Keil U, Weiland S K, Birk T, Spelsberg A
Abteilung für Sozialmedizin und Epidemiologie, Ruhr-Universität Bochum.
Soz Praventivmed. 1992;37(2):50-63. doi: 10.1007/BF01322734.
Epidemiologic studies of occupationally exposed subjects allow to detect diseases caused by the work environment and to identify hazardous exposures. They provide the basis for preventive measures and workers compensation. Occupational epidemiology traditionally emphasized the study of work related cancer. Long latency periods for the development of most cancers and limited information about the exposure history of the study subjects are problems for all study types. The specific advantages and limitations of different study designs are discussed. Research strategies in occupational epidemiology are demonstrated using as an example two studies from the American tire and rubber industry. The specific contributions of a historical cohort study and a nested case-control study, concerning the association between lymphosarcoma and exposure to solvents, are discussed. Experiences and first results from a historical cohort study in the German rubber industry are reported. Future research in occupational epidemiology should concentrate more on the study of work related morbidity such as musculoskeletal disorders, hearing loss, accidents and the influence of the work environment on the mental and physical well being. Modern research methods such as prospective cohort studies or workforce monitoring should be used more often. Prospective cohort studies provide quantitatively and qualitatively more precise information about exposures and potential confounders, e.g. cigarette smoking or alcohol consumption, than traditional study methods. The promising perspectives of biological markers warrant further research. The situation of occupational epidemiology in Germany can only be improved if all concerned parties and institutions realize the importance of occupational epidemiology. Laws concerning data confidentiality which seriously hamper epidemiologic research must be modified.
对职业暴露人群的流行病学研究有助于发现由工作环境引起的疾病，并识别有害暴露。这些研究为预防措施和工人补偿提供了依据。传统上，职业流行病学侧重于研究与工作相关的癌症。大多数癌症的发病潜伏期较长，且关于研究对象暴露史的信息有限，这对所有研究类型来说都是问题。本文讨论了不同研究设计的具体优势和局限性。以美国轮胎和橡胶行业的两项研究为例，展示了职业流行病学的研究策略。讨论了一项历史性队列研究和一项巢式病例对照研究在探讨淋巴肉瘤与溶剂暴露之间关联方面的具体贡献。报告了德国橡胶行业一项历史性队列研究的经验和初步结果。职业流行病学未来的研究应更多地关注与工作相关的发病率研究，如肌肉骨骼疾病、听力损失、事故以及工作环境对身心健康的影响。应更频繁地使用前瞻性队列研究或劳动力监测等现代研究方法。与传统研究方法相比，前瞻性队列研究能在数量和质量上提供关于暴露和潜在混杂因素（如吸烟或饮酒）更精确的信息。生物标志物的前景广阔，值得进一步研究。只有所有相关方和机构都认识到职业流行病学的重要性，德国职业流行病学的状况才能得到改善。必须修改严重阻碍流行病学研究的数据保密法律。
