矿工接触柴油机废气和呼吸性粉尘与慢性阻塞性肺疾病（COPD）死亡率（DEMS II）。
Diesel exhaust and respiratory dust exposure in miners and chronic obstructive pulmonary disease (COPD) mortality in DEMS II.
机构信息
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
出版信息
Environ Int. 2024 Mar;185:108528. doi: 10.1016/j.envint.2024.108528. Epub 2024 Feb 24.
BACKGROUND
Diesel exhaust and respirable dust exposures in the mining industry have not been studied in depth with respect to non-malignant respiratory disease including chronic obstructive pulmonary disease (COPD), with most available evidence coming from other settings.
OBJECTIVES
To assess the relationship between occupational diesel exhaust and respirable dust exposures and COPD mortality, while addressing issues of survivor bias in exposed miners.
METHODS
The study population consisted of 11,817 male workers from the Diesel Exhaust in Miners Study II, followed from 1947 to 2015, with 279 observed COPD deaths. We fit Cox proportional hazards models for the relationship between respirable elemental carbon (REC) and respirable dust (RD) exposure and COPD mortality. To address healthy worker survivor bias, we leveraged the parametric g-formula to assess effects of hypothetical interventions on both exposures.
RESULTS
Cox models yielded elevated estimates for the associations between average intensity of REC and RD and COPD mortality, with hazard ratios (HR) corresponding to an interquartile range width increase in exposure of 1.46 (95 % confidence interval (CI): 1.12, 1.91) and 1.20 (95 % CI: 0.96, 1.49), respectively for each exposure. HRs for cumulative exposures were negative for both REC and RD. Based on results from the parametric g-formula, the risk ratio (RR) for COPD mortality comparing risk under an intervention eliminating REC to the observed risk was 0.85 (95 % CI: 0.55, 1.06), equivalent to an attributable risk of 15 %. The corresponding RR comparing risk under an intervention eliminating RD to the observed risk was 0.93 (95 % CI: 0.56, 1.31).
CONCLUSIONS
Our findings, based on data from a cohort of nonmetal miners, are suggestive of an increased risk of COPD mortality associated with REC and RD, as well as evidence of survivor bias in this population leading to negative associations between cumulative exposures and COPD mortality in traditional regression analysis.
背景
对于非恶性呼吸道疾病（包括慢性阻塞性肺疾病[COPD]），矿业的柴油废气和可呼吸粉尘暴露尚未进行深入研究，大多数现有证据来自其他环境。
目的
评估职业性柴油废气和可呼吸粉尘暴露与 COPD 死亡率之间的关系，同时解决暴露矿工中幸存者偏差的问题。
方法
研究人群由来自矿工中柴油废气研究 II 的 11817 名男性工人组成，从 1947 年随访至 2015 年，有 279 例观察到的 COPD 死亡。我们拟合了 Cox 比例风险模型，以评估可呼吸元素碳（REC）和可呼吸粉尘（RD）暴露与 COPD 死亡率之间的关系。为了解决健康工人幸存者偏差问题，我们利用参数 g 公式来评估假设干预对两种暴露的影响。
结果
Cox 模型得出的平均 REC 和 RD 强度与 COPD 死亡率之间的关联存在升高的估计值，暴露量每增加一个四分位间距，风险比（HR）分别为 1.46（95%置信区间[CI]：1.12，1.91）和 1.20（95%CI：0.96，1.49）。对于两种暴露，累积暴露的 HR 均为负值。基于参数 g 公式的结果，与观察到的风险相比，在消除 REC 的干预下比较 COPD 死亡率的风险比（RR）为 0.85（95%CI：0.55，1.06），相当于 15%的归因风险。与观察到的风险相比，在消除 RD 的干预下比较 COPD 死亡率的 RR 为 0.93（95%CI：0.56，1.31）。
结论
我们基于非金属矿工队列的数据得出的发现表明，REC 和 RD 与 COPD 死亡率的风险增加有关，并且在这种人群中存在幸存者偏差的证据，导致传统回归分析中累积暴露与 COPD 死亡率之间的负相关。
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