exposures. Discussion Prevalence of silicosis and tuberculosis were high in the studies identified in this review. Our modelling demonstrated the greatest respiratory health benefits of reducing RCS are in those with highest exposures. ASM face a high occupational respiratory disease burden which can be reduced by low-cost and effective reductions in RCS.