钨矿作业工人死因分析

目的 探讨危害钨矿作业工人健康的主要死因并分析他们与累积粉尘接触量之间的关系.方法 以湖南、江西两省6个钨矿1970至1972年之间至少工作1年以上的全部在册职工建立研究队列,随访至2003年底,以全国城市居民年龄别死亡率为参照计算标化死亡比(SMR),采用趋势分析探讨累积粉尘接触量与钨矿作业主要死亡疾病的关系.结果 队列共18 027人,到2003年底,共随访470 722.21人年,死亡6135人,总死亡率为13.03‰.钨矿作业工人死亡的主要疾病按死亡率依次为心血管疾病(3.54‰)、呼吸系统疾病(2.79‰)、恶性肿瘤(2.14‰)和肺结核(1.87‰),这4种疾病死亡人数约占总死亡人数的79.32‰.全死因死亡率(13.03‰)明显高于全国平均水平(SMR=1.19,95%CI:1.16～1.22).死亡率明显升高的疾病为尘肺、肺结核、鼻咽癌、传染病、呼吸系统疾病、心血管疾病和肝癌,SMR分别为79.11,4.11,2.51,2.46,2.00,1.85和1.30.全死因、尘肺、肺结核、呼吸系统疾病和心血管疾病的.SMR随累积接尘量升高有明显的上升趋势,差异有统计学意义(P《0.01).结论 钨矿作业场所粉尘明显危害接尘工人健康,累积粉尘接触量与全死因、肺结核、呼吸系统疾病(尘肺)、心血管疾病标化死亡比之间存在明显的剂量-反应关系.     

铁矿工人队列死因研究

目的 探索危害铁矿作业工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 用流行病学队列研究方法,对武钢大冶铁矿7 469名职工从1972年开始随访30余年,以全国城市居民年龄别死亡率为参照,用标化死亡比（SMR）作为统计指标,并计算95%可信区间.结果 自1972年至2003年底,共计199 108.0人年,死亡1 752人,累积死亡率为23.5%.影响铁矿工人寿命的主要疾病按累积死亡率从高到低排序分别是：肿瘤（7.8%）、脑血管疾病（3.9%）、心血管系疾病（3.4%）和呼吸系疾病（2.9%）,恶性肿瘤以肺癌和肝癌最多,分别占总死亡数的10%和7.4%.全死因SMR为1.06,高于全国平均水平.死亡率明显升高的疾病有鼻咽癌、肝癌、肺癌、尘肺和意外事故,SMR分别为1.84、1.51、1.83、14.94和1.25.队列中接尘工人与非接尘工人比较,接尘工人全死因、胃癌、肺癌、呼吸系统疾病、心血管疾病和意外事故的累积死亡率明显升高（相对危险度分别为1.35、1.83、1.61、2.27、1.34和1.69）.结论 以粉尘为主的职业有害因素明显影响铁矿工人健康和寿命.     

景德镇瓷厂工人死因分析

目的 探索危害陶瓷工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,对景德镇3个瓷厂1972年到1974年在册且工作一年以上所有陶瓷工人建立队列,随访至2003年底.队列中对死者均查询死因,陶工尘肺由当地疾病控制中心诊断小组确诊,肺癌均收集医院诊断病例.以全国城市居民年龄别死亡率为参照计算标化死亡比(SMR).结果 队列成员共4957名,随访至2003年底,共计130 783.6人年,死亡1636人,死亡率为1250.9/10万,累计死亡率为33.1%.影响陶瓷工人寿命的主要疾病按累计死亡率从高到低排序分别是:恶性肿瘤、心血管疾病、呼吸系统疾病、传染性疾病.与全国平均水平比较,陶瓷工人全死因死亡率基本持平,标化死亡比为1.01,死亡率明显升高的疾病有呼吸系统疾病(SMR=1.30)、陶工尘肺(SMR=36.35)、传染性疾病(SMR=5.08)和肺结核(SMR=4.06).陶瓷粉尘对工人寿命的影响十分明显,接尘工人多种疾病的死亡率均高于非接尘组,除陶工尘肺外,接尘组肺癌(RR=1.9,95%CI:1.2～3.1)、呼吸系统疾病(RR=2.4,95%CI:1.8～3.2)、肺结核(RR=1.6,95%CI:1.2～2.1)明显高于非接尘组,差异有统计学意义.研究还发现全死因、肠癌、肺癌、呼吸系统疾病、肺结核危险度均随接尘严重程度而明显增加,呈现接触一反应关系.结论 陶瓷行业主要职业危害为粉尘,卫生工作重点应是控尘和预防肺结核.     

