背景:美国海军陆战队基地(MCB)营地的饮用水,从1953年到1985年,北卡罗来纳州被三氯乙烯和其他工业溶剂污染。
方法:对海军陆战队/海军人员进行了队列死亡率研究,在1975年至1985年之间,开始服役并驻扎在Lejeune营地(N=159,128)或MCBPendleton营地,加利福尼亚(N=168,406),1972年10月至1985年12月期间在Lejeune营地(N=7,332)或Pendleton营地(N=6,677)雇用的文职人员。彭德尔顿营地的饮用水没有被工业溶剂污染。死亡率随访时间为1979年至2018年。使用比例风险回归来计算调整后的风险比(aHRs),比较Lejeune营地和Pendleton营地队列的死亡率。95%置信区间(CI)上限和下限的比率,orCIR,用于评估aHR的精度。该研究的重点是aHR≥1.20且CIRs≤3的死亡原因。
结果:勒琼营地和彭德尔顿营地海军陆战队/海军人员的死亡总数分别为19,250和21,134。Lejeune营地和Pendleton营地文职人员的死亡总数分别为3,055和3,280。与彭德尔顿营地海军陆战队/海军人员相比,对于肾癌,Lejeune营地的aHR≥1.20,CIRs≤3(aHR=1.21,95%CI:0.95,1.54),食管(aHR=1.24,95%CI:1.00,1.54)和女性乳腺(aHR=1.20,95%CI:0.73,1.98)。aHR≥1.20且CIR>3的死亡原因包括帕金森病,骨髓增生异常综合征和睾丸癌,子宫颈和卵巢。与彭德尔顿营地的文职人员相比,对于慢性肾脏病(aHR=1.88,95%CI:1.13,3.11)和帕金森病(aHR=1.21,95%CI:0.72,2.04),Lejeune营地的aHR≥1.20,CIRs≤3。女性乳腺癌的aHR为1.19(95%CI:0.76,1.88),在肾癌和咽癌中观察到aHRs≥1.20,CIRs>3,黑色素瘤,霍奇金淋巴瘤,和慢性髓细胞性白血病.定量偏倚分析表明,吸烟和饮酒造成的混淆不会对研究结果产生明显影响。
结论:与Pendleton营地相比,在Lejeune营地可能暴露于受污染的饮用水的海军陆战队/海军人员和文职人员在几种死亡原因方面的危险比增加。
BACKGROUND: Drinking water at U.S. Marine Corps Base (MCB) Camp Lejeune, North Carolina was contaminated with
trichloroethylene and other industrial solvents from 1953 to 1985.
METHODS: A cohort mortality study was conducted of Marines/Navy personnel who, between 1975 and 1985, began service and were stationed at Camp Lejeune (N = 159,128) or MCB Camp Pendleton, California (N = 168,406), and civilian workers employed at Camp Lejeune (N = 7,332) or Camp Pendleton (N = 6,677) between October 1972 and December 1985. Camp Pendleton\'s drinking water was not contaminated with industrial solvents. Mortality follow-up was between 1979 and 2018. Proportional hazards regression was used to calculate adjusted hazard ratios (aHRs) comparing mortality rates between Camp Lejeune and Camp Pendleton cohorts. The ratio of upper and lower 95% confidence interval (CI) limits, or CIR, was used to evaluate the precision of aHRs. The study focused on underlying causes of death with aHRs ≥ 1.20 and CIRs ≤ 3.
RESULTS: Deaths among Camp Lejeune and Camp Pendleton Marines/Navy personnel totaled 19,250 and 21,134, respectively. Deaths among Camp Lejeune and Camp Pendleton civilian workers totaled 3,055 and 3,280, respectively. Compared to Camp Pendleton Marines/Navy personnel, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for cancers of the kidney (aHR = 1.21, 95% CI: 0.95, 1.54), esophagus (aHR = 1.24, 95% CI: 1.00, 1.54) and female breast (aHR = 1.20, 95% CI: 0.73, 1.98). Causes of death with aHRs ≥ 1.20 and CIR > 3, included Parkinson disease, myelodysplastic syndrome and cancers of the testes, cervix and ovary. Compared to Camp Pendleton civilian workers, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for chronic kidney disease (aHR = 1.88, 95% CI: 1.13, 3.11) and Parkinson disease (aHR = 1.21, 95% CI: 0.72, 2.04). Female breast cancer had an aHR of 1.19 (95% CI: 0.76, 1.88), and aHRs ≥ 1.20 with CIRs > 3 were observed for kidney and pharyngeal cancers, melanoma, Hodgkin lymphoma, and chronic myeloid leukemia. Quantitative bias analyses indicated that confounding due to smoking and alcohol consumption would not appreciably impact the findings.
CONCLUSIONS: Marines/Navy personnel and civilian workers likely exposed to contaminated drinking water at Camp Lejeune had increased hazard ratios for several causes of death compared to Camp Pendleton.