南非煤矿工人尸检时的呼吸系统检查结果

Respiratory outcomes among South African coal miners at autopsy.

作者信息

Naidoo Rajen N, Robins Thomas G, Murray Jill

机构信息

Centre for Occupational and Environmental Health/Department of Community Health, University of KwaZulu-Natal, Durban, South Africa.

出版信息

Am J Ind Med. 2005 Sep;48(3):217-24. doi: 10.1002/ajim.20207.

DOI:10.1002/ajim.20207

PMID:16094611

Abstract

BACKGROUND

Studies of dose-response relationships between respiratory outcomes at autopsy and coal dust exposure are limited. The Pathology Automation System (PATHAUT) database of South African miners, is one of the largest autopsy databases of occupational lung disease. This study described the prevalence of respiratory outcomes among South African coal miners at autopsy, and determined whether dose response relationships existed between emphysema and exposure.

METHODS

Autopsies conducted from 1975 to 1997 on coal miners with exclusive coal mining exposure and having exposure duration information (n = 3,167) were analyzed from PATHAUT. Logistic regression was used to determine relationships between exposure and outcomes, controlling for race, smoking and age on a subset for whom smoking history was available (n = 725).

RESULTS

The mean duration of exposure was 11.0 years. Most were black miners (75.3%) with significant differences in the mean ages of black and white miners (37.9 and 55.3 years, respectively). Only 22.9% of cases had information on smoking. The prevalence of silicosis, tuberculosis (TB), coal workers' pneumoconiosis (CWP), and moderate and marked emphysema were 10.7%, 5.2%, 7.3%, and 6.4%, respectively. All diseases, except TB, were associated with exposure duration. Black miners had 8.3 and 1.2 fold greater risks for TB and CWP, respectively, than white miners. White miners had an increased risk of 1.4 and 5.4 for silicosis and moderate to marked emphysema, respectively. In models unadjusted for age, and including smoking, moderate to marked emphysema was strongly associated with exposure duration (OR = 3.4; 95% CI = 1.9-5.9 for highest tercile of exposure duration). Exposure-related risk estimates were reduced when age was introduced into the model. However, age and duration of exposure were highly correlated, (r = 0.68) suggesting a dilution of the exposure effect by age.

CONCLUSIONS

There were significant dose related associations of disease, including emphysema, with coal dust exposure.

摘要

背景

关于尸检时呼吸系统结局与煤尘暴露之间剂量反应关系的研究有限。南非矿工的病理自动化系统（PATHAUT）数据库是职业性肺病最大的尸检数据库之一。本研究描述了南非煤矿工人尸检时呼吸系统结局的患病率，并确定肺气肿与暴露之间是否存在剂量反应关系。

方法

对1975年至1997年对仅从事煤矿开采且有暴露持续时间信息的煤矿工人进行的尸检（n = 3167）进行PATHAUT分析。使用逻辑回归确定暴露与结局之间的关系，在有吸烟史的子集中控制种族、吸烟和年龄（n = 725）。

结果

平均暴露持续时间为11.0年。大多数是黑人矿工（75.3%），黑人和白人矿工的平均年龄有显著差异（分别为37.9岁和55.3岁）。只有22.9%的病例有吸烟信息。矽肺、肺结核（TB）、煤工尘肺（CWP）以及中度和重度肺气肿的患病率分别为10.7%、5.2%、7.3%和6.4%。除TB外，所有疾病均与暴露持续时间相关。黑人矿工患TB和CWP的风险分别比白人矿工高8.3倍和1.2倍。白人矿工患矽肺和中度至重度肺气肿的风险分别增加1.4倍和5.倍。在未校正年龄且包括吸烟的模型中，中度至重度肺气肿与暴露持续时间密切相关（对于暴露持续时间最高三分位数，OR = 3.4；95% CI = 1.9 - 5.9）。当将年龄纳入模型时，与暴露相关的风险估计值降低。然而，年龄与暴露持续时间高度相关（r = 0.68），表明年龄对暴露效应有稀释作用。