Jöckel K H, Ahrens W, Pohlabeln H, Bolm-Audorff U, Müller K M
Institute for Medical Informatics, Biometry and Epidemiology, University Clinics of Essen, Germany.
Am J Ind Med. 1998 Apr;33(4):313-20. doi: 10.1002/(sici)1097-0274(199804)33:4<313::aid-ajim1>3.0.co;2-v.
In a case-control study, 839 male hospital-based cases of primary lung cancer and the same number of population-based controls--matched by sex, age, and region of residence--were personally interviewed for their job and smoking histories. The study allows to quantify occupational asbestos exposure that was thought to be a welding-associated risk: 6% of cases and 2% of controls were classified into the occupational category "welders or burners# (odds ratio [OR] = 2.65). This OR was reduced to 1.93 (95% confidence limit [CL]: 1.03-3.61) after adjustment for smoking and asbestos. In contrast, a history of welding in general for at least a half-year is 28% among cases and 23% among controls, yielding an OR of 1.25 (95% CL: 0.94-1.65) after adjustment for both confounders. The OR of welding for more than 6,000 hr is 1.45 (95% CL = 1.04-2.02), reduced to 1.10 after adjustment for smoking and asbestos. Oxyacetylene welding for more than 6,000 hr lifelong is associated with an OR of 1.86 (95% CL = 1.01-3.43) reduced to 1.46 (n.s.) after adjustment for smoking and asbestos. The risk of oxyacetylene welding seems to be highest for oat cell carcinoma with an adjusted OR for ever-exposure of 1.46 (95% CL = 0.69-3.10). Therefore, the present study supports the hypothesis that some, but not all, of the excess risk of welders observed in the literature may be due to a history of cigarette smoking and occupational asbestos exposure. The elevated risk for the subgroup of employees in the aircraft industry reported for the midterm evaluation of the study still prevails, though no longer statistically significant. However, employees in this industry who ever welded show an OR of 2.29 (95% CL = 1.19-4.42) after adjustment for smoking and asbestos.
在一项病例对照研究中，对839例以医院为基础的男性原发性肺癌病例以及相同数量的以人群为基础的对照者（按性别、年龄和居住地区匹配）进行了关于其工作和吸烟史的个人访谈。该研究能够对被认为与焊接相关风险的职业性石棉暴露进行量化：6%的病例和2%的对照者被归类为职业类别“焊工或烧焊工”（优势比[OR]=2.65）。在对吸烟和石棉暴露进行调整后，该OR降至1.93（95%置信区间[CL]：1.03 - 3.61）。相比之下，一般而言，至少有半年焊接史的情况在病例中占28%，在对照者中占23%，在对两个混杂因素进行调整后，得出的OR为1.25（95% CL：0.94 - 1.65）。焊接超过6000小时的OR为1.45（95% CL = 1.04 - 2.02），在对吸烟和石棉暴露进行调整后降至1.10。终身氧乙炔焊接超过6000小时与OR为1.86（95% CL = 1.01 - 3.43）相关，在对吸烟和石棉暴露进行调整后降至1.46（无统计学意义）。对于燕麦细胞癌，氧乙炔焊接的风险似乎最高，曾经暴露者的调整后OR为1.46（95% CL = 0.69 - 3.10）。因此，本研究支持这样一种假设，即文献中观察到的焊工的部分而非全部额外风险可能归因于吸烟史和职业性石棉暴露。尽管在中期评估中该研究报告的航空业员工亚组的风险升高不再具有统计学意义，但仍然存在。然而，该行业中曾经焊接过的员工在对吸烟和石棉暴露进行调整后，OR为2.29（95% CL = 1.19 - 4.42）。
