INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France.
Giscop93, UFR SMBH, Paris University, Bobigny, France.
Ann Work Expo Health. 2018 Apr 18;62(4):450-464. doi: 10.1093/annweh/wxx116.
Complex exposure situations are frequent at the workplace, but few studies have characterized multiple occupational carcinogenic exposures (MOCE) and their gendered differences across jobs' characteristics. We assessed MOCE separately in male and female jobs and identified patterns of MOCE at job level. Participants (834 men and 183 women) were cancer patients recruited between March 2002 and December 2010 in the ongoing SCOP93 cohort study, Seine-Saint-Denis department, France. Job histories were collected through personal interviews, and carcinogenic exposures were assessed by a multidisciplinary expert committee using a list of 53 carcinogens. Proportion of MOCE (i.e. ≥2 carcinogens) was assessed for male and female jobs separately. Principal component analysis combined with hierarchical ascendant classification was used to identify patterns of MOCE. Among the 5202 male jobs and 885 female jobs, respectively 42 and 9% were multi-exposed. Blue-collar workers and jobs in the construction and industry sectors had the highest rates of MOCE, contrasting with jobs held in recent periods (≥1997) and by patients aged ≥45 years at job start. A gradient of MOCE was also observed according to occupational segregation for both men and women. Eight patterns of MOCE were identified among male jobs: widespread carcinogens, mixed silica dust, heavy metals/combustion products, organic compounds/radiation, metal working, solvents/heavy metals, wood dust/formaldehyde/pesticides, and fuel exhausts. Three patterns of MOCE were found among female jobs: biological/organic compounds, industrial working, and fuel exhausts. Some patterns of MOCE were job-specific, whereas other patterns were found across different occupations. These results suggest that patterns of MOCE partly differ between men and women. They stress the importance of gendering multiple exposure assessment studies and point out the inadequacy of occupational disease compensation systems based on a single factor and non-gendered approach of carcinogenesis, ignoring differences between men and women in complex occupational exposure situations.
工作场所经常存在复杂的暴露情况，但很少有研究描述过多种职业致癌暴露（MOCE）及其在不同工作特征中的性别差异。我们分别评估了男性和女性工作中的 MOCE，并确定了工作层面的 MOCE 模式。参与者（834 名男性和 183 名女性）是 2002 年 3 月至 2010 年 12 月期间在法国塞纳-圣但尼部门进行的正在进行的 SCOP93 队列研究中招募的癌症患者。通过个人访谈收集职业史，致癌暴露由一个多学科专家委员会使用 53 种致癌物质清单进行评估。分别评估男性和女性工作中的 MOCE（即≥2 种致癌物质）的比例。使用主成分分析结合层次聚类对 MOCE 模式进行识别。在 5202 个男性工作和 885 个女性工作中，分别有 42%和 9%是多暴露的。蓝领工人和建筑及工业部门的工作暴露率最高，与最近时期（≥1997 年）和工作开始时年龄≥45 岁的患者的工作形成对比。根据职业隔离，男性和女性的 MOCE 也存在梯度。在男性工作中确定了 8 种 MOCE 模式：广泛的致癌物质、混合二氧化硅粉尘、重金属/燃烧产物、有机化合物/辐射、金属加工、溶剂/重金属、木屑/甲醛/农药和燃料废气。在女性工作中发现了 3 种 MOCE 模式：生物/有机化合物、工业工作和燃料废气。一些 MOCE 模式是特定于工作的，而其他模式则存在于不同的职业中。这些结果表明，MOCE 模式在男性和女性之间存在部分差异。它们强调了对多种暴露评估研究进行性别划分的重要性，并指出基于单一因素和非性别化致癌方法的职业病赔偿制度的不足，忽略了在复杂职业暴露情况下男女之间的差异。
