首都钢铁公司男工主要死亡原因的前瞻性研究

Major causes of death among male steelworkers in Beijing: a prospective study

目的探讨首都钢铁公司男工队列人群的主要死亡原因及其影响因素。方法2001年对1974、1979和1980年入选的5137名平均年龄在45岁的北京首都钢铁公司男工进行了全死因及冠心病、脑卒中发病死亡的随访,平均随访时间为20．8年。疾病死亡登记按MONICA方案进行。用观察人年计算死亡率,并采用我国2000年人口构成进行年龄调整。用Cox回归模型进行多因素分析,用校正的相对危险度计算人群归因危险度百分比。结果随访期间共发生死亡事件760例,全因死亡率为732．9／10万人年,年龄标化死亡率为643．0／10万人年。排序在前3位的死亡原因分别是恶性肿瘤、脑卒中和心脏疾病,其年龄标化死亡率分别为231．3／10万人年、139．3／10万人年和96．4／10万人年。因恶性肿瘤、脑卒中和心脏病死亡的人数占总死亡人数的77．4％。在恶性肿瘤死亡中肺癌的死亡居第一位,在心血管疾病死亡中排在前列的死因分别是脑卒中、冠心病、肺心病和心衰。经多因素调整后,吸烟、高血压和高胆固醇血症总死亡的相对危险度分别是1．440(1．174-1．765)、1．615(1．370-1．904)和1．274(1．057-1．537),人群归因危险度百分比分别是24．4％、16．5％和4．5％。结论癌症和心脑血管病是首都钢铁公司男工的主要死因,吸烟、高血压和高胆固醇血症是增加总死亡率的主要原因。

Objective To evaluate the major causes of death and risk factors among male steelworkers in Beijing. Methods The study included 5137 men from the cohort of Beijing Capital Steel and Iron Company. The baseline survey was performed in 1974, 1979 and 1980 and the final follow-up evaluation was made in 2001 with a mean follow-up of 20. 8 years. Causes of death were coded according to the Ninth Revision of International Classification of Diseases （ICD-9）. The mortality was calculated by person-years of follow-up and age-standardized according to the 2000 census data in China. Cox proportionalhazards models adjusting for risk factors were used to estimate the relative risk of death. Results There is 760 deaths during follow-up. Age-standardized mortality from all causes was 643. 0 per 100 000 person-years. The three leading causes of death were malignant neoplasms （ mortality, 231.3 per 100 000 person-years）, cerebrovascular diseases （mortality, 139.3 per 100 000 person-years） and heart diseases （mortality, 96. 4 per 100 000 person-years ）. The multivariate-adjusted relative risk of death and the population attributable risk proportion for risk factors were as follow： cigarette smoking （95% CI, 1. 174 to 1. 765） ; hypertension （95% CI, 1. 370 to 1. 904） and hypercholesterolemia（95% CI, 1. 057 to 1. 537）. Conclusions Our study indicates that malignant neoplasms, cerebrovascular diseases and heart diseases were major causes of death among male steelworkers. Furthermore, cigarette smoking, hypertension and hypercholesterolemia are leading preventable risk factors for death.