Table 4.
Estimated excess relative risks of circulatory disease in the Japanese atomic bomb survivors and in other groups with moderate-or low-dose radiation exposure, with mean dose generally < 0.5 Gy. (Adapted from Little and Lipshultz [31]). All data are in relation to underlying cause of death, unless otherwise indicated.
| Cohort/Study | Reference | Mean (range) heart/brain dose, Sv | Persons (person years of follow-up) | Endpoint (mortality unless otherwise indicated) | Excess relative risk Sv-1 (95% CI) |
|---|---|---|---|---|---|
| Japanese atomic bomb survivors | |||||
|
| |||||
| Japanese atomic bomb survivors | Shimizu et al. [24] | 0.1 (0 - 4)a | 86,611 (n.a.) | Ischemic heart disease (ICD9 410-414) | 0.02 (-0.10, 0.15) |
| Myocardial infarction (ICD9 410) | 0.00 (-0.15, 0.18) | ||||
| Hypertensive heart disease (ICD9 402, 404) | 0.37 (0.08, 0.72) | ||||
| Rheumatic heart disease (ICD9 393-398) | 0.86 (0.25, 1.72) | ||||
| Heart failure (ICD9 428) | 0.22 (0.07, 0.39) | ||||
| Other heart disease (ICD9 390-392, 415-427, 429) | -0.01 (-0.21, 0.24) | ||||
| Hypertensive disease without heart disease (ICD9 401, 403, 405) | 0.07 (-0.22, 0.55) | ||||
| Heart disease total (ICD9 393-429 excluding 401, 403, 405) | 0.18 (0.11, 0.25)b | ||||
| Cerebral infarction (ICD9 433,434) | 0.04 (-0.10, 0.20) | ||||
| Cerebral hemorrhage (ICD9 431) | 0.05 (-0.06, 0.17) | ||||
| Subarachnoid hemorrhage (ICD9 430) | 0.30 (-0.04, 0.76) | ||||
| Other or unspecified cerebrovascular disease | 0.16 (0.01, 0.34) | ||||
| Cerebrovascular disease total (ICD9 430-438) | 0.12 (0.05, 0.19)b | ||||
| Circulatory disease apart from heart disease and stroke (ICD9 390-392, 401, 403, 405, 439-459) | 0.58 (0.45, 0.72)b | ||||
| Other circulatory disease (ICD9 399-400, 406-409, 439-459) | -0.01 (<-0.01, 0.34) | ||||
| All circulatory disease (ICD9 390-459) | 0.15 (0.10, 0.20)b | ||||
|
| |||||
| Japanese atomic bomb survivors | Yamada et al. [23] | 0.1 (0 - 4)b | 10,339 (n.a.) | Hypertension incidence, 1958-1998 (ICD9 401) | 0.05 (-0.01, 0.10)c |
| Hypertensive heart disease incidence, 1958-1998 (ICD9 402, 404) | -0.01 (-0.09, 0.09)c | ||||
| Ischemic heart disease incidence, 1958-1998 (ICD9 410-414) | 0.05 (-0.05, 0.16)c | ||||
| Myocardial infarction incidence, 1964-1998 (ICD9 410) | 0.12 (-0.16, 0.60)c | ||||
| Occlusion incidence, 1958-1998 (ICD9 433, 434) | 0.06 (-0.11, 0.30)c | ||||
| Aortic aneurysm incidence, 1958-1998 (ICD9 441, 442) | 0.02 (-0.22, 0.41)c | ||||
| Stroke incidence, 1958-1998 (ICD9 430, 431, 433, 434, 436) | 0.07 (-0.08, 0.24)c | ||||
|
| |||||
| Japanese atomic bomb survivors | Tatsukawa et al. [54] | 0.001 (0-1.79) | 506 (9,265) | Morbidity in utero: hypertension | 0.20 (-0.39, 1.38) |
| Morbidity in utero: nonfatal stroke or myocardial infarction | -0.91 (-1.00, 79.3) | ||||
|
| |||||
| Japanese atomic bomb survivors | Tatsukawa et al. [54] | 0.13 (0-3.53) | 1,053 (20,216) | Morbidity: hypertension | 0.15 (-0.01, 0.34) |
| Morbidity: stroke or myocardial infarction | 0.72 (0.24, 1.40) | ||||
|
| |||||
| Occupational studies | |||||
|
| |||||
| Mayak workers | Moseeva et al. [33] | 0.62 ± 0.80 (males)d | 22,377 (447,281) | Ischemic heart disease morbidity (ICD9 410-414) | 0.14 (0.08, 0.21)e |
| Azizova et al. [32] | 0.51 ± 0.68 (females)d | Ischemic heart disease morbidity (ICD9 410-414) | 0.14 (0.08, 0.21)f | ||
| Ischemic heart disease morbidity (ICD9 410-414) | 0.16 (0.10, 0.24)g | ||||
| 22,377 (836,048) | Ischemic heart disease mortality (ICD9 410-414) | 0.05 (-0.01, 0.13)e | |||
| Ischemic heart disease mortality (ICD9 410-414) | 0.05 (-0.01, 0.13)f | ||||
| Ischemic heart disease mortality (ICD9 410-414) | 0.05 (-0.01, 0.13)g | ||||
