Amabile Jean-Christophe, Leuraud Klervi, Vacquier Blandine, Caër-Lorho Sylvaine, Acker Alain, Laurier Dominique
French Defense Radiation Protection Service (SPRA), Clamart, France.
Health Phys. 2009 Dec;97(6):613-21. doi: 10.1097/01.HP.0000363842.62922.58.
This case-control study nested in the French cohort of uranium miners provides an opportunity to take account of silicosis and smoking in the assessment of the relation between radon and lung cancer. The study includes 100 miners who died of lung cancer and 500 matched controls born within the same period of birth and of the same age at the time of death of the matching case. Data on radon exposure are obtained from individual monitoring of the miners, and data on smoking come from medical records and interviews. To identify cases of silicosis among the 600 miners surveyed, appraisals carried out as part of the compensation process for occupational diseases are used. Statistical analyses are based on a conditional logistic regression, and the linear model for excess relative risk was used to model the risk of death due to lung cancer according to cumulative radon exposure. The percentage of missing data on silicotic status is less than 20%. The study reveals a significant association between the relative risk of lung cancer and silicosis (ORsilicosis = 3.6; 95% CI: 1.4-8.9), and the relation between radon and lung cancer persists after adjusting for smoking and silicotic status (ERRradon per WLM = 1.0%; 95% CI: 0.1-3.5%). Radon, cigarette smoking and silicotic status appear to be three factors that each have a specific effect on the risk of lung cancer. This study reminds us of the complexity involved in assessing occupational risks in the case of multiple sources of exposure.
这项嵌套于法国铀矿矿工队列中的病例对照研究，为在评估氡与肺癌的关系时考虑矽肺和吸烟因素提供了契机。该研究纳入了100名死于肺癌的矿工以及500名匹配对照，这些对照与相应病例在出生时期相同且在匹配病例死亡时年龄相同。氡暴露数据来自对矿工的个体监测，吸烟数据则来自医疗记录和访谈。为在接受调查的600名矿工中识别矽肺病例，采用了作为职业病赔偿程序一部分所进行的评估。统计分析基于条件逻辑回归，并且使用超额相对风险线性模型根据累积氡暴露对肺癌死亡风险进行建模。矽肺状态缺失数据的百分比低于20%。该研究揭示了肺癌相对风险与矽肺之间存在显著关联（矽肺的比值比=3.6；95%置信区间：1.4 - 8.9），并且在对吸烟和矽肺状态进行调整后，氡与肺癌之间的关系依然存在（每工作水平月的氡超额相对风险=1.0%；95%置信区间：0.1 - 3.5%）。氡、吸烟和矽肺状态似乎是对肺癌风险各自具有特定影响的三个因素。这项研究提醒我们在存在多种暴露源的情况下评估职业风险所涉及的复杂性。
