Background Silicosis, a chronic respiratory disease caused by crystalline silica exposure, is a persistent global lung health issue. No systematic review of the relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis exists. UK exposure limits are currently under review. We therefore performed a systematic review and dose-response meta-analysis of this relationship. Methods Web of Science, Medline and Embase were searched on 24 February 2023. Studies of radiographic, autopsy or death certificate silicosis, with an estimated average follow-up of over 20 years since first employment, were included. Cumulative silicosis risk methods were compared. The relative risks (RR) of silicosis at increasing cumulative exposures were calculated and used to estimate the absolute risk reduction (ARR). Results Eight eligible studies, including 10 cohorts, contributed 8792 cases of silicosis among 65 977 participants. Substantial differences in cumulative risk estimates between methodologies exist. Using the same method, we observed higher cumulative silicosis risks among mining compared with non-mining cohorts. A reduction from 4 to 2 mg/m³-years in cumulative RCS exposure corresponded to substantial risk reductions among miners (RR 0.23 (95% CI 0.18 to 0.29, I2=92.9%) with an ARR of 323 (95% CI 298 to 344) per 1000) and non-miners (RR 0.55 (95% CI 0.36 to 0.83, I2=77.0%) with an ARR of 23 (95% CI 9 to 33) per 1000). Conclusion Despite significant heterogeneity, our findings support a reduction in permissible exposure limits from 0.1 mg/m3 to 0.05 mg/m³, particularly among mining populations. Further research is needed among non-miners as only two studies were eligible. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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累积二氧化硅暴露与矽肺病之间的关系：系统评价和剂量反应荟萃分析


背景 矽肺病是一种由结晶二氧化硅暴露引起的慢性呼吸系统疾病，是一个持续的全球性肺部健康问题。尚无关于累积可吸入结晶二氧化硅 （RCS） 暴露与矽肺病之间关系的系统评价。英国的暴露限值目前正在审查中。因此，我们对这种关系进行了系统评价和剂量反应荟萃分析。方法 于 2023 年 2 月 24 日检索 Web of Science、Medline 和 Embase。纳入放射学、尸检或死亡证明矽肺病的研究，估计自首次就业以来平均随访超过 20 年。比较累积矽肺病风险方法。计算累积暴露增加时矽肺病的相对风险 （RR） 并用于估计绝对风险降低 （ARR）。结果 8 项符合条件的研究，包括 10 个队列，在 65 977 名参与者中贡献了 8792 例矽肺病病例。方法之间的累积风险估计存在很大差异。使用相同的方法，我们观察到与非采矿队列相比，采矿的累积矽肺风险更高。累积 RCS 暴露量从 4 毫克/立方米减少到 2 毫克/立方米年对应于矿工 （RR 0.23 （95% CI 0.18 至 0.29，I2=92.9%），ARR 为 323 （95% CI 298 至 344） /1000）和非矿工 （RR 0.55 （95% CI 0.36 至 0.83，I2=77.0%），ARR 为 23 （95% CI 9 至 33）/1000）。结论 尽管存在显著的异质性，但我们的研究结果支持将允许的暴露限值从 0.1 mg/m3 降低到 0.05 mg/m³，尤其是在采矿人群中。需要在非矿工中进行进一步研究，因为只有两项研究符合条件。 与研究相关的所有数据都包含在文章中或作为补充信息上传。