Shimizu Y, Kato H, Schull W J, Hoel D G
Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
Radiat Res. 1992 May;130(2):249-66.
Deaths in the RERF Life Span Study (LSS) sample have been determined for the years 1950-1985 and an analysis of cancer mortality with the revised DS86 doses has been described separately. In this report, we examine the relationship to dose of deaths from all diseases other than cancer. Although the evidence is still limited, there seems to be an excess risk from noncancer death at high doses (2 or 3 Gy and over). Statistically, a pure quadratic or a linear-threshold model [the estimated threshold dose is 1.4 Gy (0.6-2.8 Gy)] is found to fit better than a simple linear or linear-quadratic model. This increase in noncancer mortality is statistically demonstrable, generally, after 1965 and among the younger survivors (less than 40 at the time of the bombing), suggesting a sensitivity for this age group. For specific causes of death, an excess in relative risk at the high dose level, that is, 2 Gy or more, is seen in circulatory and digestive diseases. The relative risk is, however, much smaller than that for cancer. These findings, based as they are on death certificates, have their limitations. Most significant, perhaps, is the possible erroneous attribution of radiation-related cancer deaths to other causes. At present, the contribution such errors may make to the apparent increase in non-cancer deaths at the higher doses cannot be estimated as rigorously as is obviously desirable. However, even now, this increase does not appear to be fully explicable in terms of errors in classification. Further follow-up of mortality in this LSS cohort as well as disease revealed by the biennial physical examinations of the morbidity subsample (Adult Health Study) of the LSS cohort will be needed to confirm this suggestion of a radiation-related increase in mortality from causes other than cancer, and to determine whether it results in a demonstrable life shortening among the heavily exposed A-bomb survivors.
已确定了原子弹爆炸辐射效应研究基金会（RERF）寿命研究（LSS）样本在1950年至1985年期间的死亡情况，并且已另行描述了使用修订后的DS86剂量对癌症死亡率进行的分析。在本报告中，我们研究了除癌症之外所有疾病的死亡与剂量之间的关系。尽管证据仍然有限，但在高剂量（2或3 Gy及以上）下，似乎存在非癌症死亡的额外风险。从统计学上看，发现纯二次模型或线性阈值模型[估计阈值剂量为1.4 Gy（0.6 - 2.8 Gy）]比简单线性模型或线性二次模型拟合得更好。一般来说，这种非癌症死亡率的增加在统计学上是可证明的，在1965年之后以及较年轻的幸存者（轰炸时年龄小于40岁）中尤为明显，这表明该年龄组具有敏感性。对于特定死因，在高剂量水平（即2 Gy或更高）下，循环系统疾病和消化系统疾病的相对风险有所增加。然而，相对风险远小于癌症的相对风险。这些基于死亡证明的发现存在局限性。也许最重要的是，可能会将与辐射相关的癌症死亡错误归因于其他原因。目前，这些错误可能对高剂量下非癌症死亡明显增加所造成的影响，无法像我们明显期望的那样进行严格估计。然而，即使在现在，这种增加似乎也不能完全用分类错误来解释。需要对该LSS队列的死亡率以及LSS队列发病率子样本（成人健康研究）每两年一次体检所揭示的疾病进行进一步随访，以确认除癌症之外其他原因导致的与辐射相关的死亡率增加这一推测，并确定这是否会导致重度暴露的原子弹爆炸幸存者出现明显的寿命缩短。
