石棉累积暴露与肺癌相对风险关系的荟萃分析。
A meta-analysis of the relation between cumulative exposure to asbestos and relative risk of lung cancer.
作者信息
Lash T L, Crouch E A, Green L C
机构信息
Cambridge Environmental Inc., Massachusetts 02141, USA.
出版信息
Occup Environ Med. 1997 Apr;54(4):254-63. doi: 10.1136/oem.54.4.254.
OBJECTIVES
To obtain summary measures of the relation between cumulative exposure to asbestos and relative risk of lung cancer from published studies of exposed cohorts, and to explore the sources of heterogeneity in the dose-response coefficient with data available in these publications.
METHODS
15 cohorts in which the dose-response relation between cumulative exposure to asbestos and relative risk of lung cancer has been reported were identified. Linear dose-response models were applied, with intercepts either specific to the cohort or constrained by a random effects model; and with slopes specific to the cohort, constrained to be identical between cohorts (fixed effect), or constrained by a random effects model. Maximum likelihood techniques were used for the fitting procedures and to investigate sources of heterogeneity in the cohort specific dose-response relations.
RESULTS
Estimates of the study specific dose-response coefficient (kappa 1.i) ranged from zero to 42 x 10(-3) ml/fibre-year (ml/f-y). Under the fixed effect model, a maximum likelihood estimate of the summary measure of the coefficient (k1) equal to 0.42 x 10(-3) (95% confidence interval (95% CI) 0.22 to 0.69 x 10(-3)) ml/f-y was obtained. Under the random effects model, implemented because there was substantial heterogeneity in the estimates of kappa 1.i and the zero dose intercepts (Ai), a maximum likelihood estimate of k1 equal to 2.6 x 10(-3) (95% CI 0.65 to 7.4 x 10(-3)) ml/f-y, and a maximum likelihood estimate of A equal to 1.36 (95% CI 1.05 to 1.76) were found. Industry category, dose measurements, tobacco habits, and standardisation procedures were identified as sources of heterogeneity.
CONCLUSIONS
The appropriate summary measure of the relation between cumulative exposure to asbestos and relative risk of lung cancer depends on the context in which the measure will be applied and the prior beliefs of those applying the measure. In most situations, the summary measure of effect obtained under the random effects model is recommended. Under this model, potency, k1, is fourfold lower than that calculated by the United States Occupational Safety and Health Administration.
目的
通过已发表的暴露队列研究，获取石棉累积暴露与肺癌相对风险之间关系的汇总测量值，并利用这些出版物中的可用数据探讨剂量反应系数异质性的来源。
方法
确定了15个已报告石棉累积暴露与肺癌相对风险之间剂量反应关系的队列。应用线性剂量反应模型，截距要么针对特定队列，要么由随机效应模型约束；斜率针对特定队列，在队列之间约束为相同（固定效应），或者由随机效应模型约束。最大似然技术用于拟合程序，并研究队列特定剂量反应关系中的异质性来源。
结果
研究特定剂量反应系数（kappa 1.i）的估计值范围从零到42×10⁻³毫升/纤维年（ml/f-y）。在固定效应模型下，系数汇总测量值（k1）的最大似然估计值等于0.42×10⁻³（95%置信区间（95%CI）0.22至0.69×10⁻³）ml/f-y。在随机效应模型下，由于kappa 1.i和零剂量截距（Ai）的估计值存在显著异质性而实施该模型，发现k1的最大似然估计值等于2.6×10⁻³（95%CI 0.65至7.4×10⁻³）ml/f-y，A的最大似然估计值等于-1.36（95%CI 1.05至1.76）。行业类别、剂量测量、吸烟习惯和标准化程序被确定为异质性来源。
结论
石棉累积暴露与肺癌相对风险之间关系的适当汇总测量值取决于该测量值的应用背景以及应用该测量值者的先验信念。在大多数情况下，建议采用随机效应模型下获得的效应汇总测量值。在此模型下，效力k1比美国职业安全与健康管理局计算的值低四倍。
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