Dement John M, Ringen Knut, Welch Laura S, Bingham Eula, Quinn Patricia
Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Ind Med. 2009 Sep;52(9):671-82. doi: 10.1002/ajim.20729.
The U.S. Department of Energy (DOE) established medical screening programs at the Hanford Nuclear Reservation, Oak Ridge Reservation, the Savannah River Site, and the Amchitka site starting in 1996. Workers participating in these programs have been followed to determine their vital status and mortality experience through December 31, 2004.
A cohort of 8,976 former construction workers from Hanford, Savannah River, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. Cause-specific standardized mortality ratios (SMRs) were calculated based on US death rates.
Six hundred and seventy-four deaths occurred in this cohort and overall mortality was slightly less than expected (SMR = 0.93, 95% CI = 0.86-1.01), indicating a "healthy worker effect." However, significantly excess mortality was observed for all cancers (SMR = 1.28, 95% CI = 1.13-1.45), lung cancer (SMR = 1.54, 95% CI = 1.24-1.87), mesothelioma (SMR = 5.93, 95% CI = 2.56-11.68), and asbestosis (SMR = 33.89, 95% CI = 18.03-57.95). Non-Hodgkin's lymphoma was in excess at Oak Ridge and multiple myeloma was in excess at Hanford. Chronic obstructive pulmonary disease (COPD) was significantly elevated among workers at the Savannah River Site (SMR = 1.92, 95% CI = 1.02-3.29).
DOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor' Energy Employees Occupational Illness Compensation Program (EEOCIPA). Asbestos-related cancers were significantly elevated.
美国能源部（DOE）自1996年起在汉福德核保留地、橡树岭保留地、萨凡纳河工厂和阿姆奇特卡岛设立了医疗筛查项目。对参与这些项目的工人进行了跟踪，以确定他们截至2004年12月31日的生命状态和死亡情况。
利用国家死亡指数对来自汉福德、萨凡纳河、橡树岭和阿姆奇特卡岛的8976名前建筑工人组成的队列进行跟踪，直至2004年12月31日，以确定生命状态和死亡原因。根据美国死亡率计算特定病因的标准化死亡比（SMR）。
该队列中有674人死亡，总体死亡率略低于预期（SMR = 0.93，95%可信区间 = 0.86 - 1.01），表明存在“健康工人效应”。然而，观察到所有癌症（SMR = 1.28，95%可信区间 = 1.13 - 1.45）、肺癌（SMR = 1.54，95%可信区间 = 1.24 - 1.87）、间皮瘤（SMR = 5.93，95%可信区间 = 2.56 - 11.68）和石棉沉着病（SMR = 33.89，95%可信区间 = 18.03 - 57.95）的死亡率显著过高。橡树岭的非霍奇金淋巴瘤死亡率过高，汉福德的多发性骨髓瘤死亡率过高。萨凡纳河工厂的工人中慢性阻塞性肺疾病（COPD）显著升高（SMR = 1.92，95%可信区间 = 1.02 - 3.29）。
发现这四个地点的美国能源部建筑工人在劳工部能源员工职业疾病补偿计划（EEOCIPA）所涵盖的综合癌症部位存在显著过高风险。与石棉相关的癌症显著增加。
