某市职业人群噪声性听力损失的双向队列研究  

Amb ispective cohort study of noise-induced hearing loss among occupationally noise-exposed workers in a city

作　　者：邓永芳[1] 黄俊阳 冯简青[1] 王淑玉[1] 傅绍周[1] 刘浩中 刘可平 黄奕平[1] DENG Yongfang;HUANG Junyang;FENG Jianqing;WANG Shuyu;FU Shaozhou;LIU Haozhong;LIU Keping;HUANG Yiping(Zhongshan City Center for Disease Control and Prevention,Zhongshan,Guangdong 528403,China;Community Health Service Center of Zhongshan Torch Hi tech Industrial Development Zone,Zhongshan,Guangdong 528403,China)

机构地区：[1]中山市疾病预防控制中心,广东中山528403 [2]中山火炬高技术产业开发区社区卫生服务中心,广东中山528403

出　　处：《职业卫生与应急救援》2022年第6期645-649,共5页Occupational Health and Emergency Rescue

基　　金：中山市卫生和计划生育局医学科研项目(2018J171)。

摘　　要：目的了解某市职业人群噪声性听力损失情况及其影响因素,分析不同噪声接触声级的相对危险度、归因危险度。方法采用整群抽样方法,选择2010年1月1日—2016年12月31日进行职业健康体检的20家企业接触噪声的3580名作业工人为研究对象。2017年1月1日建立动态研究队列,观察终止时间为2019年12月31日。收集研究对象2017年之前的现场检测和体检数据,并开始观察对象2017年1月1日之后3年的听力损失情况,采用多因素Cox比例风险模型研究工人噪声性听力损失发生的影响因素。结果3580名工人中男性2849人,女性731人;平均年龄(39.42±7.69)岁;平均工龄(11.50±7.06)年。随访时间共计28585.65人年,发生噪声性听力损失91例,发病密度为0.0032/人年。随着接触噪声声级的增加,工人噪声性听力损失发病密度、相对危险度(RR)、归因危险度百分比(AR%)也随之增加。Cox比例风险模型的回归分析结果显示:女性发生听力损失的风险是男性的0.148倍;防护用品合适且全程佩戴工人发生听力损失的风险是不合适或不佩戴的0.407倍;年龄每增加1岁,工人发生听力损失的风险增加至1.074倍,三班制工人发生听力损失的风险是白班制的2.588倍;吸烟工人发生听力损失的风险是不吸烟工人的1.092倍;噪声接触声级>85 dB(A)工人发生听力损失的风险是噪声接触声级≤85 dB(A)工人的4.272~25.430倍(P均<0.05)。结论噪声接触声级增加是噪声性听力损失的危险因素,要加强高噪声接触企业的监管力度,重视企业工人防护用品的佩戴情况。Objective To understand the incidence and potential affecting factors of noise induced hearing loss(NIHL)among occupationally noise-exposed workers in a city.Methods Totally 3580 workers exposed to noise,who received occupational health examination during January 1,2010 to December 31,2016 in 20 enterprises,were selected by the cluster random sampling method to establish a cohort.The cohort was followed till the end of December 31,2019,with retrospective collection of previous physical examination data before 2016.The Cox proportional risk model was used to study the influencing factors of noise induced hearing loss of workers.Results Among 3580 workers,2849 were male and 731 were female with average age of(39.42±7.69)years and average service time of(11.50±7.06)years.The total follow-up time was 28585.65 person years,and 91 cases had noise induced hearing loss with incidence density of0.0032/person year.With the increase of noise exposure level,the incidence density,relative risk(RR)and attributable risk percentage(AR%)of NIHL of workers also increased.Regression analysis of Cox proportional risk model showed that the risk of NIHL in women was 0.148 times higher than that in men;the risk of NIHL of workers who used appropriate protective equipment all the time was 0.407 times that of those who did not use;the risk of NIHL increased to 1.074times with one year increment of age,and the risk of NIHL of workers with shifts was 2.588 times that of workers with regular day-shift;the risk of NIHL of smoking workers was 1.092 times that of non-smoking workers;the risk of NIHL of workers exposed to noise of sound level more than 85 dB(A)was 4.272-25.430 times that of workers exposed to noise with sound level lower than 85 dB(A)(P<0.05).Conclusions Higher noise exposure level was a risk factor of NIHL.It is necessary to strengthen the supervision of enterprises exposed to high-level noise,and pay attention to the wearing of protective equipment for workers in enterprises.

关 键 词：噪声性听力损失 噪声接触强度 COX分析 发病密度 

分 类 号：R135.8[医药卫生—劳动卫生]