Division of Population Science, Thomas Jefferson University, United States of America.
College of Health and Human Services, George Mason University, United States of America.
Prev Med. 2021 Feb;143:106355. doi: 10.1016/j.ypmed.2020.106355. Epub 2020 Dec 7.
The relationship between racial disparities in occupational risk and lung cancer diagnosis is not well defined. We examined occupational exposure to asbestos, silica, and other workplace chemicals, fumes, or dusts as reported in the National Lung Screening Trial (NLST). Descriptive analyses and multivariate logistic regression models were performed. Among the NLST study cohort, 3.9% were diagnosed with lung cancer. African-Americans had a higher rate of lung cancer diagnosis than White individuals (4.3% vs. 3.9%). About 28% reported at least one occupational exposure, including 6.5% exposed to silica and 4.7% to asbestos. African-Americans reported occupational exposure more frequently than White participants, including exposures to asbestos and silica. In a multivariate model, the interactions of all measures of occupational exposures and smoking status were significant. Current smokers with occupational exposures had higher odds of lung cancer diagnosis (aOR = 2.01, 95% CI = 1.76-2.30 for any exposure as well as higher odds after silica (aOR = 2.35, 95% CI = 1.89-2.91) or asbestos (aOR = 1.97, 95% CI = 1.52-2.56) exposure compared to former smokers without any exposures. African-Americans had higher odds of lung cancer diagnosis than White individuals (aOR = 1.24 to 1.25, 95% CI = 1.01-1.54). Our findings indicate that we need more effective public health prevention programs, especially for minorities who may have disproportionately greater occupational exposures due to socioeconomic constructs and barriers. Interventions may include education about occupational risks and lung cancer screening or instituting workplace policies for smoke-free environments with tobacco cessation support.
种族间职业风险与肺癌诊断差异的关系尚未明确。我们研究了国家肺癌筛查试验（NLST）中报告的石棉、二氧化硅和其他工作场所化学物质、烟雾或粉尘暴露情况。进行了描述性分析和多变量逻辑回归模型分析。在 NLST 研究队列中，3.9%的人被诊断患有肺癌。非裔美国人肺癌的诊断率高于白人（4.3%比 3.9%）。约 28%的人报告至少有一种职业暴露，包括 6.5%的人接触过二氧化硅，4.7%的人接触过石棉。非裔美国人比白人参与者更频繁地报告职业暴露，包括接触石棉和二氧化硅。在多变量模型中，所有职业暴露和吸烟状况的测量指标的交互作用均有统计学意义。有职业暴露的当前吸烟者肺癌诊断的可能性更高（任何暴露的比值比[aOR]为 2.01，95%置信区间[CI]为 1.76-2.30，接触二氧化硅[aOR]为 2.35，95%CI 为 1.89-2.91）或接触石棉[aOR]为 1.97，95%CI 为 1.52-2.56）与没有任何暴露的前吸烟者相比。非裔美国人肺癌诊断的可能性高于白人（比值比[aOR]为 1.24 至 1.25，95%CI 为 1.01-1.54）。我们的研究结果表明，我们需要更有效的公共卫生预防计划，特别是针对由于社会经济结构和障碍而可能面临不成比例的更多职业暴露的少数族裔。干预措施可能包括有关职业风险和肺癌筛查的教育，或制定无烟环境的工作场所政策，并提供烟草戒断支持。
