Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Cancer Med. 2021 Jun;10(12):4066-4074. doi: 10.1002/cam4.3943. Epub 2021 May 7.
Previous analyses within the National Health and Nutrition Examination Survey (NHANES) II and III cycles suggested an association between blood lead levels (BLLs) and lung cancer mortality, although the evidence was limited by small case numbers. To clarify this relationship, we conducted updated analyses of 4,182 and 15,629 participants in NHANES II and III, respectively, (extending follow-up 20 and 8 years) aged ≥20 with BLL measurements and mortality follow-up through 2014. We fit multivariable Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) relating BLLs and lung cancer with adjustment for smoking and other factors. We did not observe an overall association between BLLs and lung cancer after adjustment for smoking (both surveys) and serum cotinine and environmental tobacco smoke exposure (NHANES III), although suggestive associations were observed among women (NHANES II: HR 2.7, 95% CI 0.7, 10.0 for ≥20.0 µg/dl vs. <10.0 µg/dl, P = 0.07; NHANES III: HR 11.2, 95% CI 2.1, 59.4 for ≥10.0 µg/dl vs. <2.5 µg/dl, P = 0.04). After stratifying on smoking status, an association with elevated BLLs was observed in NHANES II only among former smokers (HR 3.2, 95% CI 1.3, 8.0 for ≥15 vs. <15 µg/dl) and in NHANES III only among current smokers (HR 1.7, 95% CI 1.1, 2.8 for ≥5 vs. <5 µg/dl). In summary, we found elevated BLLs to be associated with lung cancer mortality among women in both NHANES II and III. Given the absence of an association among non-smokers, we cannot rule out residual confounding as an explanation for our findings.
先前在国家健康和营养检查调查（NHANES）II 期和 III 期的分析表明，血铅水平（BLL）与肺癌死亡率之间存在关联，尽管证据受到小病例数量的限制。为了澄清这种关系，我们对 NHANES II 和 III 分别进行了更新分析，分别对 4182 名和 15629 名年龄≥20 岁的参与者进行了分析，这些参与者有 BLL 测量值，并通过 2014 年进行了死亡率随访。我们拟合了多变量 Cox 模型来估计与 BLL 和肺癌相关的危险比（HR）和 95%置信区间（CI），并对吸烟和其他因素进行了调整。我们没有观察到在调整了吸烟（两个调查）和血清可替宁和环境烟草烟雾暴露（NHANES III）后，BLL 与肺癌之间的总体关联，但在女性中观察到了提示性关联（NHANES II：HR 2.7，95%CI 0.7，10.0 对于≥20.0μg/dl 与 <10.0μg/dl，P=0.07；NHANES III：HR 11.2，95%CI 2.1，59.4 对于≥10.0μg/dl 与 <2.5μg/dl，P=0.04）。在按吸烟状况分层后，仅在 NHANES II 中观察到 BLL 升高与肺癌之间存在关联，仅在以前的吸烟者中观察到（HR 3.2，95%CI 1.3，8.0 对于≥15 与 <15μg/dl），并且仅在 NHANES III 中在当前吸烟者中观察到（HR 1.7，95%CI 1.1，2.8 对于≥5 与 <5μg/dl）。总之，我们发现 BLL 升高与 NHANES II 和 III 中女性的肺癌死亡率有关。鉴于非吸烟者之间没有关联，我们不能排除残余混杂是我们发现的原因。
