{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T08:31:48Z","timestamp":1793435508223,"version":"4.5.0"},"reference-count":37,"publisher":"Radiation Research Society","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Radiation Research"],"published-print":{"date-parts":[[2022,2,9]]},"abstract":"<jats:p>Exposure to ionizing radiation can damage the cerebrovascular system, however there is uncertainty regarding the effects after chronic exposure to low doses of radiation, such as that experienced by the public and those occupationally exposed. This study uses data from the UK National Registry for Radiation Workers cohort to assess the association between low-dose exposure to external radiation and cerebrovascular disease (CeVD) mortality. Poisson regression was used to estimate the Excess Relative Risk of CeVD mortality per Sievert (ERR\/Sv) of radiation exposure. Estimates were obtained for all CeVD combined, ischemic stroke, hemorrhagic stroke and other\/ill-defined CeVD. Results were adjusted for attained age, calendar period, sex, employer, industrial category and employment length. 166,812 nuclear workers (3,665,413 person-years) were included. By the end of 2011, 23% were dead including 3,219 deaths with an underlying cause of CeVD. The ERR\/Sv for all CeVD deaths was 0.57 (95% CI: 0.00, 1.31; p = 0.05). Increased CeVD mortality rates were observed after doses as low as 10\u201320 mSv. However, a linear-exponential model fit the data significantly better than a linear model (p = 0.02). In the sub-type analyses, no evidence of linear associations were observed, however the patterns of response appeared to differ and there was some suggestion of an increased risk of hemorrhagic stroke at lower doses. These results are broadly consistent with other occupational cohort studies and suggest external radiation exposure may increase CeVD risk at lower doses than current ICRP protection guidelines suggest. Exploration of factors driving the observed dose-response shape, the potential impact of the healthy worker survivor effect, and further studies of cohorts with data on other potential confounders would be valuable.<\/jats:p>","DOI":"10.1667\/rade-20-00204.1","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T14:11:42Z","timestamp":1644415902000},"page":"459-470","source":"Crossref","is-referenced-by-count":21,"title":["Cerebrovascular Disease Mortality after occupational Radiation Exposure among the UK National Registry for Radiation Workers Cohort"],"prefix":"10.1667","volume":"197","author":[{"given":"Catherine A.","family":"Hinksman","sequence":"first","affiliation":[{"name":"UK Health Security Agency, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire, OX11 0RQ, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G. E.","family":"Haylock","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire, OX11 0RQ, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gillies","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire, OX11 0RQ, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1243","reference":[{"key":"1","unstructured":"\"Global Health Estimates.\"  (2021)"},{"key":"2","unstructured":"T Truelsen, S Begg, C Mathers,  \"The Global Burden of Cerebrovascular Disease.\"  (2000)"},{"key":"3","doi-asserted-by":"crossref","unstructured":"FA Stewart, AV Akleyev, M Hauer-Jensen, et al.  \"Ann ICRP.\"  41, \"ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs \u2014 Threshold Doses for Tissue Reactions in a Radiation Protection Context.\" 1 (2012)","DOI":"10.1016\/j.icrp.2012.02.001"},{"key":"5","doi-asserted-by":"crossref","unstructured":"M Kreuzer, F Dufey, M Sogl, et al.  \"Radiat Environ Biophys.\"  52, \"External gamma radiation and mortality from cardiovascular diseases in the German WISMUT uranium miners cohort study, 1946\u20132008.\" 37 (2013)","DOI":"10.1007\/s00411-012-0446-5"},{"key":"7","doi-asserted-by":"crossref","unstructured":"C Simonetto, H Sch\u00f6llnberger, T V. Azizova, et al.  \"PLoS One.\"  10, \"Cerebrovascular diseases in workers at Mayak PA: The Difference in radiation risk between incidence and mortality.\" e0125904 (2015)","DOI":"10.1371\/journal.pone.0125904"},{"key":"9","doi-asserted-by":"crossref","unstructured":"MP Little, T V Azizova, D Bazyka, et al.  \"Environ Health Perspect.\"  120, \"Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks.\" (2012)","DOI":"10.1289\/ehp.1204982"},{"key":"10","doi-asserted-by":"crossref","unstructured":"MP. Little,  \"Mutat Res Mutat Res.\"  770, \"Radiation and circulatory disease.\" 299 (2016)","DOI":"10.1016\/j.mrrev.2016.07.008"},{"key":"11","doi-asserted-by":"crossref","unstructured":"MP Little, T V Azizova, N Hamada,  \"Int J Radiat Biol.\"  97, \"Low- and moderate-dose non-cancer effects of ionizing radiation in directly exposed individuals, especially circulatory and ocular diseases: a review of the epidemiology.\" 782 (2021)","DOI":"10.1080\/09553002.2021.1876955"},{"key":"13","doi-asserted-by":"crossref","unstructured":"CR Muirhead, JA O'Hagan, RGE Haylock, et al.  \"Br J Cancer.\"  100, \"Mortality and cancer incidence following occupational radiation exposure: third analysis of the National Registry for Radiation Workers.\" (2009)","DOI":"10.1038\/sj.bjc.6604825"},{"key":"14","unstructured":"CR Muirhead, JA O'Hagan, GE Haylock, et al.  \"Third Analysis of the National Registry for Radiation Workers: Occupational Exposure to Ionising Radiation in Relation to Mortality and Cancer Incidence. HPA-RPD-06.\"  (2009)"},{"key":"15","doi-asserted-by":"crossref","unstructured":"C Muirhead, A Goodill, R Haylock, et al.  \"Second Analysis of the National Registry for Radiation Workers: Occupational Exposure to Ionising Radiation and Mortality.\"  1 (1999)","DOI":"10.1088\/0952-4746\/19\/1\/002"},{"key":"16","doi-asserted-by":"crossref","unstructured":"GM Kendall, CR Muirhead, BH MacGibbon, et al.  \"Br Med J.\"  304, \"Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers.\" 220 (1992)","DOI":"10.1136\/bmj.304.6821.220"},{"key":"17","unstructured":"H. Akaike,  \"2nd International Symposium on Information Theory.\"  267 (1973)"},{"key":"18","unstructured":"\"The 20th Century Mortality Files.\""},{"key":"19","unstructured":"\"The 21st Century Mortality Files.\""},{"key":"20","unstructured":"D Preston, J Lubin, D Pierce, et al.  \"EPICURE version 2 user guide.\"  (2015)"},{"key":"21","doi-asserted-by":"crossref","unstructured":"AJ. McMichael,  \"J Occup Med.\"  18, \"Standardized mortality ratios and the \u201chealthy worker effect\u201d: Scratching beneath the surface.\" (1976)","DOI":"10.1097\/00043764-197603000-00009"},{"key":"22","doi-asserted-by":"crossref","unstructured":"HM Arrighi  and I Hertz-Picciotto  \"Epidemiology.\"  5, \"The evolving concept of the healthy worker survivor effect.\" (1994)","DOI":"10.1097\/00001648-199403000-00009"},{"key":"23","doi-asserted-by":"crossref","unstructured":"R. McNamee,  \"Occup Environ Med.\"  60, \"Confounding and confounders.\" (2003)","DOI":"10.1136\/oem.60.3.227"},{"key":"24","doi-asserted-by":"crossref","unstructured":"J. Robins,  \"Math Model.\"  7, \"A new approach to causal inference in mortality studies with a sustained exposure period\u2014application to control of the healthy worker survivor effect.\" (1986)","DOI":"10.1016\/0270-0255(86)90088-6"},{"key":"25","doi-asserted-by":"crossref","unstructured":"FA Stewart, I Seemann, S Hoving, et al.  \"Clin Oncol.\"  25, \"Understanding Radiation-induced Cardiovascular Damage and Strategies for Intervention.\" (2013)","DOI":"10.1016\/j.clon.2013.06.012"},{"key":"27","doi-asserted-by":"crossref","unstructured":"REJ Mitchel, M Hasu, M Bugden, et al.  \"Radiat Res.\"  175, \"Low-dose radiation exposure and atherosclerosis in ApoE2-\/-Mice.\" (2011)","DOI":"10.1667\/RR2176.1"},{"key":"28","doi-asserted-by":"crossref","unstructured":"D Lowe  and K Raj  \"Aging Cell.\"  13, \"Premature aging induced by radiation exhibits pro-atherosclerotic effects mediated by epigenetic activation of CD44 expression.\" (2014)","DOI":"10.1111\/acel.12253"},{"key":"29","unstructured":"\"Types of Stroke.\""},{"key":"30","doi-asserted-by":"publisher","unstructured":"Y Shimizu, K Kodama, N Nishi, et al.  \"BMJ.\"  340, \"Radiation exposure and circulatory disease risk: Hiroshima and Nagasaki atomic bomb survivor data, 1950-2003.\" b5349 (2010)","DOI":"10.1136\/bmj.b5349"},{"key":"31","unstructured":"S. Ka\u0142ucka,  \"Przegl Lek.\"  63, \"The occurrence of chronic obstructive pulmonary disease (COPD) in cigarette smoking families.