Seel E A, Zaebst D D, Hein M J, Liu J, Nowlin S J, Chen P
National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, 4676 Columbia Parkway, Cincinnati, OH 45226, USA.
Ann Occup Hyg. 2007 Oct;51(7):601-10. doi: 10.1093/annhyg/mem037. Epub 2007 Sep 10.
A retrospective exposure assessment of asbestos, welding fumes, chromium and nickel (in welding fumes) was conducted at the Portsmouth Naval Shipyard for a nested case-control study of lung cancer risk from external ionizing radiation. These four contaminants were included because of their potential to confound or modify the effect of a lung cancer-radiation relationship. The exposure assessment included three experienced industrial hygienists from the shipyard who independently assessed exposures for 3519 shop/job/time period combinations. A consensus process was used to resolve estimates with large differences. Final exposure estimates were linked to employment histories of the 4388 study subjects to calculate their cumulative exposures. Inter-rater agreement analyses were performed on the original estimates to better understand the estimation process. Although concordance was good to excellent (78-99%) for intensity estimates and excellent (96-99%) for frequency estimates, overall simple kappa statistics indicated only slight agreement beyond chance (kappa < 0.2). Unbalanced distributions of exposure estimates partly contributed to the weak observed overall inter-rater agreement. Pairwise weighted kappa statistics revealed better agreement between two of the three panelists (kappa = 0.19-0.65). The final consensus estimates were similar to the estimates made by these same two panelists. Overall welding fume exposures were fairly stable across time at the shipyard while asbestos exposures were higher in the early years and fell in the mid-1970s. Mean cumulative exposure for all study subjects was 520 fiber-days cc(-1) for asbestos and 1000 mg-days m(-3) for welding fumes. Mean exposure was much lower for nickel (140 microg-days m(-3)) and chromium (45 microg-days m(-3)). Asbestos and welding fume exposure estimates were positively associated with lung cancer in the nested case-control study. The radiation-lung cancer relationship was attenuated by the inclusion of these two confounders. This exposure assessment provided exposure estimates that aided in understanding of the lung cancer-radiation relationship at the shipyard.
在朴茨茅斯海军造船厂开展了一项针对石棉、焊接烟雾、铬和镍（存在于焊接烟雾中）的回顾性暴露评估，用于一项关于外部电离辐射导致肺癌风险的巢式病例对照研究。纳入这四种污染物是因为它们有可能混淆或改变肺癌与辐射关系的影响。暴露评估由造船厂的三名经验丰富的工业卫生学家进行，他们独立评估了3519种车间/工作/时间段组合的暴露情况。采用共识流程来解决差异较大的估计值。最终的暴露估计值与4388名研究对象的就业历史相关联，以计算他们的累积暴露量。对原始估计值进行了评分者间一致性分析，以更好地理解估计过程。尽管强度估计的一致性良好至优秀（78 - 99%），频率估计的一致性优秀（96 - 99%），但总体简单kappa统计量表明，一致性仅略高于随机水平（kappa < 0.2）。暴露估计值的不均衡分布部分导致了观察到的总体评分者间一致性较弱。两两加权kappa统计量显示，三名小组成员中的两名之间的一致性更好（kappa = 0.19 - 0.65）。最终的共识估计值与这两名小组成员的估计值相似。造船厂的总体焊接烟雾暴露在不同时间相当稳定，而石棉暴露在早期较高，并在20世纪70年代中期下降。所有研究对象的石棉平均累积暴露量为520纤维 - 天·cc⁻¹，焊接烟雾为1000毫克 - 天·m⁻³。镍（140微克 - 天·m⁻³）和铬（45微克 - 天·m⁻³）的平均暴露量要低得多。在巢式病例对照研究中，石棉和焊接烟雾暴露估计值与肺癌呈正相关。纳入这两个混杂因素后，辐射与肺癌的关系减弱。这项暴露评估提供的暴露估计值有助于理解造船厂的肺癌与辐射关系。
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