汽车铸造作业工人队列死因研究

目的 分析危害汽车铸造作业工人健康的主要疾病,探讨铸造作业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,以某汽车铸造厂1980年在册的3529名职工为研究对象,从1980年随访至2005年底,以全国城市居民年龄别死亡率均值为参照,用标化死亡比(SMR)作为统计指标,并计算95%可信区间.结果 随访至2005年底,共计84 999人年,共死亡265人,死亡率3.12‰,累积死亡率为7.51%.铸工队列全死因SMR为0.96(95%CI:0.85～1.08)与全国平均水平持平,随着年龄增长,全死因SMR呈现升高趋势,50岁以上组工人的SMR均大于1.影响铸造工人寿命的主要疾病按累积死亡率从高到低排序分别是:恶性肿瘤(3.43%)、意外伤害(1.16%)、脑血管疾病(1.08%)、心血管疾病(0.79%).恶性肿瘤占总死亡原因的45.7%.铸造工人中死亡率明显升高的疾病有恶性肿瘤(SMR=7.87)、意外伤害(SMR=2.70)、心血管疾病(SMR=2.68)、消化系统疾病(SMR=2.79).一线作业工人恶性肿瘤死亡是辅助丁人的1.95倍(RR=1.95,P<0.05).结论 铸造作业中粉尘等职业危害因素明显影响工人的健康,恶性肿瘤死亡明显增加,应加强防护.     

广西锡矿工人死因分析

为评价锡矿工人的死亡原因,对广西４个锡矿共７８５５名工人进行队列研究,追访到１９９４年底,共计１７１２５０人年。结果表明,锡矿工人全死因标准化死亡比（ＳＭＲ＝１．０２）略高于全国居民平均水平,死亡超高的疾病主要是肺结核、恶性呼吸系疾病（包括陶工尘肺）、心血管疾病和肝癌。影响工人寿命的主要疾病是恶性肿瘤、憬血管疾病、非恶性呼吸系统病和脑血和疾病。接尘工人非恶性呼吸系统病、脑血管疾病和肺癌死亡均明显高     

锡矿粉尘生物学活性与致病能力的关系

目的 通过体外细胞实验评价锡矿含石英粉尘的生物特性和毒性,并与接尘工人尘肺和肺癌等疾病发生进行比较.方法 选择鼠肺巨噬细胞为靶细胞,分别测定4个锡矿的呼吸性粉尘样本作用于靶细胞后,葡萄糖苷酸酶、乳酸脱氢酶、过氧化氢以及活性氧自由基（ROS）和肿瘤坏死因子-α（TNF-α）的释放.以标准石英（DQ12）和氧化铝作为对照.矿工人群流行病学研究为回顾前瞻性队列研究.结果 流行病学研究显示,锡矿接尘工人的尘肺标化死亡比（SMR）高达49.7（95%CI：39.5～61.8）,肿瘤（SMR=1.58,95%CI：1.39～1.76）和肺癌死亡率（SMR=3.17,95%CI：2.59～3.76）高于全国平均水平.锡矿粉尘的细胞毒性与细胞功能损伤作用高于氧化铝而低于石英,其诱导的ROS水平明显高于氧化铝和石英,此外,粉尘样本还导致TNF-α分泌升高,超过或接近纯石英粉尘的作用.结论 现场粉尘体外细胞实验结果能较好地解释人群流行病学调查的趋势,粉尘的体外毒性测定可能具有筛检现场粉尘危害的作用.     

