zurniimtpeМедицина труда и промышленная экологияRussian Journal of Occupational Health and Industrial Ecology1026-94282618-8945FSBSI “Izmerov Research Institute of Occupational Health”10.31089/1026-9428-2023-63-3-179-192zurniimtpe-3138Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWБаза данных по стандартизованному отношению смертности (SMR all causes и SMR all cancer) для различных профессий (706 когорт/групп): максимальный «эффект здорового работника» — у космонавтов и врачейDatabase on the Standardized mortality ratio (SMR all causes and SMR all cancer) for various professions (706 cohorts/groups): the maximum "health worker effect" for cosmonauts and doctorshttps://orcid.org/0000-0001-8700-7624КотеровАлексей НиколаевичKoterovAleksey N.

Зав. лабораторией ФГБУ ГНЦ ФМБЦ им. А.И. Бурназяна, д-р биол. наук.

e-mail: govorilga@inbox.ru

Alexey N. Koterov, the Head of laboratory at the Burnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency, Dr. of Sci. (Biol.).

e-mail: govorilga@inbox.ru

govorilga@inbox.ruhttps://orcid.org/0000-0001-8486-8007УшенковаЛилия Н.UshenkovaLiliya N.noemail@neicon.ruДибиргаджиевИдрис Г.DibirgadzhievIdris G.noemail@neicon.ruФГБУ «Государственный научный центр Российской Федерации — Федеральный медицинский биофизический центр им. А.И. Бурназяна» ФМБА РоссииРоссияState Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological AgencyRussian Federation202317032023633179192Copyright © Котеров А.Н., Ушенкова Л.Н., Дибиргаджиев И.Г., 20232023Котеров А.Н., Ушенкова Л.Н., Дибиргаджиев И.Г.Koterov A.N., Ushenkova L.N., Dibirgadzhiev I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journal-irioh.ru/jour/article/view/3138

Сформирована база данных для работ по оценке индексов «стандартизованного отношения смертности» (SMR±95% доверительные интервалы — CI) сравнительно с генеральной популяцией по общей смертности и смертности от всех злокачественных новообразований («всех раков») для различных профессий и типов занятости (преимущественно мужчины). База включает 689 публикаций (706 когорт/групп, 67 профессий и типов занятости). Проведена оценка наличия «эффекта здорового работника» (HWE) в вошедших в базу исследованиях на основе критерия величины верхнего 95% CI меньшего единицы.

Обнаружено, что среди всех профессий и типов занятости HWE по общей смертности выявлен только для 52%, а по смертности от всех раков — только для 28% когорт/групп. HWE по обоим индексам одновременно и только по общей смертности имел место в 26% случаев. Для 2% исследований показана обратная зависимость (отсутствие HWE по общей смертности при наличии эффекта по смертности от всех раков), которая, скорее всего, случайна.

Не выявлено строгих зависимостей между HWE и канцерогенным потенциалом деятельности, хотя и имелась определённая тенденция. Частота работ с HWE для конкретных профессий и занятостей выявила в качестве наиболее «неполезных» работу с такими тяжёлыми металлами, как Hg, Cd, Pb, Cu (частота HWE равна 0% по общей смертности и 5% (шахтёры, добывающие ртуть) по смертности от злокачественных новообразований; одна публикация), затем деятельность, связанную с воздействием пыли (тальк, кварц, различные минералы и т. п.; 5% и 6%) и асбеста (10% и 2%). По наивысшей частоте HWE лидирующие позиции занимали пилоты (89% и 65%), работники нефтяной и нефтехимической промышленности (97% и 56%), а также врачи (94% и 96%) и космонавты/астронавты (100% и 67%; выборка мала).

