Steenland Kyle, Zhao Liping, Winquist Andrea
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Occup Environ Med. 2015 May;72(5):373-80. doi: 10.1136/oemed-2014-102364. Epub 2015 Jan 19.
Determine if perfluorooctanoic acid (PFOA) is associated with an incident disease in an occupational cohort.
We interviewed 3713 workers or their next of kin in 2008-2011, and sought medical records for self-reported disease. These workers were a subset of a previously studied cohort of 32,254 community residents and workers. We estimated historical PFOA serum levels via a job-exposure matrix based on over 2000 serum measurements. Non-occupational exposure from drinking water was also estimated. Lifetime serum cumulative dose (combining occupational and non-occupational exposure) was our exposure metric. We studied 17 disease outcomes with more than 20 validated cases.
The median measured serum level was 113 ng/mL in 2005 (n=1881), compared with 4 ng/mL in the US. Ulcerative colitis (10-year lag) showed a significant trend (p≤0.05) with increasing dose (quartile rate ratios (RRs)=1.00, 3.00, 3.26, 6.57, n=28, p for trend=0.05), similar to earlier findings in the community study. Rheumatoid arthritis (no lag) showed a positive trend in a categorical trend test (RRs=1.00, 2.11, 4.08, 4.45, n=23, p for trend=0.04). Positive non-significant trends were also observed for prostate cancer, non-hepatitis liver disease and male hypothyroidism, which have been implicated in other studies. A significant negative trend was found for bladder cancer and asthma with medication. No marked trends were seen for high cholesterol, which had been seen in the community study.
Ulcerative colitis and rheumatoid arthritis were positively linked to PFOA exposure among workers. Data were limited by small numbers, under-representation of hard-to-trace decedents and few low-exposed referents.
确定全氟辛酸（PFOA）是否与职业队列中的新发疾病相关。
我们在2008 - 2011年期间对3713名工人或其近亲进行了访谈，并查找了自我报告疾病的医疗记录。这些工人是先前研究的32254名社区居民和工人队列的一个子集。我们通过基于2000多次血清测量的工作暴露矩阵估算了历史PFOA血清水平。还估算了饮用水中的非职业暴露。终身血清累积剂量（结合职业和非职业暴露）是我们的暴露指标。我们研究了17种疾病结局，每种结局有超过20例经证实的病例。
2005年测量的血清水平中位数为113 ng/mL（n = 1881），而美国为4 ng/mL。溃疡性结肠炎（10年滞后）随剂量增加呈现显著趋势（p≤0.05）（四分位数率比（RRs）= 1.00、3.00、3.26、6.57，n = 28，趋势p值 = 0.05），与社区研究中的早期发现相似。类风湿性关节炎（无滞后）在分类趋势检验中呈现阳性趋势（RRs = 1.00、2.11、4.08、4.45，n = 23，趋势p值 = 0.04）。在前列腺癌、非肝炎性肝病和男性甲状腺功能减退症中也观察到了阳性但不显著的趋势，其他研究也表明这些疾病与PFOA有关。在膀胱癌和使用药物治疗的哮喘中发现了显著的负趋势。在高胆固醇方面未观察到明显趋势，而在社区研究中曾观察到这种趋势。
工人中溃疡性结肠炎和类风湿性关节炎与PFOA暴露呈正相关。数据受限于样本量小、难以追踪的死者代表性不足以及低暴露对照者较少。
