Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
JAMA Netw Open. 2021 Feb 1;4(2):e2037530. doi: 10.1001/jamanetworkopen.2020.37530.
Occupational exposure to carcinogens has been shown to pose a serious disease burden at the global, regional, and national levels. Based on epidemiologic studies and clinical observations, working environment appears to have important effects on the occurrence of human malignant tumors; however, to date, no systematic articles have been published that specifically investigated cancer burden due to occupational exposure in an individual and collective manner.
To estimate the degree of exposure and evaluate the cancer burden attributable to occupational carcinogens (OCs) individually and collectively by sex, age, year, and location.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study including data on 195 countries from the Global Burden of Diseases, Injuries, and Risk Factors Study from January 1, 1990, to December 31, 2017. Data were analyzed from June 24, 2020, to July 20, 2020.
Thirteen OCs (ie, arsenic, asbestos, benzene, beryllium, cadmium, chromium, diesel engine exhaust, formaldehyde, nickel, polycyclic aromatic hydrocarbons, silica, sulfuric acid, and trichloroethylene).
The degree and change patterns of exposure as well as the attributable cancer burden, including deaths and disability-adjusted life years (DALYs), by sex, age, year, and location for 13 OCs. The calculation of the population-attributable fraction was based on past exposure in the population and relative risks.
Based on the GBD 2017 study, 13 OCs attributable to 7 cancer types were included. Most summary exposure values for the 13 OCs, particularly those of diesel engine exhaust (35.6% increase; 95% uncertainty interval [UI], 32.4%-38.5%) and trichloroethylene (30.3% increase; 95% UI, 27.3%-33.5%), increased from 1990 to 2017. Only exposure to asbestos decreased by 13.8% (95% UI, -26.7% to 2.2%). In 2017, 319 000 (95% UI, 256 000-382 000) cancer deaths and 6.42 million (95% UI, 5.15 million to 7.76 million) DALYs were associated with OCs combined, accounting for 61.0% (95% UI, 59.6%-62.4%) of the total cancer deaths and 48.3% (46.3% to 50.2%) of the DALYs. Among the 13 OCs, the 3 leading risk factors for cancer burden were asbestos (71.8%), silica (15.4%), and diesel engine exhaust (5.6%). For most OCs, the attributed cancer outcome was tracheal, bronchial, and lung cancer, which accounted for 89.0% of attributable cancer deaths. China (61 644 cancer deaths), the US (42 848), and Japan (20 748) accounted for the largest number of attributable cancer deaths in 2017; for DALYs, China (1.47 million), the US (0.71 million), and India (0.37 million) were the 3 leading countries.
Results of this study suggest that although OC exposure levels have decreased, the overall cancer burden is continuously increasing.
职业暴露于致癌物已被证明在全球、区域和国家层面造成了严重的疾病负担。基于流行病学研究和临床观察，工作环境似乎对人类恶性肿瘤的发生有重要影响；然而，迄今为止，尚无专门针对个体和集体职业接触致癌物质（OCs）导致的癌症负担的系统文章发表。
通过性别、年龄、年份和地点，估计暴露程度并评估归因于职业致癌物质（OCs）的癌症负担。
设计、地点和参与者：本研究为一项包括来自全球疾病、伤害和风险因素研究（从 1990 年 1 月 1 日至 2017 年 12 月 31 日）的 195 个国家的数据的横断面研究。数据分析于 2020 年 6 月 24 日至 7 月 20 日进行。
13 种 OCs（即砷、石棉、苯、铍、镉、铬、柴油机废气、甲醛、镍、多环芳烃、二氧化硅、硫酸和三氯乙烯）。
13 种 OCs 所致 7 种癌症类型的暴露程度和变化模式，以及按性别、年龄、年份和地点计算的归因于癌症的死亡人数和伤残调整生命年（DALYs）。人群归因分数的计算基于人群过去的暴露情况和相对风险。
根据 2017 年 GBD 研究，纳入了 13 种归因于 7 种癌症类型的 OCs。13 种 OCs 的大多数汇总暴露值，特别是柴油机废气（35.6%增加；95%置信区间[UI]，32.4%-38.5%）和三氯乙烯（30.3%增加；95% UI，27.3%-33.5%），从 1990 年到 2017 年增加。只有石棉的暴露量减少了 13.8%（95% UI，-26.7%至 2.2%）。2017 年，OCs 联合导致 31.9 万（95% UI，25.6 万至 38.2 万）例癌症死亡和 642 万（95% UI，515 万至 776 万）伤残调整生命年（DALYs），占癌症总死亡人数的 61.0%（95% UI，59.6%-62.4%）和 DALYs 的 48.3%（46.3%至 50.2%）。在 13 种 OCs 中，癌症负担的前 3 大风险因素是石棉（71.8%）、二氧化硅（15.4%）和柴油机废气（5.6%）。对于大多数 OCs，归因于癌症的结果是气管、支气管和肺癌，占归因于癌症的死亡人数的 89.0%。2017 年归因于癌症死亡人数最多的国家是中国（61644 例）、美国（42848 例）和日本（20748 例）；对于 DALYs，中国（147 万）、美国（71 万）和印度（37 万）是 3 个主要国家。
本研究结果表明，尽管 OC 暴露水平有所下降，但总体癌症负担仍在持续增加。
