International Agency for Research on Cancer, Lyon, France.
Am J Respir Crit Care Med. 2011 Apr 1;183(7):941-8. doi: 10.1164/rccm.201006-0940OC. Epub 2010 Oct 29.
Diesel motor exhaust is classified by the International Agency for Research on Cancer as probably carcinogenic to humans. The epidemiologic evidence is evaluated as limited because most studies lack adequate control for potential confounders and only a few studies have reported on exposure-response relationships.
Investigate lung cancer risk associated with occupational exposure to diesel motor exhaust, while controlling for potential confounders.
The SYNERGY project pooled information on lifetime work histories and tobacco smoking from 13,304 cases and 16,282 controls from 11 case-control studies conducted in Europe and Canada. A general population job exposure matrix based on ISCO-68 occupational codes, assigning no, low, or high exposure to diesel motor exhaust, was applied to determine level of exposure.
Odds ratios of lung cancer and 95% confidence intervals were estimated by unconditional logistic regression, adjusted for age, sex, study, ever-employment in an occupation with established lung cancer risk, cigarette pack-years, and time-since-quitting smoking. Cumulative diesel exposure was associated with an increased lung cancer risk highest quartile versus unexposed (odds ratio 1.31; 95% confidence interval, 1.19-1.43), and a significant exposure-response relationship (P value < 0.01). Corresponding effect estimates were similar in workers never employed in occupations with established lung cancer risk, and in women and never-smokers, although not statistically significant.
Our results show a consistent association between occupational exposure to diesel motor exhaust and increased risk of lung cancer. This association is unlikely explained by bias or confounding, which we addressed by adjusted models and subgroup analyses.
国际癌症研究机构将柴油发动机尾气列为可能对人类致癌物质。由于大多数研究缺乏对潜在混杂因素的充分控制，只有少数研究报告了暴露-反应关系，因此，流行病学证据被评估为有限。
在控制潜在混杂因素的情况下，研究职业接触柴油发动机尾气与肺癌风险的关系。
SYNERGY 项目汇集了来自欧洲和加拿大的 11 项病例对照研究中 13304 例病例和 16282 例对照的终生工作史和吸烟史信息。基于 ISCO-68 职业代码的一般人群职业暴露矩阵，根据柴油发动机尾气暴露的无、低或高情况对暴露水平进行了赋值。
通过非条件逻辑回归，调整年龄、性别、研究、曾从事肺癌风险明确的职业、吸烟包年数和戒烟时间后，估计了肺癌的比值比和 95%置信区间。与未暴露相比，累积柴油暴露与肺癌风险增加相关（最高四分位数与未暴露相比，比值比为 1.31；95%置信区间为 1.19-1.43），且存在显著的暴露-反应关系（P 值<0.01）。在从未从事肺癌风险明确职业的工人中，以及在女性和从不吸烟者中，相应的效应估计值相似，尽管没有统计学意义。
我们的研究结果表明，职业接触柴油发动机尾气与肺癌风险增加之间存在一致的关联。这种关联不太可能是由我们通过调整模型和亚组分析解决的偏差或混杂因素引起的。
