National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, South Korea.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
Radiat Res. 2024 Oct 1;202(4):649-661. doi: 10.1667/RADE-23-00148.1.
High-dose radiation has been widely recognized as a risk factor for circulatory diseases. There is increasing evidence for risk of circulatory diseases in response to low and moderate radiation doses in recent years, but the results are not always consistent. We aimed to evaluate the associations between low-dose radiation exposure (<0.1 Gy) and the incidence of circulatory disease in a large cohort of Korean radiation workers. We collected data from a cohort of 187,001 radiation workers monitored for personal radiation dose since 1984 and linked with the National Health Insurance Service data from 2002 to 2021. Excess relative risks (ERRs) per 100 mGy were calculated to quantify the radiation dose-response relationship. The mean duration of follow-up was 13.3 years. A total of 12,705 cases of cerebrovascular disease (CeVD) and 19,647 cases of ischemic heart disease (IHD) were diagnosed during the follow-up period (2002-2021). The average cumulative heart dose was 4.10 mGy, ranging from 0 to 992.62 mGy. The ERR per 100 mGy with 10-year lagged cumulative heart doses was estimated at -0.094 (95% CI -0.248, 0.070) for CeVD and -0.173 (95% CI -0.299, -0.041) for IHD. The ERRs were not significantly changed after adjusting for confounding factors such as smoking, income, blood pressure, body mass index, and blood glucose level. A linear quadratic model was found to provide a better fit for the ERR of CeVD and IHD than a linear model (P = 0.009 and 0.030, respectively). There were no statistically significant variations in ERR/100 mGy estimates for either CeVD or IHD in terms of sex, attained age, and duration of employment; however, heterogeneity in the ERR/100 mGy estimates for CeVD among occupations was observed (P = 0.001). Our study did not find conclusive evidence supporting the association between occupational low-dose radiation and an increased risk of circulatory diseases. The significant negative ERR estimates for IHD need further investigation with a more extended follow-up period.
高剂量辐射已被广泛认为是循环系统疾病的一个风险因素。近年来，越来越多的证据表明，低剂量和中剂量辐射也会增加循环系统疾病的风险，但结果并不总是一致的。我们旨在评估大规模韩国辐射工作者队列中低剂量辐射暴露（<0.1Gy）与循环系统疾病发病之间的关联。我们从 1984 年开始对 187001 名辐射工作者进行个人辐射剂量监测的队列中收集数据，并与 2002 年至 2021 年期间的国家健康保险服务数据进行了关联。计算超额相对风险（ERR）每 100mGy 来量化辐射剂量-反应关系。随访的平均时间为 13.3 年。在随访期间（2002-2021 年）共诊断出 12705 例脑血管疾病（CeVD）和 19647 例缺血性心脏病（IHD）。平均累积心脏剂量为 4.10mGy，范围从 0 到 992.62mGy。对于 CeVD，10 年滞后累积心脏剂量每 100mGy 的 ERR 估计值为-0.094（95%CI-0.248，0.070），对于 IHD，ERR 估计值为-0.173（95%CI-0.299，-0.041）。调整吸烟、收入、血压、体重指数和血糖水平等混杂因素后，ERR 无显著变化。对于 CeVD 和 IHD，线性二次模型比线性模型更能拟合 ERR（P=0.009 和 0.030）。对于 CeVD 和 IHD，无论性别、达到年龄和就业年限如何，ERR/100mGy 的估计值均无统计学差异；然而，在职业方面，CeVD 的 ERR/100mGy 估计值存在异质性（P=0.001）。本研究没有得出支持职业低剂量辐射与循环系统疾病风险增加之间存在关联的结论性证据。对于 IHD，显著的负 ERR 估计值需要进一步调查，以延长随访时间。
