接触环氧乙烷的工人的死亡率。

Mortality among workers exposed to ethylene oxide.

作者信息

Steenland K, Stayner L, Greife A, Halperin W, Hayes R, Hornung R, Nowlin S

机构信息

National Institute for Occupational Safety and Health, Cincinnati, OH 45226.

出版信息

N Engl J Med. 1991 May 16;324(20):1402-7. doi: 10.1056/NEJM199105163242004.

DOI:10.1056/NEJM199105163242004

PMID:2020295

Abstract

BACKGROUND

Ethylene oxide is a sterilant gas that causes leukemia and other cancers in animals. Studies in Sweden have shown an excess of leukemia and stomach cancer in humans exposed to ethylene oxide, but other studies have generally failed to confirm these findings.

METHODS

We conducted a study of mortality in 18,254 U.S. workers exposed to ethylene oxide at 14 plants producing sterilized medical supplies and spices. The subjects averaged 4.9 years of exposure to the gas and 16 years of follow-up. The exposure levels in recent years averaged 4.3 ppm (eight-hour time-weighted adjusted exposure) for sterilizer operators and 2.0 ppm for other workers. The levels in earlier years are likely to have been several times higher. Mortality in this cohort was compared with that in the general U.S. population.

RESULTS

Overall there was no significant increase in mortality from any cause in the study cohort. The standardized mortality ratios (SMRs) were 0.97 for leukemia (95 percent confidence interval, 0.52 to 1.67; 13 deaths observed), 1.06 for all hematopoietic cancers (95 percent confidence interval, 0.75 to 1.47; 36 deaths), and 0.94 for stomach cancer (95 percent confidence interval, 0.45 to 1.70; 11 deaths). Analyses according to job category and according to the duration of exposure showed no excess in cancers, as compared with the rate in the general population, but there was a significant trend toward increased mortality with increasing lengths of time since the first exposure for all hematopoietic cancers. The rate of death from hematopoietic cancer (especially non-Hodgkin's lymphoma) was significantly increased among men (SMR, 1.55; 27 deaths). Mortality from leukemia in recent years (1985 through 1987) was significantly increased among men (SMR, 3.45; 5 deaths).

CONCLUSIONS

For the entire cohort, there was no increase in mortality from hematopoietic cancer. There was a slight but significant increase among men, however. Among men and women combined, there was a trend toward an increased risk of death from hematopoietic cancer with increasing lengths of time since the first exposure to ethylene oxide.

摘要

背景

环氧乙烷是一种杀菌气体，可导致动物患白血病和其他癌症。瑞典的研究表明，接触环氧乙烷的人群中白血病和胃癌发病率过高，但其他研究普遍未能证实这些发现。

方法

我们对美国14家生产消毒医疗用品和香料的工厂中18254名接触环氧乙烷的工人进行了死亡率研究。这些受试者平均接触该气体4.9年，随访16年。近年来，消毒操作人员的接触水平平均为4.3 ppm（八小时时间加权调整接触量），其他工人为2.0 ppm。早些年的接触水平可能高出几倍。将该队列的死亡率与美国普通人群的死亡率进行比较。

结果

总体而言，研究队列中任何原因导致的死亡率均无显著增加。白血病的标准化死亡比（SMR）为0.97（95%置信区间，0.52至1.67；观察到13例死亡），所有造血系统癌症为1.06（95%置信区间，0.75至1.47；36例死亡），胃癌为0.94（95%置信区间，0.45至1.70；11例死亡）。按工作类别和接触时间进行的分析显示，与普通人群的发病率相比，癌症发病率没有过高，但所有造血系统癌症的死亡率随首次接触后时间的延长有显著增加趋势。男性造血系统癌症（尤其是非霍奇金淋巴瘤）的死亡率显著增加（SMR，1.55；27例死亡）。近年来（1985年至1987年）男性白血病死亡率显著增加（SMR，3.45；5例死亡）。