Chau N, Bertrand J P, Mur J M, Figueredo A, Patris A, Moulin J J, Pham Q T
INSERM U 115 Santé au Travail et Santé Publique: Méthodes et Applications, Faculté de Médecine, Vandoeuvre-lès-Nancy, France.
Br J Ind Med. 1993 Feb;50(2):127-35. doi: 10.1136/oem.50.2.127.
A previous study on 536 retired coke oven plant workers in Lorraine Collieries (France) reported an excess of deaths from lung cancer (standardised mortality ratio (SMR) = 251) compared with the French male population. Occupational exposures during working life were retraced for each subject, but the number of deaths during the observation period (1963-82) was small, and smoking habits were known only for dead subjects. In 1988, the cohort was re-examined (182 deaths occurred between 1963 and 1987) and smoking habits were determined for all the subjects. This study confirmed the excess of lung cancer (SMR = 238, p < 0.001). It showed an excess of mortality from all causes (SMR = 141, p < 0.001), overall cancers (SMR = 133, p < 0.05), and cardiovascular diseases (SMR = 133, p < 0.05). A significant excess of deaths was found for subjects who worked near the ovens for all causes (145, p < 0.01), lung cancer (SMR = 252, p < 0.01), colon cancer (SMR = 381, p < 0.05), and cardiovascular diseases (SMR = 155, p < 0.05). A significant excess mortality was also found from all causes (176, p < 0.05) and stomach cancer (SMR = 538, p < 0.01) in subjects who worked in byproducts, from lung cancer (SMR = 433, p < 0.001) in those in the workshops, and from cirrhosis of the liver and alcoholism (SMR = 360, p < 0.01) in those underground; but, due to small numbers, these figures were not robust. An excess of mortality from all causes (SMR = 163, p<001), lung cancer (SMR = 228, p<0.05) and cardiovascular diseases (SMR = 179, p<0.01) was shown also for non-exposed or slightly exposed subjects. The fact that, on the whole, mortality of various exposed groups was similar to that of non-exposed or slightly exposed workers may be explained in part by the selection at hiring and the healthy worker effect. As an increased risk of lung cancer was noted among subjects who worked in the old generations of plant compared with the other workers (although the relative risk was not significant) it is concluded that the role of occupational hazards could not be excluded.
此前一项针对法国洛林煤矿536名退休焦炉厂工人的研究报告称，与法国男性人口相比，肺癌死亡人数过多（标准化死亡比（SMR）=251）。对每名受试者工作期间的职业暴露情况进行了追溯，但观察期（1963 - 1982年）内的死亡人数较少，且仅了解死亡受试者的吸烟习惯。1988年，对该队列进行了重新检查（1963年至1987年间有182人死亡），并确定了所有受试者的吸烟习惯。这项研究证实了肺癌死亡人数过多（SMR = 238，p < 0.001）。研究表明，所有原因导致的死亡人数过多（SMR = 141，p < 0.001），总体癌症（SMR = 133，p < 0.05）以及心血管疾病（SMR = 133，p < 0.05）。发现靠近焦炉工作的受试者在所有原因导致的死亡方面（145，p < 0.01）、肺癌（SMR = 252，p < 0.01）、结肠癌（SMR = 381，p < 0.05）以及心血管疾病（SMR = 155，p < 0.05）方面存在显著过多死亡。在从事副产品工作的受试者中，所有原因导致的死亡（176，p < 0.05）和胃癌（SMR = 538，p < 0.01）、在车间工作的受试者中的肺癌（SMR = 433，p < 0.001）以及地下工作的受试者中的肝硬化和酒精中毒（SMR = 360，p < 0.01）方面也发现了显著过多死亡；但由于人数较少，这些数据并不稳健。未暴露或轻度暴露的受试者在所有原因导致的死亡（SMR = 163，p<0.01）、肺癌（SMR = 228，p<0.05）和心血管疾病（SMR = 179，p<0.01）方面也显示出死亡人数过多。总体而言，各暴露组的死亡率与未暴露或轻度暴露工人的死亡率相似，这一事实部分可由招聘时的选择和健康工人效应来解释。由于与其他工人相比，在老一代工厂工作的受试者中肺癌风险增加（尽管相对风险不显著），因此得出职业危害的作用不能排除的结论。
