Mundt K A, Dell L D, Austin R P, Luippold R S, Noess R, Bigelow C
Applied Epidemiology, PO Box 2424, Amherst, MA 01004, USA.
Occup Environ Med. 2000 Nov;57(11):774-81. doi: 10.1136/oem.57.11.774.
To update and assess mortality from neoplasms to 31 December 1995 among 10 109 men employed in a job exposed to vinyl chloride for at least 1 year between 1942 and 1972 at any of 37 North American factories. Previous analyses indicated associations between employment in vinyl production and increased mortality risk from cancers of the liver and biliary tract, due to increased mortality from angiosarcoma of the liver, and brain cancer.
Standardised mortality ratio (SMR) analyses, overall and stratified by several work related variables, were conducted with United States and state reference rates. Cox's proportional hazards models and stratified log rank tests were used to further assess occupational factors.
895 of 3191 deaths (28%) were from malignant neoplasms, 505 since the previous update to the end of 1982. Mortality from all causes showed a deficit (SMR 83, 95% confidence interval (95% CI) 80 to 86), whereas mortality from all cancers combined was similar to state referent rates. Mortality from cancers of the liver and biliary tract was clearly increased (SMR 359, 95% CI 284 to 446). Modest excesses of brain cancer (SMR 142, 95% CI 100 to 197) and cancer of connective and soft tissue (SMR 270, 95% CI 139 to 472) were found. Stratified SMR and Cox's proportional hazard analyses supported associations with age at first exposure, duration of exposure, and year of first exposure for cancers of the liver and soft tissues, but not the brain.
Excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continues. Risk of mortality from brain cancer has attenuated, but its relation with exposure to vinyl chloride remains unclear. A potentially work related excess of deaths from cancer of connective and soft tissue was found for the first time, but was based on few cancers of assorted histology.
更新并评估1995年12月31日前，北美37家工厂中，1942年至1972年期间从事氯乙烯相关工作至少1年的10109名男性的肿瘤死亡率。此前分析表明，氯乙烯生产工作与肝癌、胆管癌、因肝血管肉瘤导致的死亡率增加以及脑癌之间存在关联。
采用标准化死亡率比（SMR）分析，按美国和各州参考率进行总体分析，并按多个与工作相关的变量进行分层分析。使用Cox比例风险模型和分层对数秩检验进一步评估职业因素。
3191例死亡中有895例（28%）死于恶性肿瘤，自上次更新至1982年底有505例。全因死亡率呈下降趋势（SMR 83，95%置信区间（95%CI）80至86），而所有癌症合并死亡率与各州参考率相似。肝癌和胆管癌死亡率明显增加（SMR 359，95%CI 284至446）。发现脑癌（SMR 142，95%CI 100至197）和结缔组织及软组织癌（SMR 270，95%CI 139至472）有适度超额。分层SMR和Cox比例风险分析支持肝癌和软组织癌的死亡率与首次接触年龄、接触持续时间和首次接触年份有关，但与脑癌无关。
肝癌和胆管癌的超额死亡风险仍然存在，主要归因于血管肉瘤。脑癌的死亡风险已减弱，但其与接触氯乙烯的关系仍不清楚。首次发现结缔组织和软组织癌的死亡可能与工作相关超额，但基于各类组织学的癌症病例较少。
