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[背景]近来,柴油机尾气(DEE)被列为一种已知的人类致癌物。[目的]根据假设的职业和环境暴露场景,得出DEE与肺癌死亡率的meta暴露-反应曲线(ERC),以及肺癌死亡率的估计寿命超额风险(ELRs)。[方法]根据三项大型职业队列研究(包括两项有关货运行业工人的研究和一项有关矿工的研究)得出的相对危险度(RR),对肺癌死亡率与累积元素碳(EC,为DEE的一个替代指标)暴露进行meta回归分析。根据所得出的风险函数,计算终身职业和环境暴露情况下的ELRs,并计算因DEE导致的年肺癌死亡分数。[结果]线性meta回归模型显示,累计EC每增加1μg/(m3·年),肺癌死亡率的lnRR值为0.000 98(95%CI为0.000 55～0.001 4)。各研究相对应的lnRRs介于0.000 61～0.001 2。直到80岁终身职业性暴露于1、10和25μg/m3 EC的环境中,每10 000人中所对应的额外肺癌死亡人数的估计值分别为17、200和689例。终生暴露于0.8μg/m3 EC环境中,每10 000人的额外肺癌死亡数估值为21例。基于对过去的职业和环境暴露的广泛假设,估计每年约有6%的肺癌死亡可能归因于DEE暴露。[结论]三项美国职业病队列研究的综合数据表明,工作场所和室外空气中常见水平的DEE,可能造成大量额外的肺癌终生风险。这一结果高于美国和欧洲通常可接受的限值:基于职业人群和普通人群的终身暴露,限值通常分别设为1/1 000和1/100 000。
[Background] Recently, diesel exhaust (DEE) has been classified as a known human carcinogen. [Objectives] To derive the meta-exposure-response curve (ERC) for DEE and lung cancer mortality and the estimated lifetime excess risk (ELRs) for lung cancer mortality based on hypothetical occupational and environmental exposure scenarios. [Method] Based on the relative risk (RR) derived from the three large-scale occupational cohort studies (including two studies on workers in the freight industry and one on miners), the mortality and cumulative elemental carbon (EC) A proxy for DEE) was exposed for meta-regression analysis. Based on the resulting risk function, ELRs for lifelong occupational and environmental exposures were calculated and the annual lung cancer death score due to DEE was calculated. [Results] The linear meta-regression model showed that the lnRR of lung cancer mortality was 0.000 98 (95% CI 0.000 55 ~ 0.001 4) for every 1 μg / (m3 · year) increase in cumulative EC. The lnRRs for each study ranged from 0.000 61 to 0.001 2. The estimated number of additional lung cancer deaths per 10,000 deaths was 17,200 and 689, respectively, up to 80 years of lifetime occupational exposure to 1, 10 and 25 μg / m3 EC. Lifetime exposures to 0.8 μg / m3 EC are estimated at 21 additional lung cancer deaths per 10,000 inhabitants. Based on extensive assumptions about past occupational and environmental exposures, it is estimated that about 6% of lung cancer deaths each year may be due to DEE exposure. [Conclusions] The combined data from three US occupational disease cohort studies show that DEE, a common level in the workplace and in outdoor air, can result in a substantial additional lifetime risk of lung cancer. This result is above the generally accepted limits in the United States and Europe: the limits are generally set at 1/1 000 and 1/100 000, respectively, based on the lifetime exposure of working people and the general population.