职业接尘及吸烟致呼吸系统疾病死亡危险度比较的队列研究

A prospective cohort study on comparison of risk of death of respiratory system diseases between occupational dust exposure and smoking

目的比较接尘、吸烟对呼吸系统疾病死亡的影响。方法在1989年至1992年广州建立职业健康监护档案的基础上对30岁以上、职业接触粉尘和无粉尘接触的80 987名工人进行前瞻性队列研究。结果(1)队列平均年龄43．5岁,职业性粉尘接触率16．3%,吸烟率43．7%,饮酒率33．5%。(2)队列平均随访8年,35人失访,失访率0．04%,总死亡1593人中,219人死于肺癌,90人死于非恶性肿瘤性呼吸系统疾病。(3)调整相关因素后,相对于不吸烟者,吸烟者肺癌死亡相对危险度(RR)为3．32,是粉尘接触者相对于无粉尘接触者肺癌死亡RR(1．53)的2．2倍。粉尘接触者非恶性肿瘤性呼吸系统疾病死亡RR为2．41,是吸烟者(1．89)的1．28倍。尤其是矽尘接触者,其非恶性肿瘤性呼吸系统疾病死亡RR为5．72,是吸烟者的3．03倍。既接触粉尘又吸烟,呼吸系统疾病死亡RR增加更明显。(4)男性吸烟者呼吸系统疾病死亡危险分别随日吸烟量、烟龄的增加而增加。结论职业接触粉尘和吸烟均可引致超额的呼吸系统疾病死亡,两者存在协同作用。吸烟致肺癌死亡RR高于接尘,而致非恶性肿瘤性呼吸系统疾病死亡RR则低于接尘。吸烟与呼吸系统疾病死亡危险存在明显的剂量-效应关系。

Objective To compare the effects of dust exposure and smoking on mortality of respiratory system diseases（RSD）. Methods Based on the Guangzhou Occupational Health Surveillance Record System established between 1989 and 1992,80,987 factory workers,aged 30 years old or older,occupationally exposed or not exposed to dusts, were included in a prospective cohort study. Results （ 1）The mean age of the cohort was 43.5. Most subjects were workers, had secondary education, and almost all were married. The dust exposure rate was 16.3% ,the smoking rate 43.7% and the alcohol-drinking rate 33.5%. （2）The cohort was followed up for 8 years on average, but 35 people（0.04%） were lost for follow up.Among the 1593 deaths, 219 and 90 people died of lung cancer and non-cancer respiratory system diseases（NCRSD） respectively. （3）The adjusted relative risk（RR） of death of lung cancer for smokers,3.32, was 2.2 times of that for dust exposed workers, 1.53, and the RR of death of NCRSD for dust exposed workers,2.41,1.28 times of that for smokers, 1.89, especially for silica dust-exposed workers, 5.72,3.03 times of that for smokers. Dust exposure combined with smoking caused significantly higher RR of death of RSD. （4）In male,the death risks of RSD were increased with the amount of smoking per day and years of smoking. Conclusion Occupational dust exposure and smoking may cause excessive lung cancer and NCRSD death with synergistic effects. Smoking has higher RR of Lung cancer death than dust exposure. However, the dust exposure contributes to higher RR of NCRSD death. There is a significant dose-effect relationship between smoking and the death risk of RSD.