广西锡矿工人恶性肿瘤死亡率研究

对大厂和栗木锡矿1972～1974年的在册职工7849人进行了历史前瞻性队列研究;并通过多种监测手段对环境有害因子进行了监测。结果表明,锡矿全死因死亡率为632.7/10万,与全国居民死亡率计算的期望数比较,SMR=1.11(95％CI为1.03～1.19),恶性肿瘤死亡为全死因之首(占39.3％),其次是脑血管疾病和心脏病。恶性肿瘤死亡明显超高(SMR=1.56),且主要集中在肺癌、肝癌和鼻咽癌,其中肺癌占首位(32.1％),SMR为1.98,肝癌和鼻咽癌的SMR为1.79和3.71。监测结果进一步表明,大厂矿肺癌超高与接尘水平及其可吸入砷浓度的高低有明显的联系。     

西欧船厂电焊工肺癌的回顾性研究

为研究电焊工肺癌的危险性及其致癌因素,作者对来自西欧9个国家的11092名男性电焊工进行了队列调查。内容包括电焊工的首次接尘时间、持续接尘时间、累积接触量和铬、镍的累积接触浓度。结果表明,本队列的总死亡率低于对照人群,这可能与选择船厂不锈钢焊接作业工人的条件,即把技术和身体良好的工人选入队列有关。但整个队列肺癌标化死亡比(SMR)为134,显著高出对照人群。此外,作者还根据电焊工接触不同焊接材料进一步分析了船厂不同电焊工肺癌的SMR,结果     

某焦化厂恶性肿瘤死亡的回顾性队列研究

[目的]了解职业有害因素对某焦化厂工人恶性肿瘤死亡的影响。[方法]对该焦化厂工人疾病死因进行14年(1988～2001年)回顾性队列分析，以上海市人口的肿瘤死亡率作为标准对照，计算标准化死亡率比(SMR)及其95％可信区间(95％CI)。[结果]①队列观察期间共死亡．463人，粗死亡率516．08／10万，其中恶性肿瘤死亡173人，占全死因37．37％，其他依次为血管系统疾病、呼吸系统疾病、损伤和中毒等。②炼焦工作区男性职工肺癌和膀胱癌SMR分别为2．77和8．03；副产品工作区男性职工胃癌和白血病．SMR分别为1．89和4．14。累计工龄超过20年以上的炼焦工作区男性职工肺癌SMR为2．84；副产品工作区男性职工肺癌和胃癌SMR分别为2．13和2．05；传输工作区男性职工胃癌SMR为2．92。[结论]该焦化厂职业危害因素有使男性职工恶性肿瘤死亡率增高的趋势，但需在控制职业和非职业因素的情况下作更深入的研究。     

矽肺对肺癌及总死亡影响的回顾性队列研究

目的 利用香港矽肺患者队列的资料进行分析,探讨矽尘、矽肺与肺癌的关系.方法 选择1981年1月1日至1998年12月31日期间在香港尘肺诊所登记的2789例男性矽肺病例为研究对象,取用同时期一般男性人群作为对照.用人年的方法估计各死因的标化死亡比(SMR),用Axelson's法间接调整吸烟的混杂影响.矽尘与肺癌的剂量-效应关系采用多因素p-spline平滑法模型来拟合最佳风险模型.结果 该组研究队列人数为2789,共观察24 992.6人年,失访率仅为2.9%.该队列主要工种为建筑工人(5 1.09%)和地下沉箱操作工人(37.54%).队列总死亡人数为853人,平均死亡年龄为(63.8±10.27)岁,整个队列中86例死于肺癌.全死因及全癌的SMR均明显上升,首位死因是呼吸道疾病,肺癌的5MR明显增加(SMR:1.69,95%CI:1.35～2.09).去除年龄、时期和吸烟的混杂因素的影响,矽肺对肺癌的相对危险度下降到1.12(95%CI:0.89～1.38).间接调整吸烟的混杂影响后建筑工人及地下沉箱工人肺癌的相对危险度分别为1.09(95%CI:0.82～1.42)和1.56(0.98～2.36).多因素p-spline平滑法风险模型分析显示,肺癌与累积呼吸性矽尘总量或平均矽尘浓度的关系无剂量-效应关系.结论 队列研究未发现接触矽尘或矽肺能增加肺癌死亡的危险,平滑法模型拟合的风险模型并不支持矽尘与肺癌死亡之间存在剂量-效应关系.     

