Wong Otto
Department of Epidemiology, Tulane University, New Orleans, Louisiana, USA.
Toxicol Rev. 2003;22(2):91-102. doi: 10.2165/00139709-200322020-00004.
This article presents a comprehensive critical review of the epidemiology of multiple myeloma in relation to occupational diesel exhaust exposure. The review includes cohort and proportional mortality studies of workers exposed to diesel exhaust, and population-based case-control studies of multiple myeloma. None of the cohort or proportional mortality studies reported a significant increase of multiple myeloma in relation to diesel exhaust, with the exception of a study of Danish truck drivers. Several limitations in this Danish study (such as inadequate cohort identification, small number of multiple myeloma deaths and inappropriate analytical method) made the result unreliable. Furthermore, the data in this study of Danish truck drivers were part of and, hence, superseded by a large study in Denmark, which did not find any increased risk of multiple myeloma. Similarly, none of the case-control studies reported a significant increase of multiple myeloma in relation to diesel exhaust, with the exception of the smallest case-control study based on multiple myeloma patients in central and southeast Sweden. The result of this small Swedish study was not reliable because of incomplete case ascertainment, inappropriate controls and confounding. Furthermore, the data in this small Swedish study were part of and, hence, superseded by a large national study of workers exposed to diesel exhaust in Sweden, which did not find any increased risk of multiple myeloma. Other than the study of Danish truck drivers and the small case-control study of multiple myeloma patients in central and southeast Sweden, all other epidemiological investigations consistently reported no increase of multiple myeloma in relation to occupational diesel exhaust exposure. Furthermore, none of the studies reported a positive exposure-response relationship between diesel exhaust and multiple myeloma. Several studies that analysed data by jobs or occupations according to level of exposure and by duration of exposure did not find any upward trend. In addition to the review, a formal causation analysis based on an application of the Hill criteria confirms that there is no causal relationship between diesel exhaust and multiple myeloma.
本文对与职业性接触柴油废气相关的多发性骨髓瘤流行病学进行了全面的批判性综述。该综述包括对接触柴油废气工人的队列研究和比例死亡率研究，以及基于人群的多发性骨髓瘤病例对照研究。除了一项针对丹麦卡车司机的研究外，队列研究或比例死亡率研究均未报告多发性骨髓瘤与柴油废气接触之间有显著增加。丹麦这项研究存在若干局限性（如队列识别不充分、多发性骨髓瘤死亡病例数量少以及分析方法不当），导致结果不可靠。此外，这项丹麦卡车司机研究中的数据是丹麦一项大型研究的一部分，因此已被该大型研究取代，而后者未发现多发性骨髓瘤风险增加。同样，病例对照研究中除了基于瑞典中部和东南部多发性骨髓瘤患者的最小规模病例对照研究外，均未报告多发性骨髓瘤与柴油废气接触之间有显著增加。这项瑞典小型研究的结果不可靠，原因是病例确定不完整、对照不合适以及存在混杂因素。此外，这项瑞典小型研究中的数据是瑞典一项针对接触柴油废气工人的大型全国性研究的一部分，因此已被该大型研究取代，而后者未发现多发性骨髓瘤风险增加。除了丹麦卡车司机研究和瑞典中部及东南部多发性骨髓瘤患者的小型病例对照研究外，所有其他流行病学调查均一致报告职业性接触柴油废气与多发性骨髓瘤增加无关。此外，没有研究报告柴油废气与多发性骨髓瘤之间存在正暴露 - 反应关系。几项根据接触水平和接触持续时间按工作或职业分析数据的研究未发现任何上升趋势。除了该综述外，基于希尔标准应用的正式因果关系分析证实，柴油废气与多发性骨髓瘤之间不存在因果关系。
