Axelson O
Department of Occupational and Environmental Medicine, University Hospital, Linköping, Sweden.
Scand J Work Environ Health. 1994;20 Spec No:9-18.
Occupational epidemiology has grown rapidly since the late 1970s. Case-referent studies have become popular, but more recent development relates to analyses of cohort data. Length of follow-up and employment status can now be adjusted for in such analyses. Attention should also be given to "time windows" of relevant exposure, not only in cancer studies. In cross-sectional studies of common diseases, the prevalence rate ratio should be used rather than the currently popular but unintelligible odds ratio as obtained by logistic regression. Exposure assessment should involve measures that would best reveal an existing risk and dose-response relationships. New achievements in molecular biology are currently influencing the development in occupational epidemiology. Not only DNA (or protein) adducts as markers of exposure or early effect, but also the possibilities to use data on metabolic polymorphism to identify genetically susceptible individuals attract interest. Activated oncogenes and inactivated tumor suppressor gene are useful for subspecifying various cancer types so as to obtain more sensitive studies.
自20世纪70年代末以来,职业流行病学发展迅速。病例对照研究已变得很普遍,但最近的发展与队列数据分析有关。现在在这类分析中可以对随访时间和就业状况进行调整。不仅在癌症研究中,对于相关暴露的“时间窗”也应予以关注。在常见疾病的横断面研究中,应使用患病率比,而不是目前流行但难以理解的逻辑回归得到的比值比。暴露评估应采用最能揭示现有风险和剂量反应关系的测量方法。分子生物学的新成果目前正在影响职业流行病学的发展。不仅作为暴露或早期效应标志物的DNA(或蛋白质)加合物,而且利用代谢多态性数据识别遗传易感个体的可能性也引起了人们的兴趣。激活的癌基因和失活的肿瘤抑制基因对于细分各种癌症类型很有用,从而可以进行更敏感的研究。