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[石嘴山市1963年至2020年职业性尘肺病生存及疾病负担趋势分析]

[Survival and disease burden trend analysis of occupational pneumoconiosis from 1963 to 2020 in Shizuishan City].

作者信息

Tong Y, Kong Y Y, Bian H, Zheng J Z, Wu Y J, Zhang Y

机构信息

School of Public Health, Shanxi Medical University, Taiyuan 030000, China Shizuishan City Center for Disease Control and Prevention, Shizuishan 753000, China.

Shizuishan City Center for Disease Control and Prevention, Shizuishan 753000, China.

出版信息

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 May 20;40(5):341-347. doi: 10.3760/cma.j.cn121094-20210906-00439.

Abstract

To understand the survival status and its influencing factors of occupational pneumoconiosis patients in Shizuishan City, and to analyze the disease burden of occupational pneumoconiosis and its trend, so as to provide scientific basis for formulating comprehensive prevention and treatment measures of occupational pneumoconiosis. A retrospective survey was conducted during July to December 2020 to explore the survival status of occupational pneumoconiosis patients who had been reported from 1963 to 2020 in Shizuishan City. The Kaplan-Meier method and Life-table method were used for survival analysis, and Cox proportional hazards regression model was used to analyze the influencing factors of survival time. The disability adjusted life years (DALY) was applied to analyze the disease burden of occupational pneumoconiosis and its temporal trend. From 1963 to 2020, a total of 3263 cases of occupational pneumoconiosis were reported in Shizuishan City, of which 1467 died, so that the fatality rate was 44.96%. The median survival time was 26.71 years, average age of death was (70.55±10.92) years old. There were significant differences in the survival rates of occupational pneumoconiosis patients among different types, diagnosis age, exposure time, industry, initial diagnosis stage and whether upgraded (<0.05) . As the survival time increased, the survival rate of patients decreased gradually. When the survival time was ≥50 years, the cumulative survival rate of patients was 4.20%. Cox regression analysis suggested that the type of pneumoconiosis, industry, diagnosis age, exposure time, initial diagnosis stage and whether upgraded were the influencing factors for the survival time of patients with occupational pneumoconiosis (<0.05) . The total DALY attributable to occupational pneumoconiosis from 1963 to 2020 in Shizuishan City was 48026.65 person years, of which the years of life lost (YLL) was 15155.39 person years, and the average YLL was 10.33 years/person, and the years lost due to disability (YLD) was 32871.26 person years, and the average YLD was 10.07 years/person. The DALY attributed to coal worker's pneumoconiosis and silicosis were 39408.51 person years and 6565.02 person years, respectively, and they accounted for 82.06% and 13.67% of the total disease burden in Shizuishan City, respectively. The DALY caused by occupational pneumoconiosis in the age group of 40-49 years old and the first diagnosis of stage I occupational pneumoconiosis were higher, which were 20899.71 and 36231.97 person years, respectively. The average YLL and average YLD showed a volatility downtrend over time. The disease burden of occupational pneumoconiosis cannot be ignored in Shizuishan City, and timely targeted measures should be taken for key populations and key industries. It is recommended that life-cycle health management and hierarchical medical should be taken to improve the life quality of patients and prolong their lifes.

摘要

了解石嘴山市职业性尘肺病患者的生存状况及其影响因素,分析职业性尘肺病的疾病负担及其变化趋势,为制定职业性尘肺病综合防治措施提供科学依据。2020年7月至12月进行回顾性调查,以探究石嘴山市1963年至2020年报告的职业性尘肺病患者的生存状况。采用Kaplan-Meier法和寿命表法进行生存分析,采用Cox比例风险回归模型分析生存时间的影响因素。应用伤残调整生命年(DALY)分析职业性尘肺病的疾病负担及其时间趋势。1963年至2020年,石嘴山市共报告职业性尘肺病3263例,其中死亡1467例,病死率为44.96%。中位生存时间为26.71年,平均死亡年龄为(70.55±10.92)岁。不同类型、诊断年龄、接触时间、行业、初诊分期及是否晋级的职业性尘肺病患者生存率差异有统计学意义(<0.05)。随着生存时间延长,患者生存率逐渐下降。生存时间≥50年时,患者累积生存率为4.20%。Cox回归分析提示,尘肺病类型、行业、诊断年龄、接触时间、初诊分期及是否晋级是职业性尘肺病患者生存时间的影响因素(<0.05)。1963年至2020年石嘴山市职业性尘肺病所致DALY共48026.65人年,其中失能调整生命年(YLL)为15155.39人年,平均YLL为10.33年/人,伤残损失生命年(YLD)为32871.26人年,平均YLD为10.07年/人。煤工尘肺和矽肺所致DALY分别为39408.51人年和6565.02人年,分别占石嘴山市总疾病负担的82.06%和13.67%。40~49岁年龄组和职业性尘肺病Ⅰ期首次诊断所致DALY较高,分别为20899.71和36231.97人年。平均YLL和平均YLD随时间呈波动下降趋势。石嘴山市职业性尘肺病的疾病负担不容忽视,应针对重点人群和重点行业及时采取针对性措施。建议实施全生命周期健康管理和分级诊疗,以提高患者生活质量,延长患者寿命。

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