| 18,856 (341,663) | Cerebrovascular disease morbidity (ICD9 430-438) | 0.497 (0.393, 0.601) e | |||
| Cerebrovascular disease morbidity (ICD9 430-438) | 0.529 (0.415, 0.642) f | ||||
| Cerebrovascular disease morbidity (ICD9 430-438) | 0.572 (0.450, 0.695) g | ||||
|
| |||||
| 18,856 (272,525) | Cerebrovascular disease mortality (ICD9 430-438) | 0.057 (-0.046, 0.161) e | |||
|
| |||||
| Cerebrovascular disease mortality (ICD9 430-438) | 0.064 (-0.042, 0.170) f | ||||
|
| |||||
| Cerebrovascular disease mortality (ICD9 430-438) | 0.076 (-0.033, 0.186) g | ||||
|
| |||||
| Chernobyl emergency workers | Ivanov et al. [60] | 0.109 (0 - >0.5) | 61,017 (n.a.) | Hypertension (ICD10 I10-I15) morbidity | 0.26 (-0.04, 0.56) |
| Essential hypertension (ICD10 I10) morbidity | 0.36 (0.005, 0.71) | ||||
| Hypertensive heart disease (ICD10 I11) morbidity | 0.04 (-0.36, 0.44) | ||||
| Ischemic heart disease (ICD10 I20-I25) morbidity | 0.41 (0.05, 0.78) | ||||
| Acute myocardial infarction (ICD10 I21) morbidity | 0.19 (-0.99, 1.37) | ||||
| Other acute ischemic heart disease (ICD10 I24) morbidity | 0.82 (-0.62, 2.26) | ||||
| Angina pectoris (ICD10 I20) morbidity | 0.26 (-0.19, 0.71) | ||||
| Chronic ischemic heart disease (ICD10 I25) morbidity | 0.20 (-0.23, 0.63) | ||||
| Other heart disease (ICD10 I30-I52) morbidity | -0.26 (-0.81, 0.28) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity | 0.45 (0.11, 0.80) | ||||
| Morbidity from diseases of arteries, arterioles and capillaries (ICD10 I70-I79) | 0.47 (-0.15, 1.09) | ||||
| Morbidity from diseases of veins, lymphatic vessels and lymph nodes (ICD10 I80-I89) | -0.26 (-0.70, 0.18) | ||||
| All circulatory disease (ICD10 I00-I99) morbidity | 0.18 (-0.03, 0.39) | ||||
|
| |||||
| Chernobyl emergency workers | Kaschcheev et al. [61] | 0.161 (0.0001 - 1.24) | 53,772 (958,540.5) | Cerebrovascular disease (ICD10 I60-I69) morbidity after no diabetes | 0.35 (0.18, 0.53) |
| Cerebrovascular disease (ICD10 I60-I69) morbidity after diabetes | 1.29 (0.63, 1.94) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after no atherosclerosis | 0.43 (0.25, 0.62) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after atherosclerosis | 0.50 (0.09, 0.90) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after no hypertensive disease | 0.38 (0.08, 0.68) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after hypertensive disease | 0.48 (0.27, 0.68) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after no IHD | 0.41 (0.14, 0.68) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after IHD | 0.47 (0.25, 0.69) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity after no concomitant disease | 0.19 (-0.99, 1.37) | ||||
| Cerebrovascular disease (ICD10 I60-I69) morbidity | 0.45 (0.28, 0.62) | ||||
|
| |||||
| German uranium miner study | Kreuzer et al. [75] | 0.047 (0.0002 – 0.909) | 58,982 (2,180,639) | All circulatory disease (ICD10 I00-I99) | -0.13 (-0.38, 0.12)f |
| Ischemic heart disease (ICD10 I20-I25) | -0.03 (-0.38, 0.32)f | ||||
| Cerebrovascular disease (ICD10 I60-I69) | 0.44 (-0.16, 1.04)f | ||||
|
| |||||
| Électricité de France workers | Laurent et al. [77] | 0.0215 (0 – 0.6) | 22,393 (440,984) | Ischemic heart disease | 4.1 (-2.9, 13.7)h |
| Cerebrovascular disease | 17.4 (0.2, 43.9)h | ||||
| All circulatory disease | 2.7 (-2.3, 9.1)h | ||||
|
| |||||
| Eldorado uranium miners and processing (male) workers | Lane et al. [76] | 0.0522 (<0.0234 – >0.1215) | 16,236 (508,673) | Ischemic heart disease | 0.15 (-0.14, 0.58) |
| Stroke | -0.29 (<-0.29, 0.27) | ||||
| All other circulatory disease | 0.07 (<-0.33, 0.77) | ||||
|
| |||||
| British Nuclear Fuels plc. workers | McGeoghegan et al. [78] | 0.0569 (0 – >0.729) | 38,779 (1,081,570) | Ischemic heart disease (ICD9 410-414) | 0.70 (0.37, 1.07)b, g, h |
