摘要
目的介绍一种新的吸烟校正因素间接调整法在职业流行病学队列研究中的应用。方法以1981—1999年香港男性矽肺回顾性队列研究人群纯石英暴露组作为研究实例，用吸烟组[1/（1-PAR%）×RR]与非吸烟组（1/1-PAR%）各自的吸烟校正因素校正原始的标准化死亡比（SMR），用暴露超相对危险度和增效指数作为指标来判断吸烟与暴露对肺癌死亡的危险有无偏离乘法和相加模型。结果非吸烟和吸烟组矽肺队列人群的吸烟校正因素分别为1／0．33和1／1．62，校正吸烟后矽肺队列肺癌的SMR由原来的1．61（95％CI：1．22～2．10）显著地下降到1．08（95％ CI：0．81～1．41），结果与Axelson方法完全一致。矽肺超相对危险度和增效指数分别为0．63（95％CI：0．08～0．79）和0．90（95％CI：0．42～1．94），提示吸烟与矽肺对肺癌死亡的危险呈明显的负相乘交互作用。结论吸烟校正因素间接调整法的优势是能定量分析和评估吸烟的混杂和交互作用的影响，但也有局限性。
Objective Previously documented indirect adjustment methods could only adjust for the confounding effects from cigarette smoking. The aim of this paper is to introduce a novel method for dealing with the effects of smoking in occupational, epidemiological cohort studies using a ‘smoking adjustment factor＇ . Methods A retrospective cohort study among male silicotie workers purely exposed to silica dusts in Hong Kong （1981 - 1999） was used as an example. ‘Smoking adjustment factor＇ in occupationallyexposed smoking and nonsmoking sub-cohorts was expressed as [1/（1-PAR%）×RR]and（1/1-PAR%）respectively, Relative exposure effect and Synergy index were estimated to assess the multiplicative and additive interactions. Results ‘Smoking adjustment factor＇ for non-smoking and smoking silicotic workers was 1/0.33 and 1/1.62 respectively. Lung cancer standardized mortality ratio（SMR） of all cohort members was reduced from 1.61 （ 95 % CI ： 1.22- 2.10） to 1.08 （95 % CI ： 0.81-1.41 ） after indirectly adjusted for smoking effect. Results from our novel indirect method were in line with that from Axelson＇ s approach. Relative silicosis effect and synergy index were estimated to be 0,63 （ 95 % CI： 0.08- 0.79） and 0.90 （95 % CI：0.42-1.94）, suggesting a significant but negative multiplicative interaction between smoking and silicosis on the risk of lung cancer mortality. Conclusion The merit of this new method was the ability to adjust for the confounding effect and evaluate the interactive effect with smoking, However, comparability of age distribution between occupationally exposed smoking and nonsmoking sub-cohorts was a prerequisite for the accurate estimations of the smoking indirectly adjusted SMR, relative exposure effect, and/or synergy index,
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2007年第1期88-91,共4页
Chinese Journal of Epidemiology
关键词
队列
混杂
交互作用
间接调整
标准化死亡比
Cohort
Confounding
Interaction
Indirect method
Standardized mortality ratio