На полной выборке исследований SMR у зарубежных врачей (1886–2017) продемонстрировано строгое линейное снижение величины SMR по общей смертности сравнительно с населением начиная с 1940-х гг. (r=–0,927; p<0,001), с достижением к 2010-м гг. SMR=0,38 (95% CI: 0,01; 0,76). При этом смертность от всех раков у врачей была снижена сравнительно с населением практически в равной степени для всех временных периодов, начиная с 1926 г. (среднее SMR=0,6; 95% CI: 0,53; 0,66). Возможные причины уменьшенной сравнительно с населением смертности у зарубежных врачей заключаются не только в профилактике и профессиональных навыках, но, вероятно, в лучшем доступе к медицине и специалистам. В связи с профессиональной солидарностью, медицинское обслуживание и информирование врачей отличается, по-видимому, большим вниманием. Важным является и более раннее лечение нераковых патологий, недопущение их превращения в хронические, что в последующем может приводить к канцерогенным последствиям.

Участие авторов

Участие авторов:Котеров А.Н. — концепция и дизайн исследования, сбор и обработка данных, написание текста, редактирование;Ушенкова Л.Н. — сбор и обработка данных, редактирование;Дибиргаджиев И.Г. — сбор и обработка данных, редактирование.

Финансирование

Финансирование. В рамках более широкой бюджетной темы ФМБА России; без иных источников финансирования и спонсорской поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Дата поступления

Дата поступления: 17.01.2023 / Дата принятия к печати: 24.01.2023 / Дата публикации: 20.03.2023

Researchers have formed a database for work on the evaluation of the indices of the "standardized mortality ratio" (SMR±95% confidence intervals — CI) in comparison with the general population for total mortality and mortality from all malignant neoplasms ("all cancers") for various professions and types of employment (mainly men). The database includes 689 publications (706 cohorts/groups, 67 professions and types of employment).

Experts have conducted an assessment the presence of the "healthy worker effect" (HWE) in the studies included in the database based on the criterion of the upper 95% CI value of less than one.

Among all professions and types of employment, scientists have identified HWE in total mortality only in 52%, and in mortality from all types of cancer — only in 28% of cohorts/groups.

HWE for both indicators simultaneously and only for total mortality occurred in 26% of cases. For 2% of the studies, there is an inverse relationship (absence of HWE for total mortality in the presence of an effect on mortality from all types of cancer), which is most likely accidental.

There were no strict dependencies between HWE and the carcinogenic potential of activity, although there was a definite trend.

The frequency of work with HWE for specific professions identified as the most "unprofitable" work with such heavy metals as Hg, Cd, Pb, Cu (the frequency of HWE is 0% for total mortality and 5% (mercury miners) for mortality from malignant neoplasms; one publication), followed by activities related to dust exposure (talc, quartz, various minerals, etc.; 5% and 6%) and asbestos (10% and 2%). Pilots (89% and 65%), oil and petrochemical industry workers (97% and 56%), as well as doctors (94% and 96%) and cosmonauts/astronauts (100% and 67%; the sample is small) occupied leading positions in the highest frequency of HWE.

A complete sample of SMR studies of foreign doctors (1886–2017) demonstrated a strict linear decrease in the SMR value in total mortality compared with the population since the 1940s (r=–0.927; p<0.001), with SMR=0.38 (95% CI: 0.01; 0.76) achieved by the 2010s.

At the same time, mortality from all cancers among doctors was reduced in comparison with the population almost equally for all time periods since 1926 (average SMR=0.6; 95% CI: 0.53; 0.66).

Possible reasons for the reduced mortality among foreign doctors compared to the population are not only in prevention and professional skills, but probably in better access to medicine and specialists. In connection with professional solidarity, medical care and informing doctors is apparently distinguished by great attention.

Earlier treatment of non-cancerous pathologies is also important, preventing their transformation into chronic ones, which can subsequently lead to carcinogenic consequences.

Contribution

Contribution:Koterov A.N. — research concept and design, data collection and processing, writing the text, editing;Ushenkova L.N. — data collection and processing, editing;Dibirgadzhiev I.G. — data collection and processing, editing.

Funding

Funding. As part of the broader budget theme of the FMBA of Russia; without other sources of funding and sponsorship.

Conflict of interests

Conflict of interests. The authors declare no conflict of interests.

Received

Received: 17.01.2023 / Accepted: 24.01.2023 / Published: 20.03.2023

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The authors declare that there are no conflicts of interest present.