台灣地區染料工人世代死亡率的追蹤情形, 1985-2009

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Title:	台灣地區染料工人世代死亡率的追蹤情形, 1985-2009 Mortality among dyestuff worker cohort in Taiwan, 1985-2009
Authors:	林佳瑩;Lin, Chia-Ying
Contributors:	公共衛生學系碩士班
Keywords:	染料聯苯胺;標準化死亡率危險比;dye;benzidine;standardized mortality ratio;hazard ratio
Date:	2012-07-30
Issue Date:	2012-08-31 16:28:38 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	背景：台灣地區在西元1950年引進染料製造的技術，而聯苯胺為早期染料製程中重要的中間體，廣泛存在於各種染料中；過去文獻指出於工作環境中暴露於聯苯胺的染料工人，其得到癌症危險性較一般人口高；美國環境保護署(EPA)及國際癌症研究中心(IARC)並將聯苯胺列為確定致癌物質；台灣地區於1992年全面禁止進口、製造以及使用，因此染料工人世代暴露於聯苯胺物質的工作環境中將近40年的時間，而目前國內流行病學研究尚無資料顯示於染料環境中作業其工人易因癌症死亡。目的：本研究分析台灣地區染料工人世代其後續死亡情形，並以全國人口、安全衛生人員做為對照組，藉此探討此世代工人暴露於製造染料的環境中，其後續死亡原因為何。研究方法：本研究採用回溯性世代分析法，觀察長期暴露於染料製作過程中工人，其後續死亡發生情況；研究共蒐集14,030名染料工人世代，26,986名安全衛生人員，與1985-2009年的死亡登記檔進行連結後，取得13,064名染料員工(男7,518人，女5,546人)與安全衛生人員26,951名(男22,458人，女4,493人)，並搜尋其死亡原因與職業上暴露作分析比對，以同期間之全國一般人口作為研究結果之參考族群，並依性別、年齡分層計算間接標準化死亡率(SMR, Standard Mortality Ratio)；後續將染料工人世代依工作年資、職業別暴露、聯苯胺禁用時間點、工廠類別分組，以邏輯思迴歸、存活分析作組內探討，並與職業安全衛生人員以性別、年齡配對，計算其死亡危險比。結果：染料工人世代死亡人數總計為750人，其全死因中在工作年資分組中，顯示工作年資小於一年組其死亡率較全國人口高 (SMR=1.25, 95% CI= 1.14-1.37)，隨著工作年資的提高，5-9年組發現死亡率較全國人口低(SMR=0.64, 95% CI= 0.50-0.80)；於死因分類全癌症中，總人數為196人，發現各分組中死亡率與全國人口相比，死亡率皆較低；於死因分類傷害、中毒和其他外因造成的特定影響，人數為190人，其風險為全國人口的1.16倍 (95% CI= 1.00-1.34)；另以工作年資、職業別作組內分層分析，發現工作年資小於一年組死亡率較其他工作年資分組高，高暴露組亦較低、中暴露組高；而與職業安全衛生人員進行比較，染料工人亦有較高死亡風險。結論：研究結果發現染料工人世代在工作年資小於一年組別死亡率較高，而染料工人世代平均年資僅2.6年，導致較為急性的死因類別死亡率較高，而染料行業流動性較高，易有健康工人效應的現象產生，而本研究以職位類別作為職業暴露分組依據，易有分組錯誤的情況發生，建議應以現場實際暴露濃度建立暴露指標。 Background: The technology of dye manufacturing was first introduced into Taiwan in the 1950s. Benzidine served as an important intermediate early on during dye process, so it have been often found in dyes. Recent studies have shown that dyestuff workers’ exposure to benzidine may increase cancer incidence. US Environmental Protection Agency (EPA) and International Agency for Research on Cancer (IARC) further regarded benzidine as a carcinogen to humans. In Taiwan, benzidine was banned from import, manufacturing and utilization starting in 1992, suggesting that the dyestuff workers were exposed to benzidine-related substances for as long as 40 years. However, the epidemiological evidence that mortality in dyestuff workers are partly caused by cancer is still lacking in Taiwan. Aims: This study investigates a cohort of dyestuff workers and examines the mortality of these dyestuff workers. Using the Taiwan population and occupational safety and hygiene officer separately as control groups, we also aim to investigate the possible causes of mortality in these dyestuff workers death reasons. Method: This study used retrospective cohort study design to investigate the causes of mortality in dyestuff workers. After linking dyestuff worker and occupational safety and hygiene officer registry data with the mortality data of 1985-2009 from Department of Health, a total of 13,064 dyestuff worker (male 7,518, female 5,546) and 26,951 occupational safety and hygiene officer (male 22,458, female 4,493) were selected to serve as control groups for our cohort. Using general population as the reference population, standardized mortality rate was indirectly calculated using gender and age stratification (SMR, Standard Mortality Ratio). Intra-group comparisons within the dyestuff worker were subsequently performed according to seniority, type of factory, job title, before and after 1992 (year of benzidine ban). Using logistic regression model and Cox proportional hazard models, we analyzed the risk of death with covariates included. Lastly, hazard ratios for mortality in dyestuff workers after matching with occupational safety and hygiene officer (by gender and age) were computed and assessed. Results: There was a total 750 deaths observed among the dyestuff workers. Deaths from all causes were observed statistically significant in group with work seniority less than a year (SMR=1.25, 95% CI= 1.14-1.37) analysis based on Taiwan rates. With the increase in work seniority, 5-9 years group had significant lower mortality rate from all causes (SMR=0.64, 95% CI= 0.50-0.80). A total of 196 of these deaths were from cancer. In the work seniority groups, significantly lower mortality was consistently observed. A total of 190 of these deaths were from injury, poisoning and certain other consequences of external causes, and there were significant excesses of mortality (SMR=1.16, 95% CI= 1.00-1.34). Further stratification according to seniority, job title, observed that work seniority less than a year group compared with other working group, the mortality was higher, and that of high exposure group was also higher than other exposure groups. Comparing with occupational safety and hygiene officers, dyestuff workers were observed to have a higher risk of death. Conclusion: The study results showed that work seniority of less than a year group has a higher mortality rate while the mean work seniority averaged only 2.6 years, resulting in higher mortality rates of more acute causes of death categories. Dyestuff workers have high mobility in Taiwan, so it is possible that healthy worker effect exerted an influence on the results. In this study, the exposure groups were categorized based on job title, which is prone to selection bias. In the future studies, we suggest there should be actual measurements of exposure concentrations to affirm exposure levels.
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