Abstract
A detailed analysis of cerebrovascular diseases (CeVD) for the cohort of workers at Mayak Production Association (PA) is presented. This cohort is especially suitable for the analysis of radiation induced circulatory diseases, due to the detailed medical surveillance and information on several risk factors. The risk after external, typically protracted, gamma exposure is analysed, accounting for potential additional internal alpha exposure. Three different endpoints have been investigated: incidence and mortality from all cerebrovascular diseases and incidence of stroke. Particular emphasis was given to the form of the dose-response relationship and the time dependence of the radiation induced risk. Young attained age was observed to be an important, aggravating modifier of radiation risk for incidence of CeVD and stroke. For incidence of CeVD, our analysis supports a dose response sub-linear for low doses. Finally, the excess relative risk per dose was confirmed to be significantly higher for incidence of CeVD compared to CeVD mortality and incidence of stroke. Arguments are presented for this difference to be based on a true biological effect.
Highlights
Circulatory diseases are the leading cause of death worldwide [1]
We found two minima in the deviance corresponding to two different sets of parameter estimates
The excess relative risk turned out to be quite different for the endpoint of cerebrovascular diseases (CeVD) incidence compared to stroke incidence and CeVD mortality, see Table 2
Summary
The most common circulatory diseases are ischemic heart diseases (7.3 million deaths in 2008) and stroke (6.2 million deaths in 2008), each about as frequent as cancer (7.6 million deaths in 2008) [2]. These high absolute numbers reveal the impact of any relative risk enhancement due to radiation. Circulatory complications [3, 4], including cerebrovascular diseases [5, 6] are known as late effects.
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