Wong O, Harris F, Rosamilia K, Raabe G K
Applied Health Sciences, Inc, 181 Second Avenue, Suite 628, San Mateo, CA 94401, USA.
J Occup Environ Med. 2001 Apr;43(4):384-401. doi: 10.1097/00043764-200104000-00017.
The present investigation represents an update of a previous cohort mortality study of 7543 workers who were employed at a petroleum refinery in Beaumont, Texas, for at least 1 year between 1945 and 1996. The updated study covered an observation period of 51 years, from 1946 to 1996, with a total of 208,627 person-years of observation. A total of 3020 (40.0%) cohort members were known to have died. The mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs). The overall mortality of the cohort was significantly lower than expected when compared with that of the general US population (SMR, 95.7; 95% CI, 92.3 to 99.2). Overall cancer mortality was also lower than expected (SMR, 85.8; 95% CI, 79.4 to 92.5). For specific cancer sites, significant mortality deficits were observed for the following: buccal cavity and pharynx, esophagus, large intestine, rectum, larynx, lung, and bladder and other urinary organs. No significant increase was reported for any site-specific cancer. A non-significant increase in acute myeloid leukemia was observed among male employees (SMR, 147.2; 95% CI, 76.1 to 257.2). Detailed analyses indicated that the excess was restricted to workers hired before 1950. No increase was detected for other leukemia cell-types, non-Hodgkin's lymphoma, or multiple myeloma. For non-malignant diseases, the majority of SMRs were below 100, and no significant increase was observed for any cause. In particular, significant mortality deficits were reported for ischemic heart disease (SMR, 91.0; 95% CI, 85.4 to 96.9), non-malignant respiratory disease (SMR, 61.5; 95% CI, 52.2 to 72.0), pulmonary fibrosis (SMR, 51.0; 95% CI, 22.0 to 100.4), cirrhosis of the liver (SMR, 47.2; 95% CI, 30.6 to 69.7), and accidents (SMR, 81.7; 95% CI, 66.3 to 99.6). Separate analyses of male workers by job classification (process and maintenance) were conducted. Mortality from acute myeloid leukemia was elevated among employees in maintenance jobs (8 observed deaths vs 4.31 expected; SMR, 185.5; 95% CI, 80.1 to 365.6). However, no upward trend by length of service was found. A detailed analysis indicated that the acute myeloid leukemia mortality excess was limited to maintenance workers who were hired before 1950. No other significant excess was detected for any cause among maintenance or process workers. These findings from the present study were discussed in conjunction with results from previous investigations of employees at the Beaumont refinery and with results from other refinery studies. Potential limitations of the study were also discussed.
本研究是对之前一项队列死亡率研究的更新，该研究涉及1945年至1996年间在得克萨斯州博蒙特一家炼油厂工作至少1年的7543名工人。更新后的研究涵盖了1946年至1996年的51年观察期，总观察人年数为208,627人年。已知共有3020名（40.0%）队列成员死亡。根据特定病因标准化死亡率（SMR）和95%置信区间（95%CI）对死亡率数据进行了分析。与美国普通人群相比，该队列的总体死亡率显著低于预期（SMR为95.7；95%CI为92.3至99.2）。总体癌症死亡率也低于预期（SMR为85.8；95%CI为79.4至92.5）。对于特定癌症部位，观察到以下部位存在显著的死亡率不足：口腔和咽部、食管、大肠、直肠、喉、肺、膀胱及其他泌尿器官。未报告任何部位特异性癌症有显著增加。在男性员工中观察到急性髓系白血病有非显著增加（SMR为147.2；95%CI为76.1至257.2）。详细分析表明，这种增加仅限于1950年前雇用的工人。未检测到其他白血病细胞类型、非霍奇金淋巴瘤或多发性骨髓瘤有增加。对于非恶性疾病，大多数SMR低于100，未观察到任何病因有显著增加。特别是，报告了缺血性心脏病（SMR为91.0；95%CI为85.4至96.9）、非恶性呼吸道疾病（SMR为61.5；95%CI为52.2至72.0）、肺纤维化（SMR为51.0；95%CI为22.0至100.4）、肝硬化（SMR为47.2；95%CI为30.6至69.7）和事故（SMR为81.7；95%CI为66.3至99.6）存在显著的死亡率不足。按工作分类（生产和维修）对男性工人进行了单独分析。维修岗位员工的急性髓系白血病死亡率有所升高（观察到8例死亡，预期为4.31例；SMR为185.5；95%CI为80.1至365.6）。然而，未发现随服务年限的上升趋势。详细分析表明，急性髓系白血病死亡率的增加仅限于1950年前雇用的维修工人。在维修或生产工人中未检测到任何其他病因有显著增加。本研究的这些发现结合博蒙特炼油厂员工之前的调查结果以及其他炼油厂研究的结果进行了讨论。还讨论了该研究的潜在局限性。
