School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
Population and Public Health, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
Occup Environ Med. 2023 Nov 23;80(12):706-714. doi: 10.1136/oemed-2023-108865.
Ionising radiation is a human carcinogen, but the evidence is less clear that exposure to low-dose ionising radiation (LDIR) increases the risk of adverse cardiovascular outcomes. We synthesised the literature of chronic occupational exposure to LDIR and cardiovascular disease, particularly for ischaemic heart disease (IHD).The literature search was conducted using three databases including studies published between 1990 and 2022. A quality assessment of the studies was completed using the Office of Health and Assessment and Translation Risk of Bias Rating Tool. We conducted meta-analyses for IHD mortality using random effects models using measures of excess relative risk per sievert (ERR/Sv) obtained from internal cohort comparisons, as well as with standardised mortality ratios (SMRs) from external cohort comparisons.We identified 2189 articles, and of these, 26 provided data on IHD and were retained. Most studies were classified as having a 'moderate' level of risk of bias. Fourteen and 10 studies reporting external radiation doses were included in meta-analyses using SMR and ERR/Sv, respectively. The meta-summary SMR was 0.81 (95% CI 0.74 to 0.89) with evidence of reduced risk but high heterogeneity across studies. For internal cohort measures, the summary ERR/Sv for a lagged exposure of 10 years was 0.10 (95% CI 0.01 to 0.20) with low heterogeneity. The subgroup analysis by lagged exposure time showed the strongest association were for the 15 and 20 years lag.Our findings suggest that occupational exposure to LDIR increases the risk IHD mortality and highlight the relevance of internal cohort comparisons.
电离辐射是一种人类致癌物质，但暴露于低剂量电离辐射（LDIR）是否会增加不良心血管结局的风险证据尚不明确。我们综合了慢性职业暴露于 LDIR 与心血管疾病（尤其是缺血性心脏病（IHD））的文献。文献检索使用了三个数据库，包括 1990 年至 2022 年期间发表的研究。使用 Office of Health and Assessment 和 Translation 风险偏倚评估工具对研究进行了质量评估。我们使用随机效应模型对 IHD 死亡率进行了荟萃分析，使用内部队列比较获得的每西弗过量相对风险（ERR/Sv）和外部队列比较的标准化死亡率比（SMR）作为测量指标。我们确定了 2189 篇文章，其中 26 篇提供了与 IHD 相关的数据，并保留了下来。大多数研究被归类为存在中度风险偏倚。有 14 项和 10 项研究分别报告了外部辐射剂量，这些研究被纳入使用 SMR 和 ERR/Sv 的荟萃分析。SMR 的荟萃摘要为 0.81（95%CI 0.74 至 0.89），表明风险降低，但研究间存在高度异质性。对于内部队列测量，滞后暴露 10 年的 ERR/Sv 汇总值为 0.10（95%CI 0.01 至 0.20），异质性较低。滞后暴露时间的亚组分析表明，15 年和 20 年的滞后时间与最强的关联。我们的研究结果表明，职业暴露于 LDIR 会增加 IHD 死亡率的风险，并强调了内部队列比较的相关性。
