Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, Maryland, USA.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, Maryland, USA.
Environ Health Perspect. 2023 Aug;131(8):87003. doi: 10.1289/EHP12840. Epub 2023 Aug 7.
With the exception of lung cancer, the health effects associated with diesel exhaust for other cancers and nonmalignant health outcomes are not well understood.
We extended the mortality follow-up of the Diesel Exhaust in Miners Study, a cohort study of 12,315 workers, by 18 y (ending 31 December 2015), more than doubling the number of observed deaths to , to evaluate associations between mortality and diesel exhaust exposure.
Quantitative estimates of historical exposure to respirable elemental carbon (REC), a surrogate for diesel exhaust, were created for all jobs, by year and facility, using measurements collected from each mine, as well as historical measurements. Standardized mortality ratios (SMRs) and hazard ratios (HRs) were estimated for the entire cohort and by worker location (surface, underground).
We observed an excess of death for cancers of the lung, trachea, and bronchus (; ; 95% CI: 1.13, 1.37). Among workers who ever worked underground, where the majority of diesel exposure occurred, excess deaths were evident for lung, trachea, and bronchus cancers (; ; 95% CI: 1.11, 1.42). Several nonmalignant diseases were associated with excess mortality among workers ever-employed underground, including ischemic heart disease (; 95% CI: 1.00, 1.16), cerebrovascular disease (; 95% CI: 1.04, 1.43), and nonmalignant diseases of the respiratory system (; 95% CI: 1.01, 1.26). Continuous 15-y lagged cumulative REC exposure was associated with increased lung cancer risk (; 95% CI: 1.24, 3.03), but the risk declined at the highest exposures (; 95% CI: 0.74, 2.26). We also observed a significant trend in non-Hodgkin lymphoma (NHL) risk with increasing 20-y lagged cumulative REC (; 95% CI: 1.00, 9.79; ).
Increased risks of lung cancer mortality observed in the original study were sustained. Observed associations between diesel exposure and risk of death from NHL and the excesses in deaths for diseases of the respiratory and cardiovascular system, including ischemic heart disease and cerebrovascular disease, warrant further study and provide evidence of the potential widespread public health impact of diesel exposure. https://doi.org/10.1289/EHP12840.
除肺癌外，柴油废气对其他癌症和非恶性健康结果的健康影响尚未得到充分了解。
我们将矿工中柴油废气研究的死亡率随访时间延长了 18 年（截至 2015 年 12 月 31 日），观察到的死亡人数增加了一倍多，达到 ，以评估死亡率与柴油废气暴露之间的关系。
通过使用每个矿山以及历史测量数据，为所有工作、年份和设施创建了可呼吸元素碳（REC）的历史暴露定量估计值，这是柴油废气的替代物。使用标准化死亡率比（SMR）和风险比（HR）对整个队列和工人的工作地点（地面、地下）进行了估计。
我们观察到肺癌、气管和支气管癌症的死亡人数过多（ ； 95%CI：1.13，1.37）。在曾在地下工作的工人中，大部分柴油暴露发生在地下，肺癌、气管和支气管癌症的死亡人数过多（ ； 95%CI：1.11，1.42）。在曾在地下工作的工人中，有几种非恶性疾病与过量死亡有关，包括缺血性心脏病（ ； 95%CI：1.00，1.16）、脑血管疾病（ ； 95%CI：1.04，1.43）和非恶性呼吸系统疾病（ ； 95%CI：1.01，1.26）。连续 15 年滞后的累积 REC 暴露与肺癌风险增加相关（ ； 95%CI：1.24，3.03），但在最高暴露时风险下降（ ； 95%CI：0.74，2.26）。我们还观察到非霍奇金淋巴瘤（NHL）风险与 20 年滞后的累积 REC 呈显著趋势（ ； 95%CI：1.00，9.79）。
在最初的研究中观察到的肺癌死亡率增加的风险仍然存在。观察到的柴油暴露与 NHL 死亡风险之间的关联，以及呼吸系统和心血管系统疾病（包括缺血性心脏病和脑血管疾病）死亡人数的增加，需要进一步研究，并为柴油暴露对公众健康的潜在广泛影响提供证据。
