改水后10 ~ 16年饮水型地方性砷中毒病区居民恶性肿瘤死亡分析  

Analysis of cancer mortality in drinking-water-borne endemic arsenism areas 10 to 16 years after water-improvement

作　　者：尉红[1] 王正辉[1] 雷延庆[1] 李秉政[1] 李鹏飞[1] Wei Hong;Wang Zhenghui;Lei Yanqing;Li Bingzheng;Li Pengfei(Department of Kaschin-Beck,Fluoride and Arsenic Diseases,Shanxi Institute for Endemic Disease Prevention and Treatment,Linfen 041000,China)

机构地区：[1]山西省地方病防治研究所大骨节病地氟病地砷病研究室,临汾041000

出　　处：《中华地方病学杂志》2022年第1期21-26,共6页Chinese Journal of Endemiology

基　　金：山西省卫生计生委公共卫生专项科研课题(2018GW14)。

摘　　要：目的了解饮水型地方性砷中毒病区人群在改水后10~16年全死因与恶性肿瘤死亡情况,探讨改水对防治砷中毒远期危害的效果。方法2020年4月,在山西省应县和山阴县的饮水型地方性砷中毒病区,选择在2003年实施改水的病区村作为调查点,以调查点的常住居民作为砷暴露组,并选取非病区村居民作为对照组,调查分析两组人群在2013-2019年全死因与恶性肿瘤死亡情况。结果砷暴露组改水前水砷含量范围为0.060~0.345 mg/L,改水后水砷含量范围为0.00017~0.00360 mg/L。7年间,砷暴露组累计调查94128人年,对照组累计调查102086人年。砷暴露组累计全死因死亡828例,全死因粗死亡率为8.80‰,标准化死亡率为9.16‰;对照组累计全死因死亡637例,全死因粗死亡率为6.24‰,标准化死亡率为6.91‰,砷暴露组全死因粗死亡率高于对照组(χ^(2)=43.20,P<0.01)。恶性肿瘤死亡情况,砷暴露组218例死于恶性肿瘤,恶性肿瘤粗死亡率为231.60/10万,标准化死亡率为231.67/10万;对照组164例死于恶性肿瘤,恶性肿瘤粗死亡率为160.65/10万,标准化死亡率为175.97/10万,砷暴露组恶性肿瘤粗死亡率高于对照组(χ^(2)=12.69,P<0.01);两组人群恶性肿瘤死亡年龄中位数分别为72.0、68.5岁,差异无统计学意义(P>0.05)。砷暴露组男性恶性肿瘤粗死亡率为317.16/10万,高于对照组男性(198.91/10万,χ^(2)=14.21,P<0.01);砷暴露组女性恶性肿瘤粗死亡率为134.10/10万,与对照组女性(118.03/10万)比较差异无统计学意义(P>0.05)。砷暴露组和对照组恶性肿瘤粗死亡率最高的均是肺癌,分别为115.80/10万、69.55/10万,砷暴露组肺癌、胃癌、膀胱癌的粗死亡率均高于对照组(χ^(2)=11.43、4.33、5.05,P<0.01或<0.05),而其他恶性肿瘤粗死亡率两组间比较差异均无统计学意义(P均>0.05)。结论单纯采取改水措施不能阻断砷的远期健康损害,尤其是砷的致癌效应,终止砷暴露后数十年的健康�Objective To understand all causes mortality and cancer mortality of residents in drinking-water-borne endemic arsenism areas 10 to 16 years after water-improvement,and to evaluate the effects of water-improvement on prevention and treatment of the long-term harm of arsenic poisoning.Methods In April 2020,in drinking-water-borne endemic arsenism areas of Ying County and Shanyin County,Shanxi Province,the diseased villages where water-improvement was carried out in 2003 were selected,and the permanent residents of the survey sites were selected as arsenic-exposure group.The residents in non-diseased villages were selected as control group.All causes and cancer deaths from 2013 to 2019 of the two groups were investigated and analyzed.Results In arsenic-exposure group,the range of arsenic concentration in drinking water before water-improvement was 0.060 to 0.345 mg/L,and that after water-improvement was 0.00017 to 0.00360 mg/L.During the 7 years,a total of 94128 person years were investigated in arsenic-exposure group and 102086 person years in control group.There were 828 deaths from all causes in arsenic-exposure group,with a crude mortality rate of all causes of 8.80‰and a standardized mortality rate of 9.16‰.There were 637 deaths from all causes in control group,with a crude mortality rate of all causes of 6.24‰and a standardized mortality rate of 6.91‰.The crude mortality rate of all causes in arsenic-exposure group was higher than that in control group(χ^(2)=43.20,P<0.01).Totally 218 deaths from cancer were reported in arsenic-exposure group,with a cancer crude mortality rate of 231.60/100000 and a standardized mortality rate of 231.67/100000.Totally 164 deaths from cancer were reported in control group,with a cancer crude mortality rate of 160.65/100000 and a standardized mortality rate of 175.97/100000.The cancer crude mortality rate in arsenic-exposure group was higher than that in control group(χ^(2)=12.69,P<0.01).The median age of cancer deaths in the two groups was 72.0 and 68.5 years,respecti

关 键 词：砷 恶性肿瘤 死亡率 

分 类 号：R599.1[医药卫生—内科学] R73-31[医药卫生—临床医学]