Exposures to silica mixed dust and cohort mortality study in tin mines: exposure-response analysis and risk assessment of lung cancer

BACKGROUND: Mineral dusts that contain crystalline silica have been associated directly or indirectly with the development of pneumoconiosis or silicosis, non-malignant respiratory diseases, lung cancer, and other diseases. The health impacts on workers with silica mixed dust exposure in tin mines and dose-response relationships between cumulative dust exposure and the mortality from lung cancer are investigated. METHODS: A cohort of 7,837 workers registered in the employment records in 4 Chinese tin mines between 1972 and 1974 was identified for this study and the mortality follow-up was traced through 1994. Of the cohort, the cause of death was ascertained for 1,061 (97%) of the 1,094 deceased workers. Standardized mortality ratios (SMRs) were calculated for all workers, non-exposed workers, and dust-exposed workers with different exposure levels, silicotics, and non-silicotics based on Chinese national rates. RESULTS: The mortality from all causes in four tin mines was nearly the same as the national mortality. Malignant neoplasm, cerebrovascular disease, and cardiovascular disease accounted for 68.6% of all deaths. Mortality excess from lung cancer, liver cancer, all malignant diseases, and non-malignant respiratory diseases was observed among dust-exposed workers; a 50-fold excess of pneumoconiosis was observed. There was an upward trend for SMRs of lung cancer was noted from no exposure to low, medium, and high exposure levels (SMRs=1.29, 2.65, 2.66, 3.33). The shape of the exposure-response curve for risk of lung cancer at high exposure levels was inconsistent in these four mines. CONCLUSIONS: The findings indicated a positive dose-response relation between exposure to cumulative dust and the mortality of lung cancer. High arsenic content in dust particles, together with crystalline silica, may play an important role in causing increased mortality from lung cancer.     

Mortality analyses for rungsten miners]

OBJECTIVE: To investigate the mortality from main causes of death in 6 tungsten miners and explore the effects of cumulative dust exposure on standardized mortality ratios (SMRs) from main causes. METHODS: A cohort of 18027 workers registered in the employment record from 6 tungsten mines located in Hunan and Jiangxi province and working for at least 1 year was identified for this study. SMRs were calculated based on Chinese national mortality. Trend analysis was used to analyze the effect of cumulative dust exposure on SMRs of main causes of death. RESULTS: The cohort was followed up from 1972 to 2003 with an accumulative of 470 722.21 person-years. A total of 6135 workers died, and the mortality was 13.03 per thousand. Cardiovascular disease, respiratory disease, malignant neoplasm and pulmonary tuberculosis accounted for 79.32% of all death. The mortalities of all-causes, pneumoconiosis, pulmonary tuberculosis, nasopharyngeal carcinoma, infectious disease, respiratory disease, cardiovascular disease and liver cancer were found to be significantly higher than the national average level. Positive dose-response relationship between SMRs and cumulative dust exposure was observed in all-causes, pneumoconiosis, pulmonary tuberculosis, respiratory disease, cardiovascular disease (P < 0.01). CONCLUSION: The mortality from main causes of death for the dust-exposed workers are higher than that for non dust-exposed workers. Positive dose-response relationships are observed between cumulative dust exposure and SMRs from all-causes, respiratory disease (including silicosis), pulmonary tuberculosis and cardiovascular disease.     

