van Wijngaarden Edwin, Dosemeci Mustafa
Division of Epidemiology, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
Int J Cancer. 2006 Sep 1;119(5):1136-44. doi: 10.1002/ijc.21947.
We evaluated the association between potential occupational lead exposure and the risk of brain cancer mortality in the National Longitudinal Mortality Study (NLMS), which is a prospective census-based cohort study of mortality among the noninstitutionalized United States population (1979-1989). The present study was limited to individuals for whom occupation and industry were available (n = 317,968). Estimates of probability and intensity of lead exposure were assigned using a job-exposure matrix (JEM). Risk estimates for the impact of lead on brain cancer mortality were computed using standardized mortality ratio (SMR) and proportional hazards and Poisson regression techniques, adjusting for the effects of age, gender and several other covariates. Brain cancer mortality rates were greater among individuals in jobs potentially involving lead exposure as compared to those unexposed (age- and gender-adjusted hazard ratio (HR) = 1.5; 95% confidence interval (CI) = 0.9-2.3) with indications of an exposure-response trend (probability: low HR = 0.7 (95% CI = 0.2-2.2), medium HR = 1.4 (95% CI = 0.8-2.5), high HR = 2.2 (95% CI = 1.2-4.0); intensity: low HR = 1.2 (95% CI = 0.7-2.1), medium/high HR = 1.9 (95% CI = 1.0-3.4)). Brain cancer risk was greatest among individuals with the highest levels of probability and intensity (HR = 2.3; 95% CI = 1.3-4.2). These findings provide further support for an association between occupational lead exposure and brain cancer mortality, but need to be interpreted cautiously due to the consideration of brain cancer as one disease entity and the absence of biological measures of lead exposure.
我们在美国国家纵向死亡率研究（NLMS）中评估了潜在职业性铅暴露与脑癌死亡风险之间的关联，该研究是一项基于普查的前瞻性队列研究，针对的是美国非机构化人口的死亡率（1979 - 1989年）。本研究仅限于可获取职业和行业信息的个体（n = 317,968）。使用工作暴露矩阵（JEM）来确定铅暴露的概率和强度估计值。采用标准化死亡率比（SMR）以及比例风险和泊松回归技术计算铅对脑癌死亡影响的风险估计值，并对年龄、性别和其他几个协变量的影响进行了调整。与未接触者相比，可能接触铅的工作岗位上的个体脑癌死亡率更高（年龄和性别调整后的风险比（HR）= 1.5；95%置信区间（CI）= 0.9 - 2.3），且有暴露 - 反应趋势的迹象（概率：低暴露HR = 0.7（95% CI = 0.2 - 2.2），中等暴露HR = 1.4（95% CI = 0.8 - 2.5），高暴露HR = 2.2（95% CI = 1.2 - 4.0）；强度：低暴露HR = 1.2（95% CI = 0.7 - 2.1），中等/高暴露HR = 1.9（95% CI = 1.0 - 3.4））。概率和强度水平最高的个体脑癌风险最大（HR = 2.3；95% CI = 1.3 - 4.2）。这些发现进一步支持了职业性铅暴露与脑癌死亡之间的关联，但由于将脑癌视为一种疾病实体以及缺乏铅暴露的生物学测量指标，需要谨慎解读。
