Cicioni C, London S J, Garabrant D H, Bernstein L, Phillips K, Peters J M
Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles 90033-9987.
Am J Ind Med. 1991;20(3):371-9. doi: 10.1002/ajim.4700200309.
We evaluated the newly available National Institute for Occupational Safety and Health (NIOSH) National Occupational Hazard Survey (NOHS) job exposure matrix (JEM) by considering mesothelioma risk from asbestos exposure. We applied this system (NOHS-JEM) to the Los Angeles County Cancer Surveillance Program (CSP) to see how many cancer cases could be assigned asbestos exposure and how asbestos exposure affected mesothelioma risk. Using the same CSP data, our "experts" classified asbestos exposure simply by occupation and industry. Both exposure classifications were divided into low and high; the NOHS-JEM by the number of exposed people per couplet, and ours by judgements of intensity. Odds ratios (OR) for mesothelioma risk for low and high asbestos exposure for the NOHS-JEM were 2.0 (95% C.I. 1.2-3.4) and 2.5 (95% C.I. 1.2-4.8). For ours, corresponding risks were 1.6 (95% C.I. 1.1-2.4) and 6.3 (95% C.I. 2.5-15.1). Our system was able to assign more cases to couplets then the NOHS-JEM (35,895 to 22,369). Three limitations of the NOHS-JEM were that many occupation-industry couplets were not classified at all, many couplets associated with past asbestos exposure (before the 1972-1974 NOHS survey) were not classified as asbestos exposure, and no assessment of intensity was made. These limitations may apply to other exposures and should be carefully considered before the NOHS-JEM is applied to other case-control studies.
我们通过考虑石棉暴露导致间皮瘤的风险，对新获得的美国国家职业安全与健康研究所（NIOSH）的国家职业危害调查（NOHS）工作暴露矩阵（JEM）进行了评估。我们将该系统（NOHS-JEM）应用于洛杉矶县癌症监测项目（CSP），以了解有多少癌症病例可归因于石棉暴露，以及石棉暴露如何影响间皮瘤风险。使用相同的CSP数据，我们的“专家”仅根据职业和行业对石棉暴露进行分类。两种暴露分类都分为低暴露和高暴露；NOHS-JEM根据每对职业-行业的暴露人数进行划分，而我们的分类则依据强度判断。NOHS-JEM中低石棉暴露和高石棉暴露的间皮瘤风险优势比（OR）分别为2.0（95%置信区间1.2 - 3.4）和2.5（95%置信区间1.2 - 4.8）。对于我们的分类，相应的风险分别为1.6（95%置信区间1.1 - 2.4）和6.3（95%置信区间2.5 - 15.1）。我们的系统能够比NOHS-JEM将更多病例归因于职业-行业对（35,895例对22,369例）。NOHS-JEM的三个局限性在于，许多职业-行业对根本未被分类，许多与过去石棉暴露相关的职业-行业对（在1972 - 1974年NOHS调查之前）未被归类为石棉暴露，并且未进行强度评估。这些局限性可能适用于其他暴露情况，在将NOHS-JEM应用于其他病例对照研究之前应仔细考虑。