Mortality among Ontario members of the International Union of Bricklayers and Allied Craftworkers

BACKGROUND: Dust exposed workers may be at increased risk of pneumoconiosis, stomach cancer, lung cancer, and obstructive lung disease. Bricklayers may experience high exposures to silica and inorganic dusts. The aim of this study was to examine the mortality pattern of bricklayers to identify occupational associations with mortality. METHODS: A cohort of 10,953 workers was assembled from records of the International Union of Bricklayers and Allied Craftworkers (IUBAC). Mortality was ascertained by linkage to the Canadian Mortality Registry at Statistics Canada. Standardized Mortality Ratios (SMRs) were computed using Ontario general population mortality rates as the reference. RESULTS: Twenty or more years from first membership, SMRs for lung (158; 130-190) and stomach (235; 140-370) cancers were significantly elevated. There were four deaths from pneumoconiosis, but non-malignant respiratory mortality SMRs were not increased. CONCLUSIONS: Bricklayers and Allied Craftworkers are at risk from diseases associated with heavy exposure to inorganic dust: lung cancer, stomach cancer, and pneumoconiosis. Dust control as well as education and training of these workers to protect themselves against inhalation hazards is necessary.     

Mortality of a cohort of U.S. workers employed in the crushed stone industry, 1940-1980

The mortality of 3,246 males who had been employed 1 or more years during 1940-1980 at 20 crushed stone operations was evaluated for possible association between employment and death from lung cancer, pneumoconiosis, and other respiratory diseases. Four deaths were attributed to pneumoconiosis. Based on available work histories, at least two of these deaths were probably due to dust exposures in the crushed stone industry. Mortality attributed to pneumoconiosis and other nonmalignant respiratory diseases, including chronic obstructive lung disease, was significantly increased overall (SMR: 1.98; 95%CI: 1.21-3.05), and especially so for a subcohort of crushed stone workers that processed granite (SMR: 7.26; 95%CI: 1.97-18.59). With regard to lung cancer, overall SMRs were elevated (although not statistically significant). Analyzed by rock type, there was a significantly elevated lung cancer SMR among granite workers with at least 20 years latency (SMR: 3.35; 95%CI: 1.34-6.90). Although not definitive, results of this study are consistent with the hypothesis that exposure to respirable silica dust is a risk factor for lung cancer.     

Exposure-response analysis of mortality among coal miners in the United States

The quantitative relationship between exposure to respirable coal mine dust and mortality from nonmalignant respiratory diseases was investigated in a study of 8,878 working male coal miners who were medically examined from 1969 to 1971 and followed to 1979. Exposure-related mortality was evaluated using Cox proportional hazards modeling for underlying or contributing causes of death and modified lifetable methods for underlying causes. For pneumoconiosis mortality, the lifetable analyses showed increasing standardized mortality ratios (SMRs) with increasing cumulative exposure category. Significant exposure-response relationships for mortality from pneumoconiosis (P < 0.001) and from chronic bronchitis or emphysema (P < 0.05) were observed in the proportional hazards models after controlling for age and smoking. No exposure-related increases in lung cancer or stomach cancer were observed. Pneumo coniosis mortality was found to vary significantly by the rank of coal dust to which miners were exposed. Miners exposed at or below the current U.S. coal dust standard of 2 mg/m³ over a working lifetime, based on these analyses, have an elevated risk of dying from pneumoconiosis or from chronic bronchitis or emphysema.     

金属矿尘接触与肺癌发病的危险度定量评价

本文对大厂矿长坡锡矿1960～1974年井下接尘的工人进行了一次回顾性定群研究。研究队列共1113人,贡献人年26780。观察期间死于肺癌45人,与全国、上海人口比较,SMR分别为2184和519。以累计接尘量作定量评价的结果表明,工人吸入的矿尘与肺癌发病呈明显的剂量—反应关系。用对数线性模型拟合接尘量与吸烟量对肺癌发病的作用,发现接尘量与吸烟量同时引入模型后拟合优度最佳。控制吸烟因素后,不同累计接尘量水平对肺癌发病的相对危险度逐次为4.18、5.20、13.01、16.07;控制接尘量后,不同吸烟量的相对危险度分别为1.74、4.19,接尘量与吸烟量及肺癌发病危险度都呈现剂量—反应关系,表明接尘和吸烟同时为肺癌发病的危险因子。     

