Xu Z Y, Blot W J, Xiao H P, Wu A, Feng Y P, Stone B J, Sun J, Ershow A G, Henderson B E, Fraumeni J F
Liaoning Public Health and Anti-Epidemic Station, Shenyang, China.
J Natl Cancer Inst. 1989 Dec 6;81(23):1800-6. doi: 10.1093/jnci/81.23.1800.
A case-control study involving interviews with 1,249 patients with lung cancer and 1,345 population-based controls was conducted in Shenyang, an industrial city in northeastern China, where mortality rates are high among men and women. Cigarette smoking was found to be the principal cause of lung cancer in this population, accounting for 55% of the lung cancers in males and 37% in females. The attributable risk percentage among females is high compared to elsewhere in China, largely because of a higher prevalence of smoking among women. After adjustment for smoking, there were also significant increases in lung cancer risk associated with several measures of exposure to air pollutants. Risks were twice as high among those who reported smoky outdoor environments, and increased in proportion to years of sleeping on beds heated by coal-burning stoves (kang), and to an overall index of indoor air pollution. Threefold increases in lung cancer risk were found among men who worked in the nonferrous smelting industry, where heavy exposures to inorganic arsenic have been reported. The associations with both smoking and indoor air pollution were stronger for squamous cell and small cell carcinomas than for adenocarcinoma of the lung. Risks due to smoking or air pollution were not greatly altered by adjustment for consumption of fresh vegetables or sources of beta carotene or retinol, prior chronic lung diseases, or education level. The findings suggest that smoking and environmental pollution combine to account for the elevated rates of lung cancer mortality in Shenyang.
在中国东北的工业城市沈阳开展了一项病例对照研究，该研究对1249例肺癌患者和1345名基于人群的对照者进行了访谈，沈阳的男性和女性死亡率都很高。研究发现，吸烟是该人群肺癌的主要病因，占男性肺癌的55%，女性肺癌的37%。与中国其他地区相比，女性的归因风险百分比很高，这主要是因为女性吸烟率较高。在对吸烟进行调整后，与几种空气污染物暴露指标相关的肺癌风险也显著增加。报告室外环境烟雾弥漫的人群患肺癌的风险是其他人的两倍，且风险随着睡在烧煤炉（炕）加热的床上的年限以及室内空气污染综合指数的增加而上升。在有色金属冶炼行业工作的男性患肺癌的风险增加了两倍，据报告该行业存在大量无机砷暴露。吸烟和室内空气污染与肺鳞状细胞癌和小细胞癌的关联比与肺腺癌的关联更强。在对新鲜蔬菜或β-胡萝卜素或视黄醇来源的摄入量、既往慢性肺部疾病或教育水平进行调整后，吸烟或空气污染导致的风险没有太大变化。研究结果表明，吸烟和环境污染共同导致了沈阳肺癌死亡率的上升。
