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 10-20 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.
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