Mortality among U.S. underground coal miners: a 23-year follow-up

BACKGROUND: The mortality experience over 22-24 years of 8,899 working coal miners initially medically examined in 1969-1971 at 31 U.S. coal mines was evaluated. METHODS: A cohort life-table analysis was undertaken on underlying causes of death, and proportional hazards models were fitted to both underlying, and underlying and contributing causes of death. RESULTS: Elevated mortality from nonviolent causes, nonmalignant respiratory disease (NMRD), and accidents was observed, but lung cancer and stomach cancer mortality were not elevated. Smoking, pneumoconiosis, coal rank region, and cumulative coal mine dust exposure were all predictors of mortality from nonviolent causes and NMRD. Mortality from nonviolent causes and NMRD was related to dust exposure within the complete cohort and also for the never smoker subgroup. Dust exposure relative risks for mortality were similar for pneumoconiosis, NMRD, and chronic airways obstruction. CONCLUSIONS: The findings confirm and enlarge upon previous results showing that exposure to coal mine dust leads to increased mortality, even in the absence of smoking.     

Mortality among workers in the diatomaceous earth industry.

A cohort mortality study was conducted among workers from two plants in the diatomaceous earth mining and processing industry in California. Diatomaceous earth consists of the skeletal remains of diatoms. Exposure to amorphous (non-crystalline) and crystalline silica in the form of quartz results from open pit mining and exposure to crystalline silica (principally cristobalite) occurs in the processing of the material. Lung cancer and non-malignant respiratory diseases have been the health outcomes of greatest concern. The main study cohort included 2570 white men (533 Hispanic and 2017 non-Hispanic workers) who were employed for at least 12 months cumulative service in the industry and who had worked for at least one day during the follow up period, 1942-87. Vital status was ascertained for 91% of the cohort and death certificate information was retrieved for 591 of 628 (94%) identified deaths. The all causes combined standardised mortality ratio (SMR) was slightly increased (SMR = 1.12; 628 observed) compared with rates among US white males. The principal contributors to this excess were increased risks from lung cancer (SMR = 1.43; 59 observed) and non-malignant respiratory disease (NMRD) excluding infectious diseases and pneumonia (SMR = 2.59; 56 observed). The excess of lung cancer persisted when local county rates were used for comparison (SMR = 1.59). Internal rate comparisons by Poisson regression analysis were conducted to assess potential dose-response relations for lung cancer and NMRDs. Mortality trends were examined in relation to duration of employment in dust exposed jobs and with respect to an index of cumulative exposure to crystalline silica. The crystalline silica index was a semiquantitative measure that combined information on duration of exposure, differences in exposure intensity between jobs and calendar periods, the crystalline content of the various product mixes, and the use of respiratory protection devices. Increasing gradients of risk were detected for lung cancer and NMRD with both exposure indices. The relative risk trends for lung cancer and NMRD with crystalline silica exposure lagged 15 years were respectively: 1.00, 1.19, 1.37, and 2.74, and 1.00, 1.13, 1.58, and 2.71. Based on a review of available but limited data on cigarette smoking in the cohort and from application of indirect methods for assessing confounding variables, it seems unlikely that smoking habits could account for all of the association between exposure to dust and lung cancer. The intense and poorly controlled dust exposures encountered before the 1950s were probably the most aetiologically significant contributors to risks from lung cancer and NMRDs. The absence of an excess of lung cancer among workers hired since 1960, and the finding of no deaths attributed to pneumoconiosis as an underlying cause of death among workers hired since 1950 indicate that exposure reductions in the industry during the past 40 years have been successful in reducing excess risks to workers. Further mortality follow up of the cohort and the analysis of radiographic data will be needed to determine conclusively the long term patterns of disease risks in this industry.