Tsai S P, Gilstrap E L, Ross C E
Corporate Medical Department, Shell Oil Company, Houston, Texas 77252-2463, USA.
Occup Environ Med. 1996 May;53(5):299-304. doi: 10.1136/oem.53.5.299.
A 10 year extension of follow up (up to 1993) of 863 employees who had potential exposure to epichlorohydrin at two chemical plants between May 1948 and December 1965 was conducted to further evaluate the previously reported potential association between exposure to epichlorohydrin and heart disease.
The mortality observed was compared with that expected from the death rates from the local male population where these chemical plants are located. Workers were assigned to one of five exposure categories based on their job with the highest level of potential exposure. Vital status was ascertained to the end of 1993.
Among diseases of particular interest, there were no excess deaths from heart disease (standardised mortality ratio (SMR) 63.3), lung cancer (SMR 63.8), or non-malignant respiratory disease (SMR 37.7) for employees with 20 or more years after first exposure. Based on the level of potential exposure to epichlorohydrin, mortality for heart disease was slightly higher (SMR 75.7, 95% confidence interval (95% CI) 51.8-106.7) in the moderate to heavy exposure group than in the none to light exposure group (SMR 59.5, 95% CI 37.7-89.3); this difference is well within the range of random variation. The SMR for heart disease was 90.4 among employees who had both probable exposure to allyl chloride and moderate to heavy exposure to epichlorohydrin, although it was 88.1 among employees who had moderate to heavy potential exposure to epichlorohydrin but no exposure to allyl chloride.
This study does not support an association between exposure to epichlorohydrin and heart disease or lung cancer. There were no additional deaths from leukaemia in this update; the raised SMR for leukaemia noted in the previous study has substantially decreased from 500.0 to 161.3 (95% CI 33.2-471.0) and is not significant. The overall mortality and cancer mortality of employees potentially exposed to epichlorohydrin continued to be lower than that of the local population.
对1948年5月至1965年12月期间在两家化工厂可能接触环氧氯丙烷的863名员工进行了为期10年的随访(截至1993年),以进一步评估先前报道的环氧氯丙烷接触与心脏病之间的潜在关联。
将观察到的死亡率与这些化工厂所在地区当地男性人口的死亡率预期值进行比较。根据员工潜在接触水平最高的工作,将其分为五个接触类别之一。确定截至1993年底的生命状况。
在特别关注的疾病中,首次接触后20年或更长时间的员工中,心脏病(标准化死亡比(SMR)63.3)、肺癌(SMR 63.8)或非恶性呼吸道疾病(SMR 37.7)均无超额死亡。根据环氧氯丙烷的潜在接触水平,中度至重度接触组的心脏病死亡率略高于无至轻度接触组(SMR 75.7,95%置信区间(95%CI)51.8 - 106.7)(SMR 59.5,95%CI 37.7 - 89.3);这种差异完全在随机变化范围内。在可能接触烯丙基氯且中度至重度接触环氧氯丙烷的员工中,心脏病的SMR为90.4,而在中度至重度潜在接触环氧氯丙烷但未接触烯丙基氯的员工中,SMR为88.1。
本研究不支持环氧氯丙烷接触与心脏病或肺癌之间存在关联。本次更新中白血病没有额外死亡病例;先前研究中记录的白血病升高的SMR已从500.0大幅降至161.3(95%CI 33.2 - 471.0),且无统计学意义。可能接触环氧氯丙烷的员工的总体死亡率和癌症死亡率继续低于当地人口。