School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia.
Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Ann Work Expo Health. 2019 Aug 7;63(7):719-728. doi: 10.1093/annweh/wxz038.
An asbestos job-exposure matrix (AsbJEM) has been developed to systematically and cost-effectively evaluate occupational exposures in population-based studies. The primary aim of this study was to examine the accuracy of the AsbJEM in determining exposure-response relationships between asbestos exposure estimates and malignant mesothelioma (MM) incidence (indirect validation). The secondary aim was to investigate whether the assumptions used in the development of the original AsbJEM provided accurate asbestos exposure estimates.
The study population consisted of participants in an annual health surveillance program, who had at least 3-month occupational asbestos exposure. Calculated asbestos exposure indices included cumulative asbestos exposure and the average exposure intensity, estimated using the AsbJEM and duration of employment. Asbestos and MM exposure-response relationships were compared between the original AsbJEM and its variations based on manipulations of the intensity, duration and frequency of exposure. Twenty-four exposure estimates were calculated for both cumulative asbestos exposure and the average exposure intensity using three exposure intensities (50th, 75th and 90th percentile of the range of mode exposure), four peak durations (15, 30, 60 and 120 min) and two patterns of peak frequency (original and doubled). Cox proportional hazards models were used to describe the associations between MM incidence and each of the cumulative and average intensity estimates.
Data were collected from 1602 male participants. Of these, 40 developed MM during the study period. There were significant associations between MM incidence and both cumulative and average exposure intensity for all estimates. The strongest association, based on the regression-coefficient from the models, was found for the 50th percentile of mode exposure, 15-min peak duration and the doubled frequency of peak exposure. Using these assumptions, the hazard ratios for mesothelioma were 1 (reference), 1.91, 3.24 and 5.37 for the quartiles of cumulative asbestos exposure and 1 (reference), 1.84, 2.31 and 4.40 for the quartiles of the average exposure intensity, respectively.
The well-known positive exposure-response relationship between MM incidence and both estimated cumulative asbestos exposure and average exposure intensity was confirmed. The strongest relationship was found when the frequency of peak exposure in the AsbJEM was doubled from the originally published estimates.
开发了石棉职业暴露矩阵（AsbJEM），以系统且具有成本效益的方式评估基于人群的研究中的职业暴露。本研究的主要目的是检验 AsbJEM 确定石棉暴露估计值与恶性间皮瘤（MM）发病率之间的暴露反应关系的准确性（间接验证）。次要目的是调查开发原始 AsbJEM 时使用的假设是否提供了准确的石棉暴露估计值。
研究人群包括参加年度健康监测计划的参与者，这些参与者至少有 3 个月的职业性石棉暴露。计算出的石棉暴露指数包括累积石棉暴露量和平均暴露强度，使用 AsbJEM 和工作年限来估计。通过对暴露强度、持续时间和频率进行操作，比较原始 AsbJEM 及其变体之间的石棉和 MM 暴露反应关系。使用三种暴露强度（暴露模式范围的第 50、75 和 90 百分位数）、四种峰值持续时间（15、30、60 和 120 分钟）和两种峰值频率模式（原始和加倍），计算了累积石棉暴露和平均暴露强度的 24 个暴露估计值。使用 Cox 比例风险模型描述 MM 发病率与每个累积和平均强度估计值之间的关联。
从 1602 名男性参与者中收集了数据。在这些参与者中，有 40 人在研究期间患上了 MM。所有估计值均显示 MM 发病率与累积和平均暴露强度之间存在显著关联。基于模型中的回归系数，最强的关联是暴露模式的第 50 百分位数、15 分钟的峰值持续时间和峰值暴露频率的加倍。使用这些假设，间皮瘤的危险比分别为 1（参考）、1.91、3.24 和 5.37 对于累积石棉暴露的四分位数，1（参考）、1.84、2.31 和 4.40 对于平均暴露强度的四分位数。
证实了 MM 发病率与估计的累积石棉暴露量和平均暴露强度之间存在明确的正暴露反应关系。当 AsbJEM 中的峰值暴露频率从最初公布的估计值加倍时，发现了最强的关系。
