Gerhardsson L, Hagmar L, Rylander L, Skerfving S
Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
Occup Environ Med. 1995 Oct;52(10):667-72. doi: 10.1136/oem.52.10.667.
To examine the mortality pattern and the cancer incidence in a cohort of long term smelter workers exposed to lead.
The cohort consists of 664 male lead battery workers, employed for at least three months in 1942-87. From 1969 the values of all blood lead samples repeatedly obtained from these workers every two to three months, have been collected in a database. The expected mortality and morbidity 1969-89 was estimated from the county rates, specified for cause, sex, five-year age groups, and calendar year. Individual exposure matrices have been calculated and used for dose-response analyses.
The total cohort showed an increased overall mortality (standardised mortality ratio (SMR) 1.44; 95% confidence interval (95% CI) 1.16-1.79), an increased mortality from ischaemic heart diseases (SMR 1.72; 95% CI 1.20-2.42) and all malignant neoplasms (SMR 1.65; 95% CI 1.09-2.44). These risk estimates were unaffected or slightly decreased when applying a latency period of 15 years, and no dose-response pattern was shown. The non-significantly raised cancer incidence in the gastrointestinal tract (11 malignancies) in the total cohort, increased to a barely significant level in the quartile with the highest cumulative lead exposure (standardised incidence ratio (SIR) 2.34, 95% CI 1.07-4.45). No clear dose response pattern was evident when further subdividing the data into those first employed up to 1969 v those first employed after 1969 when the blood lead monitoring programme started. The risk estimate for malignancies in the gastrointestinal tract was not related to latency time. The cancer incidence was not increased at other sites.
A slightly increased incidence of gastrointestinal cancers was found in workers exposed to lead and employed before 1970. The lead cohort also showed an increased mortality from ischaemic heart diseases. These risk estimates did not show a dose-response pattern and were not associated with latency time. The results must also be interpreted with caution because of limited numbers, and lack of dietary and smoking data.
研究长期接触铅的冶炼工人队列中的死亡率模式和癌症发病率。
该队列由664名男性铅酸电池工人组成，他们在1942年至1987年期间至少工作了三个月。从1969年起，每两到三个月从这些工人身上反复采集的所有血铅样本值都已收集到一个数据库中。1969年至1989年的预期死亡率和发病率是根据按病因、性别、五岁年龄组和历年划分的县发病率估算的。已计算出个体暴露矩阵并用于剂量反应分析。
整个队列显示总体死亡率增加（标准化死亡率比（SMR）为1.44；95%置信区间（95%CI）为1.16 - 1.79），缺血性心脏病死亡率增加（SMR为1.72；95%CI为1.20 - 2.42），所有恶性肿瘤死亡率增加（SMR为1.65；95%CI为1.09 - 2.44）。应用15年的潜伏期时，这些风险估计值未受影响或略有下降，且未显示出剂量反应模式。整个队列中胃肠道癌症发病率非显著升高（11例恶性肿瘤），在累积铅暴露最高的四分位数中升至勉强显著水平（标准化发病率比（SIR）为2.34，95%CI为1.07 - 4.45）。当将数据进一步细分为1969年及以前首次就业者和1969年血铅监测项目开始后首次就业者时，未发现明显的剂量反应模式。胃肠道恶性肿瘤的风险估计与潜伏期无关。其他部位的癌症发病率未增加。
在1970年以前接触铅并就业的工人中，发现胃肠道癌症发病率略有增加。铅暴露队列还显示缺血性心脏病死亡率增加。这些风险估计未显示出剂量反应模式，也与潜伏期无关。由于样本数量有限以及缺乏饮食和吸烟数据，这些结果也必须谨慎解读。
