一组男性建筑工人中与职业暴露相关的风湿性疾病的前瞻性风险。

Prospective risk of rheumatologic disease associated with occupational exposure in a cohort of male construction workers.

作者信息

Blanc Paul D, Järvholm Bengt, Torén Kjell

机构信息

Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco.

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

出版信息

Am J Med. 2015 Oct;128(10):1094-101. doi: 10.1016/j.amjmed.2015.05.001. Epub 2015 May 22.

DOI:10.1016/j.amjmed.2015.05.001

PMID:26007670

Abstract

BACKGROUND

The association between occupational exposure and autoimmune disease is well recognized for silica, and suspected for other inhalants. We used a large cohort to estimate the risks of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis associated with silica and other occupational exposures.

METHODS

We analyzed data for male Swedish construction industry employees. Exposure was defined by a job-exposure matrix for silica and for other inorganic dusts; those with other job-exposure matrix exposures but not to either of the 2 inorganic dust categories were excluded. National hospital treatment data were linked for International Classification of Diseases, 10(th) Revision-coded diagnoses of rheumatoid arthritis (seronegative and positive), systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. The 2 occupational exposures were tested as independent predictors of prospective hospital-based treatment for these diagnoses using age-adjusted Poisson multivariable regression analyses to calculate relative risk (RR).

RESULTS

We analyzed hospital-based treatment data (1997 through 2010) for 240,983 men aged 30 to 84 years. There were 713 incident cases of rheumatoid arthritis (467 seropositive, 195 seronegative, 51 not classified) and 128 cases combined for systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. Adjusted for smoking and age, the 2 occupational exposures (silica and other inorganic dusts) were each associated with increased risk of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis combined: RR 1.39 (95% confidence interval [CI], 1.17-1.64) and RR 1.31 (95% CI, 1.11-1.53), respectively. Among ever smokers, both silica and other inorganic dust exposure were associated with increased risk of rheumatoid arthritis (RRs 1.36; 95% CI, 1.11-1.68 and 1.42; 95% CI, 1.17-1.73, respectively), while among never smokers, neither exposure was associated with statistically significant increased risk of rheumatoid arthritis.

CONCLUSION

This analysis reaffirms the link between occupational silica and a range of autoimmune diseases, while also suggesting that other inorganic dusts may also impart excess risk of such disease.

摘要

背景

职业暴露与自身免疫性疾病之间的关联在二氧化硅方面已得到充分认识，在其他吸入剂方面也受到怀疑。我们使用一个大型队列来估计与二氧化硅和其他职业暴露相关的类风湿性关节炎、系统性红斑狼疮、系统性硬化症和皮肌炎的风险。

方法

我们分析了瑞典男性建筑业员工的数据。暴露是根据二氧化硅和其他无机粉尘的工作暴露矩阵来定义的；那些有其他工作暴露矩阵暴露但未暴露于这两种无机粉尘类别的人被排除在外。将国家医院治疗数据与国际疾病分类第10版编码的类风湿性关节炎（血清阴性和阳性）、系统性红斑狼疮、系统性硬化症和皮肌炎的诊断相关联。使用年龄调整的泊松多变量回归分析将这两种职业暴露作为这些诊断的前瞻性医院治疗的独立预测因素进行测试，以计算相对风险（RR）。

结果

我们分析了240,983名年龄在30至84岁之间男性的基于医院的治疗数据（1997年至2010年）。有713例类风湿性关节炎新发病例（467例血清阳性，195例血清阴性，51例未分类）以及128例系统性红斑狼疮、系统性硬化症和皮肌炎合并病例。在调整吸烟和年龄后，这两种职业暴露（二氧化硅和其他无机粉尘）各自与类风湿性关节炎、系统性红斑狼疮、系统性硬化症和皮肌炎合并症的风险增加相关：RR分别为1.39（95%置信区间[CI]，1.17 - 1.64）和1.31（95%CI，1.11 - 1.53）。在曾经吸烟者中，二氧化硅和其他无机粉尘暴露均与类风湿性关节炎风险增加相关（RR分别为1.36；95%CI，1.11 - 1.68和1.42；95%CI，1.17 - 1.73），而在从不吸烟者中，两种暴露均与类风湿性关节炎风险增加无统计学显著关联。