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석면노출로 인한 폐암의 상대위험도에 따른 인구집단기여위험도 차이에 대한 연구

Population Attributable Fractions of Lung Cancer from Asbestos Exposure by Study Populations

  • 문은경 (보건대학원 역학및보건정보학과)

초록/요약

Objectives: Population attributable fractions (PAFs) depend on the distributions of exposure and risk estimates. Although the effect of exposure prevalence is well known, the potential impact of different risks in estimating PAFs is less investigated. The purpose of this study is to provide appropriate lung cancer risks from asbestos exposure for calculating PAFs by study populations. Methods: We conducted a systemic review of epidemiologic investigations on asbestos exposure and lung cancer risks. Studies were identified via a MEDLINE search up until September 2009. One hundred fifteen cohort and forty-five case-control studies from 22 countries, which provided quantifiable information on risk and related confidence intervals, were identified. We conducted a meta-analysis and compared the risk estimates by country, study design, study period and exposure types. We also calculated hypothetical PAFs with our results based on different exposure scenarios. Results: The combined risk for lung cancer was 1.81 varying from 0.17 to 20.97. The risk estimates were higher in Asian countries (RR=3.53), in studies published before 2000s (RR=1.91), in women (RR=1.99) than did those for European (OR=1.63) or North America (OR=1.49), in studies published after 2000s (OR=1.62), and in men (OR=1.71), respectively. The combined risk from cohort studies (OR=1.84) were slightly higher than those of case-controls studies (OR=1.74). The PAFs also greatly varied from study to study as well as from different countries and study periods. The difference in PAFs between Asian and North American studies were 15.5%, 30.3%, and 36.2% when the exposure prevalence was 10%, 30%, and 50%, respectively. Conclusion: The risk for lung cancer from asbestos exposure is variable in the area under study, exposure type and published year. Therefore, caution is required on using a single estimate for PAFs. Further, it is important to apply adequate lung cancer estimates for each study population in order to calculate PAFs from asbestos exposure. Key-words: asbestos exposure; lung neoplasms; meta-analysis; population attributable fraction.　 Abbreviations: PAFs, Population Attributable Fraction; SMR, Standardized Mortality Ratio; OR, Odds Ratio; RR, Relative Risk; SIR, Standardized Incidence Ratio; CI, confidence interval.

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목차

Ⅰ. 서론 1
Ⅱ. 연구대상 및 방법 4
1. 문헌검색전략 4
2. 문헌선정기준 5
3. 자료추출 6
4. 메타분석 7
5. 석면노출로 인한 가상의 인구집단기여위험도 산출 8
Ⅲ. 연구결과 9
1. 연구특성 9
2. 국가별 출판편향 9
3. 연구특성에 따른 하위그룹 분석 9
4. 인구집단기여위험도 예측 결과 13
Ⅳ. 고찰 24
Ⅴ. 결론 29

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