Occupational radiation exposure and excess additive risk of cataract incidence in a cohort of US radiologic technologists

Source avec lien : Occupational and Environmental Medicine, 77(1), 1/1/2020. 10.1136/oemed-2019-105902

De précédentes études portant sur la cataracte dans la population exposée aux rayonnements ionisants ont évalué le risque relatif; l’excès de risque additif radiogénique (EAR), sans doute plus important en santé publique, n’a pas été estimé. Une étude antérieure portant sur une vaste cohorte prospective de manipulateurs radio (USRT) a quantifié l’excès de risque relatif de cataracte par rapport à la dose professionnelle de rayonnements ionisants. L’objectif de cette enquête américano-japonaise est d’évaluer l’EAR de la cataracte. Cette étude suggère que des risques additifs élevés de cataracte sont associés avec une exposition à de faibles doses de rayonnements. S’ils étaient confirmés, ils pourraient avoir des implications importantes en clinique et en santé publique pour les travailleurs exposés professionnellement aux rayonnements, ainsi que pour la mise en place de mesures réglementaires.

Objectives Previous analyses of cataract in radiation-exposed populations have assessed relative risk; radiogenic excess additive risk (EAR), arguably of more public health importance, has not been estimated. Previous analysis of a large prospective cohort of US radiologic technologists (USRT) quantified excess relative risk of cataract in relation to occupational radiation dose. We aim to assess EARs of cataract. Methods We estimated EARs of cataract/cataract surgery in the USRT cohort using generalised additive models in relation to occupational radiation exposure, and assessed risk modification by a priori-selected cataract risk factors (diabetes, body mass index, smoking, race, sex, birth-year, ultraviolet B (UVB) radiation exposure). Results There were 11 345 cataract diagnoses and 5440 of cataract surgery during 832 462 and 888 402 person-years of follow-up, respectively. Cumulative occupational radiation exposure was associated with self-reported cataract, but not with cataract surgery, with EAR/104 person-year Gy=94 (95% CI: 47 to 143, p<0.001) and EAR/104 person-year Gy=13 (95% CI: <0 to 57, p=0.551), respectively. There was marked (p<0.001) variation of EAR by age and by diabetes status, with risk higher among persons ≥75 years and diabetics. There were indications of elevated risk among those with higher UVB radiation (p=0.045), whites (p=0.056) and among those with higher levels of cigarette smoking (p=0.062). Elevated additive risk was observed for estimated occupational radiation eye-lens doses <100 mGy (p=0.004) with no dose–response curvature (p=0.903). Conclusions The elevated additive risks associated with low-dose radiation, if confirmed elsewhere, have important public health and clinical implications for radiation workers as well as regulatory measures. Consultez la page de l’article

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