Mortality and Renal Disease in a Cohort Study of Lead-Exposed Workers in a Survei

描述(由申请人提供)：在过去十年中，越来越多的证据表明，即使在相对较低的环境水平下，铅暴露也与血压、心脏病、癌症和肾功能障碍有关。国际癌症机构(IARC)和国家毒理学计划(NTP)最近都宣布铅是一种可能的人类致癌物质，主要是由于肺癌和胃癌，在一些研究中，脑癌和肾癌也有所增加。证据的份量表明，铅暴露会增加成年人的血压，使中风和心脏病的后果成为人们关注的问题。众所周知，极高的铅暴露会导致非恶性肾脏疾病，而且越来越多的证据表明，低水平的铅暴露也可以导致非恶性肾脏疾病。我们建议研究1982-2005年间在11个州进行血铅监测计划的大约100,000名工人的死亡率和终末期肾病(ESRD)发病率。铅监测项目由国家职业安全与健康研究所(NIOSH)协调。受试者将根据他们的单次血铅水平或平均血铅水平被分成四组(约75%的工人只做过一次检测，25%的人做过不止一次检测)。这四个组将被分为以下四个组：5ug/md、5至25ug/dl、25至40ug/ml和40+ug/dl。这些群体中的预期人数分别为25,000，25,000，35,000和15,000。OSHA建议工人的血铅水平低于40ug/dl，ACGIH建议低于30ug/dl；目前美国成年人的几何平均血铅水平为3ug/dl。值得关注的结果将是死于癌症、中风、心脏病和非恶性肾脏疾病，以及终末期肾病的发病率。铅暴露人群的死亡率和ESRD发病率将与美国人群的死亡率和ESRD发病率进行比较。死亡率分析将同时使用潜在原因和多种原因。此外，内部分析将直接将血铅水平较高的人群与血铅水平最低的人群(&lt；5ug/dl)进行比较。将对这组人进行单独的分析，并重复进行血液测量。相关人群的优势是有记录的血铅水平，而且比之前研究过的任何铅暴露工人队列都要大。拟议中的合作将提供一个跨州监测系统汇集数据的模型，符合疾控中心最近启动的环境公共卫生跟踪计划的要求。 与公共健康相关：在过去的十年里，越来越多的证据表明，铅可以导致癌症、心脏病、中风和肾脏疾病。有记录的血铅水平的大量铅暴露工人提供了一个独特的机会，可以评估这些疾病与过去铅暴露的关系。这项拟议的研究将比之前任何针对铅暴露受试者的队列研究规模大得多，并将提供一个跨州监测系统的合作模式。

DESCRIPTION (provided by applicant): Increasing evidence in the last decade links lead exposure, even at relatively low environmental levels, to blood pressure, heart disease, cancer, and kidney dysfunction. Both the International Agency for Cancer (IARC) and the National Toxicology Program (NTP) have recently declared lead to be a probable human carcinogen, primarily based on lung and stomach cancer, with brain and kidney cancer also being elevated in some studies. The weight of the evidence indicates that lead exposure increases blood pressure in adults, making both stroke and heart disease outcomes of interest. Very high lead exposure is known to cause non-malignant kidney disease, and there is increasing evidence that low-levels can do the same, We propose to study the mortality and end-stage renal disease (ESRD) incidence in approximately 100,000 workers who have been in blood lead surveillance programs in eleven states from 1982-2005. The lead surveillance programs are coordinated by the National Institute for Occupational Safety and Health (NIOSH). Subjects will be divided into four groups, based on their single or average blood lead level (about 75% of workers have had only one test, while 25% have had more than one). The four groups will be divided as follows: <5 ug/md, 5 to <25 ug/dl, 25 to <40 ug/ml, and 40+ ug/dl. The expected numbers in these groups are 25,000, 25,000, 35,000, and 15,000. OSHA recommends that workers to have blood lead levels below 40 ug/dl, and ACGIH recommends lower than 30 ug/dl; the current geometric mean US adult blood lead level is <3 ug/dl. The outcomes of interest will be death from cancer, stroke, heart disease, and non-malignant kidney disease, as well as the incidence of ESRD. Mortality and ESRD incidence of the lead-exposed cohort will be compared to that of the US population. Mortality analyses will use both underlying and multiple cause. In addition, internal analyses will compare those with higher blood leads directly to the group with lowest blood leads (<5 ug/dl). Separate analyses will be conducted on the group with repeated blood measurements. The population of interest has the advantage of having documented blood lead levels, and being larger than any previously studied cohort of lead-exposed workers. The proposed collaboration will provide a model for pooling data across state-based surveillance systems, along the lines called for by CDC's recently initiated Environmental Public Health Tracking Program. PUBLIC HEALTH RELEVANCE: In the last decade there is increasing evidence that lead can cause cancer, heart disease, stroke, and kidney disease. A very large cohort of lead-exposed workers with documented blood lead levels offers a unique opportunity evaluate these diseases in relation to past lead exposure. The proposed study would be the far larger than any prior cohort study of lead- exposed subjects, and will provide a model of collaboration across state-based surveillance systems.