Cocco P, Ward M H, Dosemeci M
Institute of Occupational Medicine, University of Cagliari, Italy.
J Occup Environ Med. 1998 Oct;40(10):855-61. doi: 10.1097/00043764-199810000-00004.
We evaluated the risk of gastric cardia cancer by occupation and industry in a case-control study using information from death certificates for 24 US states in 1984-1992. One thousand fifty-six cases of gastric cardia cancer were identified among men aged 20 years or more, including 1,023 whites and 33 blacks. Controls were 5,280 subjects who died of nonmalignant diseases, 5:1 matched to cases by geographic region, race, gender, and 5-year age group. Among white men, occupations with elevated risk included financial managers (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.3-28.8), janitors and cleaners (OR = 1.7; 95% CI, 1.0-2.9), production inspectors (OR = 3.2; 95% CI, 1.5-6.9), and truck drivers (OR = 1.5; 95% CI, 1.0-2.2). Industries with elevated risk included pulp and paper mills (OR = 2.0; 95% CI, 1.0-37), newspaper publishing and printing (OR = 2.6; 95% CI, 1.0-6.3), industrial and miscellaneous chemicals (OR = 2.0; 95% CI, 1.0-3.9), water supply and irrigation (OR = 5.6; 95% CI, 1.6-19.9). Among black men, risks were nonsignificantly increased for subjects employed in railroads (3 cases, 2 controls) and for carpenters (3 cases, 0 controls). We created job-exposure matrices for asbestos, inorganic dust, metal dust, lead, polycyclic aromatic hydrocarbons, nitrogen oxides, nitrosamines, sulfuric acid, fertilizers, herbicides, other pesticides, and wood dust. Among white men, a consistent pattern of risk increase by level and probability of exposure was observed only for sulfuric acid mists, with a twofold excess (95% CI, 0.6-7.3) associated with high probability of high intensity exposure. A significant 30% increase in risk was observed for those subjects with a high probability of exposure (all levels combined) to lead, and a 60% increase was observed for subjects with high-level exposure to lead (all probabilities combined). However, crosstabulation of gastric cardia cancer risk by probability and level of exposure to lead did not show consistent trends. Asbestos exposure also showed an overall 50% increase but no consistent trends among white men. None of the 12 occupational hazards showed an association with risk for black men.
我们在一项病例对照研究中，利用1984 - 1992年美国24个州的死亡证明信息，按职业和行业评估了贲门癌风险。在20岁及以上男性中识别出1056例贲门癌病例，其中包括1023名白人及33名黑人。对照组为5280名死于非恶性疾病的受试者，按地理区域、种族、性别和5岁年龄组与病例以5:1进行匹配。在白人男性中，风险升高的职业包括金融经理（优势比[OR]=6.1；95%置信区间[CI]，1.3 - 28.8）、门卫和清洁工（OR = 1.7；95% CI，1.0 - 2.9）、生产检查员（OR = 3.2；95% CI，1.5 - 6.9）以及卡车司机（OR = 1.5；95% CI，1.0 - 2.2）。风险升高的行业包括纸浆和造纸厂（OR = 2.0；95% CI，1.0 - 3.7）、报纸出版和印刷业（OR = 2.6；95% CI，1.0 - 6.3）、工业及其他化学品行业（OR = 2.0；95% CI，1.0 - 3.9）、供水和灌溉业（OR = 5.6；95% CI，1.6 - 19.9）。在黑人男性中，铁路行业就业者（3例病例，2例对照）和木匠（3例病例，0例对照）的风险虽有升高但无统计学意义。我们针对石棉、无机粉尘、金属粉尘、铅、多环芳烃、氮氧化物、亚硝胺、硫酸、化肥、除草剂、其他农药以及木尘创建了工作暴露矩阵。在白人男性中，仅硫酸雾呈现出暴露水平和暴露概率增加风险的一致模式，高强度高概率暴露与之相关的风险高出两倍（95% CI，0.6 - 7.3）。对于铅暴露概率高（所有水平综合）的受试者，观察到风险显著增加30%，对于铅高暴露水平（所有概率综合）的受试者，风险增加60%。然而，按铅暴露概率和水平对贲门癌风险进行交叉制表未显示出一致趋势。石棉暴露总体也显示风险增加50%，但在白人男性中无一致趋势。12种职业危害因素中，无一与黑人男性的风险存在关联。
