Exposure-response relation for occupational exposure to respirable quartz and lung cancer risk: performance of a quantitative vs a semi-quantitative job-exposure matrix
本研究基于欧洲和加拿大11项病例对照研究的数据，比较了定量和半定量职业暴露矩阵在评估可吸入石英暴露与肺癌风险关系中的表现，发现两者结果相似，但定量方法可量化风险。
<h3>Objectives</h3> In order to estimate the exposure-response relation of respirable quartz and lung cancer risk, we developed a quantitative time/job/region specific job-exposure matrix (JEM) based on statistical modelling of historical exposure data. We compared the performance of this quantitative JEM (SYN-JEM) with an already available semi-quantitative general population JEM (DOM-JEM) within a study of pooled community-based lung cancer case-control studies (SYNERGY). <h3>Methods</h3> Detailed lifetime occupational and smoking history was available for 13 259 cases and 16 232 controls from 11 case-control studies from 12 European countries and Canada. Occupational histories were linked with SYN-JEM and DOM-JEM to derive estimates of cumulative exposure. ORs for lung cancer were estimated using unconditional logistic regression adjusted for age, gender, study, cigarette pack-years, time-since-quitting smoking, and ever occupational exposure to five other known lung carcinogens. <h3>Results</h3> Exposure to respirable quartz was associated with a monotonic increase in risk of lung cancer. Cumulative exposure estimates based on the quantitative SYN-JEM ranged from 0.005 to 104 mg/m3-years. Quartiles of cumulative exposure (categorised using the exposure distribution among exposed controls) showed significant elevated risks ranging from 1.16 to 1.40. SYN-JEM did not perform better than the ordinal DOM-JEM which provided similar ORs. <h3>Conclusions</h3> We found a positive exposure-response association between occupational exposure to respirable quartz and lung cancer in a large pooled community-based case-control study. A semi-quantitative approach showed similar results as the quantitative exposure assessment approach except that with the latter risk can be expressed in terms of mg/m3 quartz years, which would facilitate quantitative risk-assessment.