Amandus H, Costello J
Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia.
Arch Environ Health. 1991 Mar-Apr;46(2):82-9. doi: 10.1080/00039896.1991.9937433.
The association between silicosis and lung cancer mortality was estimated in 9,912 (369 silicotics and 9,543 nonsilicotics) white male metal miners. These miners were examined by the U.S. Public Health Service during 1959-1961 and were followed through 1975. Miners were excluded from this study if they were employed in a mine during 1959-1961 that used diesel equipment underground. The ores that were mined consisted of copper, lead-zinc, iron, mercury, lead silver, gold and gold-silver, tungsten, and molybenum. The standardized mortality ratio (SMR, U.S. white male rates) for lung cancer was 1.73 (95% CI: .94-2.90) in silicotics and 1.18 (95% CI: .98-1.42) in nonsilicotics. Additionally, SMRs were higher in silicotics than in nonsilicotics, even in most subgroups stratified by cigarette smoking habit, type of ore mined, years of service in an underground job, radon exposure group, or year of hire. When lung cancer mortality between silicotics and nonsilicotics was compared, the age-adjusted rate ratio (95% CI) was 1.56 (.91-2.68), and the age- and smoking-adjusted rate ratio was 1.96 (.98-3.67). Corresponding figures for miners who were employed in mines with low levels of radon exposure were 1.90 (.98-3.67) and 2.59 (1.44-4.68), respectively. These findings indicate that lung cancer mortality risk was increased in silicotics, and this probably did not result from chance or bias. However, confounding from radon exposure could not be ruled out. The findings indicate that further follow-up of this cohort is needed.
在9912名（369名矽肺患者和9543名非矽肺患者）白人男性金属矿工中，评估了矽肺与肺癌死亡率之间的关联。这些矿工在1959年至1961年期间接受了美国公共卫生服务局的检查，并一直随访至1975年。如果矿工在1959年至1961年期间受雇于地下使用柴油设备的矿井，则被排除在本研究之外。所开采的矿石包括铜、铅锌、铁、汞、铅银、金银、金、钨和钼。矽肺患者肺癌的标准化死亡率（SMR，美国白人男性发病率）为1.73（95%CI：0.94 - 2.90），非矽肺患者为1.18（95%CI：0.98 - 1.42）。此外，即使在按吸烟习惯、所采矿石类型、地下工作年限、氡暴露组或雇佣年份分层的大多数亚组中，矽肺患者的SMR也高于非矽肺患者。比较矽肺患者和非矽肺患者的肺癌死亡率时，年龄调整率比（95%CI）为1.56（0.91 - 2.68），年龄和吸烟调整率比为1.96（0.98 - 3.67）。氡暴露水平低的矿井中工作的矿工的相应数字分别为1.90（0.98 - 3.67）和2.59（1.44 - 4.68）。这些发现表明，矽肺患者的肺癌死亡风险增加，这可能不是由偶然或偏差导致的。然而，不能排除氡暴露造成的混杂因素。研究结果表明，需要对该队列进行进一步随访。
