School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
Occup Environ Med. 2020 Nov;77(11):748-751. doi: 10.1136/oemed-2020-106466. Epub 2020 Aug 11.
The natural history of coal workers' pneumoconiosis (CWP) after cessation of exposure remains poorly understood.
We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression.
A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR.
This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.
停止接触后煤工尘肺（CWP）的自然史仍知之甚少。
我们描述了 2000 年 1 月 1 日至 2013 年 12 月 31 日期间至少两次申请美国联邦福利的美国前煤矿工人中，与放射学进行性大块纤维化（PMF）相关的发展和进展情况。国际劳工组织（International Labour Office）的胸部 X 射线（CXR）分类用于确定初始和随后的疾病严重程度。多变量逻辑回归模型用于确定疾病进展的主要预测因素。
共有 3351 名前矿工在初次评估时没有 PMF 证据，但随后进行了 CXR。这些矿工的平均年龄为 59.7 岁，煤矿工作时间为 22 年。在首次 CXR 时，46.7%的矿工有单纯 CWP 的证据。在最后一次 CXR 时，有 111 名矿工（3.3%）出现了 PMF 的放射学证据。几乎所有进展为 PMF 的矿工中，有一半以上在 5 年内进展。进展的主要预测因素包括初次 CXR 时的年龄较小和单纯 CWP 的严重程度。
本研究进一步证明，即使在离开行业后没有放射学尘肺的矿工中，放射学 CWP 也可能在没有进一步暴露的情况下发生和/或进展。由于疾病进展的风险，前矿工应定期进行医学监测。
