在1986-1991年间，参与清理切尔诺贝利核污染地区的4831名爱沙尼亚男性群体中，进行了死亡率研究。他们在1986-2020年的死亡率与爱沙尼亚男性总体相比较。在4812位追踪到的男性中，共有1503人死亡。总体标准化死亡率比（SMR）为1.04（95％CI 0.99-1.09） 。所有癌症死亡率升高（SMR为1.16，95％ CI 1.03-1.28）。与辐射有关的癌症比例过高（SMR为1.20，95％ CI 1.03-1.36）; 然而，这种过高的癌症比例可以归因于吸烟和饮酒。对于吸烟相关的癌症，SMR为1.20（95％ CI 1.06-1.35），而对于饮酒相关的癌症，SMR为1.56（95％CI 1.26-1.86） 。调整后的相对风险（ARR）表明，停留在切尔诺贝利地区≥92天的工人（ARR为1.20，95％CI 1.08-1.34），非爱沙尼亚族裔（ARR为1.33，95％CI 1.19-1.47）或教育程度较低（基础或以下）（ARR为1.63，95％ CI 1.45-1.83）的工人的总体死亡风险增加。自杀死亡率增加（SMR为1.31，95％ CI 1.05-1.56），尤其是那些受过较低教育的男性（ARR为2.24，95％ CI 1.42-3.53）。我们的研究结果提供了进一步的证据，表明像饮酒和吸烟这样的不健康行为在构成爱沙尼亚切尔诺贝利清理工人的癌症死亡模式方面发挥了重要作用。过多的自杀人数表明，与切尔诺贝利有关的压力可能导致长期心理和物质使用问题，即心理社会影响比低剂量辐射对癌症的直接致癌效应更大。© 2023. The Author(s)。

Mortality was studied in a cohort of 4831 men from Estonia who participated in the environmental cleanup of the radioactively contaminated areas around Chernobyl in 1986-1991. Their mortality in 1986-2020 was compared with the mortality in the Estonian male population. A total of 1503 deaths were registered among the 4812 traced men. The all-cause standardized mortality ratio (SMR) was 1.04 (95% CI 0.99-1.09). All-cancer mortality was elevated (SMR 1.16, 95% CI 1.03-1.28). Radiation-related cancers were in excess (SMR 1.20, 95% CI 1.03-1.36); however, the excesses could be attributed to tobacco and alcohol consumption. For smoking-related cancers, the SMR was 1.20 (95% CI 1.06-1.35) and for alcohol-related cancers the SMR was 1.56 (95% CI 1.26-1.86). Adjusted relative risks (ARR) of all-cause mortality were increased among workers who stayed in the Chernobyl area ≥ 92 days (ARR 1.20, 95% CI 1.08-1.34), were of non-Estonian ethnicity (ARR 1.33, 95% CI 1.19-1.47) or had lower (basic or less) education (ARR 1.63, 95% CI 1.45-1.83). Suicide mortality was increased (SMR 1.31, 95% CI 1.05-1.56), most notably among men with lower education (ARR 2.24, 95% CI 1.42-3.53). Our findings provide additional evidence that unhealthy behaviors such as alcohol and smoking play an important role in shaping cancer mortality patterns among Estonian Chernobyl cleanup workers. The excess number of suicides suggests long-term psychiatric and substance use problems tied to Chernobyl-related stressors, i.e., the psychosocial impact was greater than any direct carcinogenic effect of low-dose radiation.© 2023. The Author(s).