\" (2006)"},{"key":"32","doi-asserted-by":"crossref","unstructured":"M. Britton,  \"Semin Oncol.\"  29, \"The epidemiology of mesothelioma.\" 18 (2002)","DOI":"10.1053\/sonc.2002.30237"},{"key":"33","doi-asserted-by":"crossref","unstructured":"RGE Haylock, M Gillies, N Hunter, et al.  \"Br J Cancer.\"  119, \"Cancer mortality and incidence following external occupational radiation exposure: an update of the 3rd analysis of the UK national registry for radiation workers.\" (2018)","DOI":"10.1038\/s41416-018-0184-9"},{"key":"34","doi-asserted-by":"crossref","unstructured":"A-H Harding, A Darnton, J Osman,  \"Occup Environ Med.\"  69, \"Cardiovascular disease mortality among British asbestos workers (1971-2005).\" (2012)","DOI":"10.1136\/oemed-2011-100313"},{"key":"36","doi-asserted-by":"crossref","unstructured":"F de Vocht, RM Martin, M Hidajat, et al.  \"Radiat Res.\"  \"Quantitative Bias Analysis of the association between occupational radiation exposure and ischemic heart disease mortality in UK nuclear workers.\" (2021)","DOI":"10.1667\/RADE-21-00078.1"},{"key":"37","doi-asserted-by":"crossref","unstructured":"M Gillies  and R Haylock  \"J Radiol Prot.\"  34, \"The cancer mortality and incidence experience of workers at British nuclear fuels plc, 1946-2005.\" 595 (2014)","DOI":"10.1088\/0952-4746\/34\/3\/595"},{"key":"26","doi-asserted-by":"crossref","unstructured":"MP Little, EJ Tawn, I Tzoulaki, et al.  \"Radiat Res.\"  169, \"A systematic review of epidemiological associations between low and moderate doses of ionizing radiation and late cardiovascular effects, and their possible mechanisms.\" 99 (2008)","DOI":"10.1667\/RR1070.1"},{"key":"8","doi-asserted-by":"crossref","unstructured":"D McGeoghegan, K Binks, M Gillies, et al.  \"Int J Epidemiol.\"  37, \"The non-cancer mortality experience of male workers at British Nuclear Fuels plc, 1946\u20132005.\" (2008)","DOI":"10.1093\/ije\/dyn018"},{"key":"12","doi-asserted-by":"crossref","unstructured":"M Gillies, DB Richardson, E Cardis, et al.  \"Radiat Res.\"  188, \"Mortality from circulatory diseases and other non-cancer outcomes among nuclear workers in France, the United Kingdom and the United States (INWORKS).\" (2017)","DOI":"10.1667\/RR14608.1"},{"key":"6","doi-asserted-by":"crossref","unstructured":"M Vrijheid, E Cardis, P Ashmore, et al.  \"Int J Epidemiol.\"  36, \"Mortality from diseases other than cancer following low doses of ionizing radiation: Results from the 15-Country Study of nuclear industry workers.\" (2007)","DOI":"10.1093\/ije\/dym138"},{"key":"4","doi-asserted-by":"crossref","unstructured":"O Laurent, C Metz-Flamant, A Rogel, et al.  \"Int Arch Occup Environ Health.\"  83, \"Relationship between occupational exposure to ionizing radiation and mortality at the French electricity company, period 1961\u20132003.\" (2010)","DOI":"10.1007\/s00420-010-0509-3"},{"key":"35","doi-asserted-by":"crossref","unstructured":"F de Vocht, M Hidajat, RM Martin, et al.  \"Radiat Res.\"  194, \"Ischemic heart disease mortality and occupational radiation exposure in a nested matched case-control study of British nuclear fuel cycle workers: Investigation of confounding by lifestyle, physiological traits and occupational exposures.\" (2020)","DOI":"10.1667\/RADE-19-00007.1"}],"container-title":["Radiation Research"],"original-title":[],"link":[{"URL":"https:\/\/meridian.allenpress.com\/radiation-research\/article-pdf\/doi\/10.1667\/RADE-20-00204.1\/3013540\/10.1667_rade-20-00204.1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/meridian.allenpress.com\/radiation-research\/article-pdf\/doi\/10.1667\/RADE-20-00204.1\/3013540\/10.1667_rade-20-00204.1.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:47:55Z","timestamp":1793432875000},"score":1,"resource":{"primary":{"URL":"https:\/\/bioone.org\/journals\/radiation-research\/volume-197\/issue-5\/RADE-20-00204.1\/Cerebrovascular-Disease-Mortality-after-occupational-Radiation-Exposure-among-the-UK\/10.1667\/RADE-20-00204.1.full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,1]]}},"URL":"https:\/\/doi.org\/10.1667\/rade-20-00204.1","relation":{},"ISSN":["0033-7587","1938-5404"],"issn-type":[{"value":"0033-7587","type":"print"},{"value":"1938-5404","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]}}}