Abstract：
BACKGROUND: Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy.
METHODS: The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE).
RESULTS: Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE.
CONCLUSIONS: The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality.
METHODS: The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE).
RESULTS: Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE.
CONCLUSIONS: The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality.
摘要：
背景：接触石棉会增加肺癌和间皮瘤的风险。很少有研究量化这些疾病在接触石棉的工人中的过早发生。专注于过早的疾病发作（速率提前或加速）可用于风险交流和评估暴露影响。我们估计总死亡率的速度提前，肺癌和胸膜间皮瘤死亡，按意大利石棉水泥（AC）工人的累积石棉暴露类别划分。
方法：队列研究包括来自21个队列的12578名工人，总共有6626人死亡，858人死于肺癌，394人死于胸膜恶性肿瘤（MN）。通过将竞争性死亡率Weibull模型拟合到自首次暴露（TSFE）以来随时间的死亡风险来估计速率提高。
结果：在不同的TSFE值下估计加速时间（AT）。累积暴露的最高水平与最低水平相比，在20年和40年的TSFE时，胸膜MN的AT为16.9年（95％CI14.9至19.2）和33.8年（95％CI29.8至38.4），分别。对于肺癌，分别为13.3年(95%CI12.0至14.7)和26.6年(95%CI23.9至29.4)，分别。至于总死亡率，在20年TSFE时，AT为3.35年(95%CI2.98至3.71)，和40年TSFE时的6.70（95%CI5.95至7.41）。
结论：目前的研究观察到石棉暴露后肺癌和胸膜间皮瘤的发生率明显升高，以及总死亡率。
方法：队列研究包括来自21个队列的12578名工人，总共有6626人死亡，858人死于肺癌，394人死于胸膜恶性肿瘤（MN）。通过将竞争性死亡率Weibull模型拟合到自首次暴露（TSFE）以来随时间的死亡风险来估计速率提高。
结果：在不同的TSFE值下估计加速时间（AT）。累积暴露的最高水平与最低水平相比，在20年和40年的TSFE时，胸膜MN的AT为16.9年（95％CI14.9至19.2）和33.8年（95％CI29.8至38.4），分别。对于肺癌，分别为13.3年(95%CI12.0至14.7)和26.6年(95%CI23.9至29.4)，分别。至于总死亡率，在20年TSFE时，AT为3.35年(95%CI2.98至3.71)，和40年TSFE时的6.70（95%CI5.95至7.41）。
结论：目前的研究观察到石棉暴露后肺癌和胸膜间皮瘤的发生率明显升高，以及总死亡率。
