景德镇瓷厂工人死因分析

目的 探索危害陶瓷工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,对景德镇3个瓷厂1972年到1974年在册且工作一年以上所有陶瓷工人建立队列,随访至2003年底.队列中对死者均查询死因,陶工尘肺由当地疾病控制中心诊断小组确诊,肺癌均收集医院诊断病例.以全国城市居民年龄别死亡率为参照计算标化死亡比(SMR).结果 队列成员共4957名,随访至2003年底,共计130 783.6人年,死亡1636人,死亡率为1250.9/10万,累计死亡率为33.1%.影响陶瓷工人寿命的主要疾病按累计死亡率从高到低排序分别是:恶性肿瘤、心血管疾病、呼吸系统疾病、传染性疾病.与全国平均水平比较,陶瓷工人全死因死亡率基本持平,标化死亡比为1.01,死亡率明显升高的疾病有呼吸系统疾病(SMR=1.30)、陶工尘肺(SMR=36.35)、传染性疾病(SMR=5.08)和肺结核(SMR=4.06).陶瓷粉尘对工人寿命的影响十分明显,接尘工人多种疾病的死亡率均高于非接尘组,除陶工尘肺外,接尘组肺癌(RR=1.9,95%CI:1.2～3.1)、呼吸系统疾病(RR=2.4,95%CI:1.8～3.2)、肺结核(RR=1.6,95%CI:1.2～2.1)明显高于非接尘组,差异有统计学意义.研究还发现全死因、肠癌、肺癌、呼吸系统疾病、肺结核危险度均随接尘严重程度而明显增加,呈现接触一反应关系.结论 陶瓷行业主要职业危害为粉尘,卫生工作重点应是控尘和预防肺结核.

Death Cause Analysis of Dust-exposed Workers in Jingdezhen Porcelain Factories

Objective To investigate the death causes of Jingdezhen porcelain workers and to explore the impact of occupational hazards on life span of workers.Methods Cohort study was conducted.All subjects employed from 1972 to 1974 and worked at least one year at three porcelain factories in Jingdezhen were selected as the cohort.Standardized mortality ratio(SMR)was calculated for the main death causes using Chinese national mortality rates as the reference.Results All 4957 workers were followed up to the end of 2003 with an accumulation of 130 783.6 person-years,1636 deaths were revealed.The cumulative mortality was 33.1%.The results showed that tumor,cardio-vascular diseases,respiratory diseases,infectious diseases were main illnesses threatening workers' life span.The standardized mortality ratio for all subjects was 1.01 which was close to the expected rates based on the China national mortality rates.Statistical significant excessivenesses were observed in respiratory diseases,pneumoconiosis,infectious diseases and pulmonary tuberculosis,SMRs were 1.30,36.35,5.08 and 4.06 respectively.Increased mortality was observed among 2974 dust-exposed workers in the cohort.Dust exposure showed significant impact on life span.In those dust exposed workers,the mortalities from lung cancer,non-malignant respiratory diseases,and pulmonary tuberculosis increased significantly in comparison with those unexposed workers,RRs were 1.9(1.2~3.1),2.4(1.8~3.2),and 1.6(1.2~2.1)respectively.The exposure-response relationships between cumulative dust exposure level and mortalities from all causes including colorectal cancer,lung cancer,respiratory diseases,and pulmonary tuberculosis were observed.Conclusions The findings indicate that dust is the main occupational hazard in porcelain industry.To control dust level and prevent pulmonary tuberculosis are key works in public health.