大姚县青石棉污染区主要恶性肿瘤的健康生命损失年分析

目的评价云南省大姚县环境青石棉污染对人群健康及社会造成的危害。方法通过查阅当地县级医院门诊和住院登记恶性肿瘤病例、人口死因登记报告中1994至2003年期间死亡的恶性肿瘤患者。用健康生命损失年评价当地恶性肿瘤引起的死亡、健康寿命损失及社会负担。结果1994至2003年，青石棉污染区肺癌、肝癌、间皮瘤、胃癌、结肠直肠癌的死亡率分别为10．15／10万、9．04／10万、8．48／10万、3．96／10万、3．55／10万。除女性乳腺癌外，男女各主要恶性肿瘤死亡率均随年龄增长而增长。肝癌、肺癌、问皮瘤、白血病、胃癌的健康生命损失年损失分别是1981．39、1886．63、1799．23、948．01、754．18人年。健康生命损失年损失的年龄分布主要集中于15～44岁和45～59岁年龄组。恶性肿瘤引起的间接经济损失以肺癌、肝癌、间皮瘤造成的损失较大，分别占总损失的15．02％、13．98％、13．01％。青石棉污染引起的健康生命损失年为3092．23人年，间接经济损失517．58万元。结论肺癌、肝癌、间皮瘤、白血病和女性乳腺癌对污染区人群健康和社会危害影响较大。恶性肿瘤造成的中老年人死亡较为严重，引起的青壮年死亡造成的社会损失最大。

Burden of major cancers on years of life lost with premature death in crocidolite-contaminated area in Dayao

OBJECTIVE: To evaluate the effects of environmental low-dose exposure to crocidolite on people's health and the society. METHODS The mortality data of cancer between 1994 and 2003 in an environmental crocidolite-contaminated area was obtained from hospital medical records of Dayao Center for Disease Prevention and Control, and Dayao Public Health Bureau. The years of life lost with premature death (YLLs), was used to measure and assess the death, health losses and social burden of cancer in this area. RESULTS: In the environmental crocidolite-contaminated area, lung cancer was the prime cause of death in all kinds of cancers between 1994 and 2003, followed by liver cancer, mesothelioma stomach cancer and colorectal cancer, with mortality 10.15/10(5), 9.04/10(5), 8.48/10(5), 3.96/10(5) and 3.55/10(5) respectively. The mortality of main cancer in male and female increased with age growing except that of breast cancer in female. Results showed that the types of leading cancers of YLLs were liver cancer, lung cancer, mesothelioma, leukemia and stomach cancer with YLLs 1981.39 person-year, 1886.63 person-year, 1799.23 person-year, 948.01 person-year and 754.18 person-year respectively. The distribution of YLLs was similar in both sexes, higher in the middle age group (aged from 15 to 44 years and 45 to 59 years) and lower in other age groups. The indirect economic loss resulting from lung cancer (15.02% of the total loss), liver cancer (13.98% of the total loss) and mesothelioma (13.01% of the total loss) was relatively great. The YLLs and the indirect economic loss attributable to environmental low-dose exposure to crocidolite were 3092.23 person-year and 5,175,800 Yuan respectively. CONCLUSION: Lung cancer, liver cancer, mesothelioma, leukemia and breast cancer are the major cancers with an important impact on people's health and premature mortality in the environmental crocidolite-contaminated area. The impact of cancer mortality is more severer in those aged over 45 years. Social burden of cancer is the greatest in persons aged from 15 to 59 years. Policies and plans should be worked out for the protection of environment and the prevention of cancer.