| Cerebrovascular disease (ICD9 430-438) | 0.66 (0.17, 1.27)b, g, h | ||||
| Other circulatory diseases (ICD9 390-398, 415-429, 440-459) | 0.83 (-0.10, 1.12)g, h | ||||
| Circulatory diseases apart from cerebrovascular (ICD9 390-429, 439-459) | 0.72 (0.39, 1.10)g, h | ||||
| All circulatory disease (ICD9 390-459) | 0.54 (0.30, 0.82)b, g, h | ||||
|
| |||||
| 3rd Analysis of UK National Registry for Radiation Workers | Muirhead et al. [73] | 0.0249 (<0.01 - >0.4) | 174,541 (3.9 × 106) | All circulatory disease (ICD9 390-459) | 0.251 (-0.01, 0.54)f |
| Circulatory disease not strongly related to smoking (ICD9 390-409, 415-440, 442-459) | 0.280 (-0.19, 0.85)f | ||||
| Aortic aneurysm (ICD9 441) | -0.132 (-1.29, 1.92)f | ||||
| Ischemic heart disease (ICD9 410-414) | 0.259 (-0.05, 0.61)f | ||||
| Cerebrovascular disease (ICD9 430-438) | 0.161 (-0.42, 0.91)f | ||||
|
| |||||
| US Oak Ridge workers | Richardson and Wing [106] | NA (0 – >0.1) | 14,095 (425,486) | Ischemic heart disease (ICD8 410-414) | -2.39 (-5.94, 1.16)e |
| Ischemic heart disease (ICD8 410-414) | -2.86 (-6.90, 1.18)f | ||||
| Ischemic heart disease (ICD8 410-414) | -0.16 (-6.02, 5.70) i | ||||
|
| |||||
| International Agency for Research on Cancer15-country nuclear worker study | Vrijheid et al. [59] | 0.0207 (0.0 - >0.5) | 275,312 (4,067,861) | Circulatory disease (ICD10 I00-I99, J60-J69, O88.2, R00-R02, R57) | 0.09 (-0.43, 0.70)f |
| Ischemic heart disease (ICD10 I20-I25) | -0.01 (-0.59, 0.69)f | ||||
| Heart failure (ICD10 I50) | -0.03 (<0, 4.91)f | ||||
| Deep vein thrombosis and pulmonary embolism (ICD10 I26, I80, I82, O88.2) | -0.95 (-1.00, 9.09)f, j | ||||
| Cerebrovascular disease (ICD10 I60-I69) | 0.88 (-0.67, 3.16)f | ||||
| All other circulatory disease (ICD10 R00-R02, R57, I00-I99 excluding I20-26, I50, I60-69, I80, I82) | 0.29 (<0, 2.40)f | ||||
|
| |||||
| Environmental studies | |||||
|
| |||||
| Techa River study | Krestinina et al. [79] | 0.035 (0-0.51)k | 29,735 (901,563) | All circulatory disease mortality (ICD9 390-459) | 0.18 (-0.13, 0.52)k, e |
| All circulatory disease mortality (ICD9 390-459) | 0.24 (-0.08, 0.59)k, f | ||||
| All circulatory disease mortality (ICD9 390-459) | 0.36 (0.02, 0.75)k, g | ||||
| Ischemic heart disease mortality (ICD9 410-414) | 0.26 (-0.22, 0.81)k, e | ||||
| Ischemic heart disease mortality (ICD9 410-414) | 0.40 (-0.11, 0.99)k, f | ||||
| Ischemic heart disease mortality (ICD9 410-414) | 0.56 (0.01, 1.19) k, g | ||||
|
| |||||
| Semipalatinsk nuclear test study | Grosche et al. [80] | 0.09 (0-0.63) | 19,545 (582,656) | Heart disease (ICD9 410-429): all settlements | 3.22 (2.33, 4.10)f |
| Heart disease (ICD9 410-429): exposed settlements | 0.06 (-0.39, 0.52)f | ||||
| Stroke (ICD9 430-438): all settlements | 2.96 (1.77, 4.14)f | ||||
| Stroke (ICD9 430-438): exposed settlements | -0.06 (-0.65, 0.54)f | ||||
| Cardiovascular disease (ICD9 390-459): all settlements | 3.15 (2.48, 3.81)f | ||||
| Cardiovascular disease (ICD9 390-459): exposed | 0.02 (-0.32, 0.37)f | ||||
CI, Confidence Interval; ICD, International Classification of Diseases
a
Analysis based on colon dose.
b
Analysis using underlying or contributing cause of death.
c
Analysis based on stomach dose, derived from Table 3 of Yamada et al. [23] with smoking and drinking in the stratification.
d
Risk estimates in relation to cumulative whole body external gamma dose; doses given here are from Moseeva et al. [33].
e
Assuming a lag period of 5 years.
f
Assuming a lag period of 10 years.
g
Assuming a lag period of 15 years.
h
90% CI
i
Assuming a lag period of 20 years.
j
Estimate derived from log-linear model, evaluated at 1 Sv.
k
Analysis based on dose to muscle.