Nicas M, Lomax G P
Center for Occupational and Environmental Health, School of Public Health, University of California, Berkeley 94720, USA.
J Occup Environ Med. 1999 Jul;41(7):535-44. doi: 10.1097/00043764-199907000-00002.
Genetic screening can identify individuals with increased susceptibility to certain workplace toxicants. One conceivable benefit is a reduction in occupational disease costs. We examine this rationale by considering the associations among genetic traits, exposure, disease risk, and disease incidence. Given appropriate information, we describe methods for computing the expectation and variance of the future number of disease cases and of the differential screening cost per worker hired (a cost-benefit measure). We present two hypothetical scenarios: (1) benzene-induced cancer with few expected cases, and (2) chronic beryllium disease with many expected cases. We show that variability in disease incidence and cost outcomes must be considered because in specific instances, screening can be cost-beneficial on average but yield an unfavorable outcome with high probability. This circumstance pertains to scenarios involving small differences between the expected number of cases in screened versus unscreened cohorts.
基因筛查能够识别出对某些工作场所毒物易感性增加的个体。一个可以想象到的好处是降低职业病成本。我们通过考虑遗传特征、暴露、疾病风险和疾病发病率之间的关联来研究这一基本原理。在给定适当信息的情况下，我们描述了计算未来疾病病例数的期望值和方差以及每位新雇佣工人的差异筛查成本（一种成本效益衡量指标）的方法。我们给出了两个假设情景：（1）预期病例数较少的苯所致癌症，以及（2）预期病例数较多的慢性铍病。我们表明必须考虑疾病发病率和成本结果的变异性，因为在特定情况下，筛查平均而言可能具有成本效益，但却很可能产生不利结果。这种情况适用于筛查队列与未筛查队列的预期病例数差异较小的情景。
