Bielefeld University, School of Public Health, Department Environment & Health, Bielefeld, Germany; University Hospital Munich, WHO Collaborating Centre for Occupational Health, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Unit Paediatric Environmental Epidemiology, Munich, Germany; Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Computer Science and Technology, Hall in Tirol, Austria.
Bielefeld University, School of Public Health, Department Environment & Health, Bielefeld, Germany; German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
Ann Glob Health. 2017 Mar-Apr;83(2):234-247. doi: 10.1016/j.aogh.2016.12.005.
Artisanal small-scale gold mining (ASGM) is the world's largest anthropogenic source of mercury emission. Gold miners are highly exposed to metallic mercury and suffer occupational mercury intoxication. The global disease burden as a result of this exposure is largely unknown because the informal character of ASGM restricts the availability of reliable data.
To estimate the prevalence of occupational mercury intoxication and the disability-adjusted life years (DALYs) attributable to chronic metallic mercury vapor intoxication (CMMVI) among ASGM gold miners globally and in selected countries.
Estimates of the number of artisanal small-scale gold (ASG) miners were extracted from reviews supplemented by a literature search. Prevalence of moderate CMMVI among miners was determined by compiling a dataset of available studies that assessed frequency of intoxication in gold miners using a standardized diagnostic tool and biomonitoring data on mercury in urine. Severe cases of CMMVI were not included because it was assumed that these persons can no longer be employed as miners. Cases in workers' families and communities were not considered. Years lived with disability as a result of CMMVI among ASG miners were quantified by multiplying the number of prevalent cases of CMMVI by the appropriate disability weight. No deaths are expected to result from CMMVI and therefore years of life lost were not calculated. Disease burden was calculated by multiplying the prevalence rate with the number of miners for each country and the disability weight. Sensitivity analyses were performed using different assumptions on the number of miners and the intoxication prevalence rate.
Globally, 14-19 million workers are employed as ASG miners. Based on human biomonitoring data, between 25% and 33% of these miners-3.3-6.5 million miners globally-suffer from moderate CMMVI. The resulting global burden of disease is estimated to range from 1.22 (uncertainty interval [UI] 0.87-1.61) to 2.39 (UI 1.69-3.14) million DALYs.
This study presents the first global and country-based estimates of disease burden caused by mercury intoxication in ASGM. Data availability and quality limit the results, and the total disease burden is likely undercounted. Despite these limitations, the data clearly indicate that mercury intoxication in ASG miners is a major, largely neglected global health problem.
手工和小规模采金（ASGM）是世界上人为汞排放的最大来源。金矿工人高度接触金属汞，患有职业性汞中毒。由于 ASGM 的非正规性质限制了可靠数据的可用性，因此，由于这种接触而导致的全球疾病负担在很大程度上是未知的。
估计全球范围内以及在选定国家中，手工和小规模采金金矿工人职业性汞中毒的患病率以及归因于慢性金属汞蒸气中毒（CMMVI）的残疾调整生命年（DALYs）。
从综述中提取手工和小规模采金（ASG）矿工的数量估计值，并通过文献检索进行补充。使用标准化诊断工具评估矿工中毒频率并结合尿液中汞的生物监测数据来编制数据集，以确定矿工中中度 CMMVI 的患病率。未包括严重的 CMMVI 病例，因为假设这些人不再能够作为矿工就业。未考虑工人家庭和社区中的病例。通过将 CMMVI 病例的数量乘以适当的残疾权重，量化 ASG 矿工因 CMMVI 导致的残疾生命年。预计不会因 CMMVI 而导致死亡，因此不计算生命损失年。通过将患病率乘以每个国家的矿工数量和残疾权重来计算疾病负担。使用矿工数量和中毒患病率的不同假设进行了敏感性分析。
全球范围内，约有 1400 万至 1900 万人从事 ASG 采金工作。根据人体生物监测数据，全球约有 330 万至 650 万矿工（占这些矿工的 25%至 33%）患有中度 CMMVI。估计由此产生的全球疾病负担范围在 122（不确定区间[UI] 0.87-1.61）至 239（UI 1.69-3.14）百万残疾调整生命年之间。
本研究首次提供了全球和国家范围内手工和小规模采金汞中毒引起的疾病负担估计。数据的可用性和质量限制了结果，总疾病负担可能被低估。尽管存在这些限制，但数据清楚地表明，ASG 矿工的汞中毒是一个主要的、在很大程度上被忽视的全球健康问题。
