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研究生:龔真儀
研究生(外文):KUNG,CHEN-YI
論文名稱:肥料製造勞工癌症死因研究
論文名稱(外文):Cancer Mortality Study In Fertilizer Workers
指導教授:陳保中陳保中引用關係
指導教授(外文):CHEN,PAU-CHUNG
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2000
畢業學年度:88
語文別:中文
論文頁數:80
中文關鍵詞:肥料工人標準死亡比惡性腫瘤標準率比
外文關鍵詞:fertilizer workersstandardized mortality rationeoplasmsstandardized rate ratio
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肥料製造業始於日據時代,為重要民生工業之一。肥料製造勞工暴露於含氮非致癌物質之作業環境,已知含氮非致癌物質可在體內形成致癌物N-nitroso化合物,在硝酸鹽肥料工廠可發現其勞工唾液中含較高濃度的硝酸鹽,可能造成胃癌之危險性增加。台灣地區一年製造或使用約150萬噸硫酸,其中60%為肥料工廠所製造或使用,根據Sathiakumar等回顧相關研究,由於工作場所硫酸潛在對上呼吸道慢性與重複性的刺激,可能會造成喉癌的危險性增加,肺癌則少有明確依據。因此本研究使用回溯性世代研究法,進行肥料製造勞工癌症死因分析。
本研究選取台灣地區某一主要肥料公司,目前共有六家工廠;同時收集該公司員工勞工保險及公務人員保險資料,以建立肥料製造勞工世代。另外收集衛生署1985至1998年死因資料電腦檔、延遲申報死因資料電腦檔、財稅資料中心1980至1997年死因資料電腦檔、戶役政資料,以進行電腦化資料連結,扣除無身分證統一號碼者、工作年資未滿一年員工、1994年以後入廠以及漏失追蹤員工,共有男性6799人及女性624人進行分析。同時使用NIOSH PC LTAS軟體,進行癌症標準死亡比分析。此外,以未滿一年之工作期間對照組,進行死因標準率比之分析,探討癌症死因標準率比是否隨著工作期間增加有上升之趨勢。
男性肥料製造工人職業世代全死因及全癌症標準死亡比分別為0.71(95% CI=0.67-0.76)及0.78(95% CI=0.69-0.87);以各器官系統癌症區分,並無惡性腫瘤達到較高統計顯著意義。女性全死因及全癌症標準死亡比分別為0.72(95% CI=0.50-1.00)及1.37(95% CI=0.82-2.13);以各器官系統癌症區分,除卵巢、輸卵管及寬韌帶惡性腫瘤(僅有3位個案)有統計顯著較高的標準死亡比(SMR=7.98,95% CI=1.64-23.33)外,其他惡性腫瘤皆未有統計顯著較高的標準死亡比。以小於一年之工作期間為對照,依工作期間分層,進行癌症標準率比之分析,腦惡性腫瘤隨著工作期間增加其標準率比呈現顯著上升之意義(工作期間1-4年SRR=3.33、5-9年之SRR=7.58、10年以上之SRR=5.89)。
本研究現階段並無發現肥料製造工人全癌症死因有較高的危險性,而且亦無發現喉癌及肺癌有較高的標準死亡比。但對於具有顯著較高標準死亡比及隨著工作期間增加其標準率比呈現上升趨勢之癌症死因,卵巢、輸卵管及寬韌帶惡性腫瘤、腦惡性腫瘤等應予以長期追蹤,以進一步釐清其因果關係。
Fertilizer manufacturing was one of the most important industries in Taiwan. It has been confirmed that fertilizer workers who expose to high concentrations of nitrate at work are likely to have high concentration of nitrate in the saliva. It might cause an excess risk of stomach cancer. About 60﹪ of one and half million tons of sulfuric acid available in Taiwan annually is used to manufacture fertilizer. It has been indicated that there is moderate association between mist containing sulfuric acid (MSA) and laryngeal cancer, but little evidence in support of a relationship between the exposure of MSA and lung cancer. We used a retrospective cohort study design to analyze cancer mortality among fertilizer workers.
We selected employees at a major fertilizer company including 6 factories for this study. We obtained the employees’ insurance information from the Bureau of Labor Insurance and the Government Employees’ Insurance Department of Central Trust of China to establish the cohort of fertilizer workers. The cohort consisted of 6799 males and 624 females. Individuals exclusions were individuals with no identification numbers, employed after January 1, 1994, and with less than 1 year of employment. The 1985-1998 death registration data from the Department of Health, delayed death registration data from the Department of Health, 1980-1997 death registration data from the Ministry of Interior, and household registration system from the Ministry of Interior were linked. We used NIOSH PC LTAS program to analyze cancer standardized mortality ratios (SMRs). Besides, we observed cancer standardized rate ratios (SRRs) by the duration of employment using controls with employment of less than 1 year as reference.
Referring to general population, overall mortality for male workers was lower (SMR=0.71, 95% CI=0.67-0.76), so was the mortality from all cancers (SMR=0.78, 95% CI=0.69-0.87). The corresponding measurements for female workers were 0.72 (95% CI=0.50-1.00) and 1.37 (95% CI=0.82-2.13). A significant elevated mortality from ovarian cancers (3 cases, SMR=7.98, 95% CI=1.64-23.33) for female workers was revealed. Using individuals with employment of less than 1 year as reference, the SRR for death from brain cancer increased as the duration of employment increased.
In conclusion, no excess mortalities for this fertilizer work related cohort were found from all cancers, larynx cancer and nasopharyngeal cancer. The excess deaths from the ovarian cancer and brain cancer for this cohort deserves further investigation.
摘要
ABSTRACT
目錄
表列
壹、前言
貳、材料與方法
一、建立肥料製造工人職業世代
二、死因與存活資料之收集
三、統計分析
參、結果
一、肥料製造勞工職業世代描述
二、員工標準死亡比分析
三、不同工作期間(暴露長度)男性員工癌症死因標準率比之趨勢分析
四、不同工廠男性員工癌症標準死亡比分析
肆、討論
一、研究設計
二、分析結果
伍、結論
參考文獻
附錄一 各種肥料之製造簡圖
附錄二 某肥料公司各廠背景資
附錄三 台灣地區職業死因分類及NIOSH 99死因分類與國際死因分類(ICD)之關係
附錄四 按台灣地區職業死因分類肥料製造工人死因分布
附錄五 腦、胃、膀胱、氣管、支氣管及肺惡性腫瘤之潛在危險、保護因子
附錄六 肥料製造工人硫酸作業的暴露評估
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