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，主要是基于肺癌和胃癌，在一些研究中脑癌和肾癌也有所增加。证据的重要性表明，铅暴露会增加成年人的血压，使中风和心脏病的结果受到关注。已知极高水平的铅暴露会导致非恶性肾脏疾病，并且越来越多的证据表明低水平的铅暴露也会导致非恶性肾脏疾病。我们建议研究1982-2005年11个州约10万名参加血铅监测项目的工人的死亡率和终末期肾病（ESRD）发病率。铅监测计划由国家职业安全与健康研究所（NIOSH）协调。受试者将根据其单一或平均血铅水平分为四组（约75%的工人只进行过一次测试，而25%的工人进行过一次以上）。四个组将如下划分：<5 ug/md、5至<25 ug/dl、25至<40 ug/ml和40+ ug/dl。这些群体的预期人数分别为25，000、25，000、35，000和15，000。OSHA建议工人的血铅水平低于40 ug/dl，ACGIH建议低于30 ug/dl;目前美国成人血铅水平的几何平均值为<3 ug/dl。关注的结局将是癌症、卒中、心脏病和非恶性肾脏疾病导致的死亡，以及ESRD的发生率。将铅暴露队列的死亡率和ESRD发生率与美国人群进行比较。死亡率分析将使用基础和多原因。此外，内部分析将直接比较血铅较高的人群与血铅最低的人群（<5微克/分升）。将对重复血液测量的组进行单独分析。感兴趣的人群具有记录血铅水平的优势，并且比任何先前研究的铅暴露工人队列都要大。拟议中的合作将提供一个模型，汇集数据在国家为基础的监测系统，沿着线所要求的疾病预防控制中心最近发起的环境公共卫生跟踪计划。 公共卫生相关性：在过去的十年里，越来越多的证据表明铅会导致癌症、心脏病、中风和肾病。一个非常大的队列的铅暴露工人与记录的血铅水平提供了一个独特的机会，评估这些疾病与过去的铅暴露。拟议的研究将远远大于任何先前的铅暴露受试者队列研究，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.