南京市1956-2021年尘肺患者生存状况及疾病负担分析

Survival and disease burden of pneumoconiosis patients in Nanjing,1956-2021:a retrospective follow-up analysis

目的了解江苏省南京市1956—2021年尘肺患者的生存状况及可能的影响因素,进一步探究其疾病负担水平,为制定新时代尘肺防治措施提供科学依据。方法于2022年10月整群抽取江苏省职业病防治信息管理系统中1956年1月1日—2021年12月31日南京市上报的3456例尘肺确诊患者进行随访调查,采用寿命表法和Kaplan-Meier法进行生存分析,应用Cox比例风险回归模型对生存时间的相关因素进行分析,并采用伤残调整寿命年(DALY)、因早死造成健康生命年的损失(YLL)和因伤残造成的健康寿命年的损失(YLD)综合分析尘肺的疾病负担。结果南京市1956—2021年累计报告尘肺病例3333例,以男性(89.3%)、初次诊断分期为Ⅰ期(89.3%)、矽肺(72.1%)为主。生存分析结果显示,截至2021年12月31日,南京市尘肺患者中位数生存时间为30.20(95%CI=29.53~30.86)年。多因素Cox比例风险回归分析结果显示,诊断年龄≥30岁和初次诊断分期为Ⅲ期是南京市尘肺患者存活的危险因素,女性和制造业是南京市尘肺患者存活的保护因素。疾病负担分析结果显示,1956—2021年南京市尘肺共造成累计DALY损失27529.49人年,例均DALY损失8.26年;累计YLD损失23440.46人年,例均YLD损失7.03年;累计YLL损失4089.03人年,例均YLL损失2.53年。南京市1956—2021年因尘肺造成的例均YLD、例均YLL和例均DALY总体均呈下降趋势(χ_(趋势)^(2)=776.437、206.153和1040.571,均P<0.001),YLD和DALY在1991—2000年造成的损失最大,分别为10042.02人年和10619.59人年,YLL则随时间的推移逐渐变大,2011—2021年造成的损失最大为1956.35人年。结论南京市1956—2021年尘肺的防控形势整体可控,但造成的疾病负担不容忽视,建议相关部门加强对重点人群、重点病种及重点行业的防控。

Objective To examine the survival,disease burden and their associates among pneumoconiosis patients reported in Nanjing city during 1956-2021 for developing targeted measures on pneumoconiosis prevention and control.Methods The records of 3456 confirmed pneumoconiosis patients reported in Nanjing from 1956 through 2021 were extracted from the Information Management System for Occupational Disease Prevention and Control of Jiangsu Province and face-to-face or telephone interviews were conducted among the patients in October 2022 for a follow-up survey.Life table and the Kaplan-Meier methods were used in survival analysis,and Cox proportional hazard regression model was applied to analyze influencing factors of survival time.Disease burden of pneumoconiosis was assessed comprehensively using disability adjusted life years(DALY),years of life lost(YLL),and years lost due to disability(YLD).Results Of the 3333 patients with valid responses,89.3%were male;89.3%had stage I pneumoconiosis at the first diagnosis;and 72.1%were diagnosed as silicosis.The median survival time for all the patients up to December 31,was 30.20(95%confidence interval[95%CI]:29.53-30.86)years.The results of Cox proportional hazard regression analysis showed that aged≥30 years and having stage III pneumoconiosis at the first diagnosis were risk factors of low survival;while,being female and being engaged in manufacturing industry were protective factors of survival for the patients.In terms of disease burden caused by pneumoconiosis during the follow-up period for all the patients,the person-years of total cumulative DALY,YLD,and YLL were 27529.49,23440.46,and 4089.03 and the years of per capita DALY,YLD,and YLL were 8.26,7.03,and 2.53,respectively.Significantly declining trend over the follow-up period was observed in years period per capita DALY(χ^(2)_(trend)=776.437),YLD(χ^(2)_(trend)=206.153),and YLL(χ^(2)_(trend)=1040.571)(P<0.001 for all).The highest year period-specific YLD(10042.02 person-years)and DALY(10619.02 person-years)were observed in 1991-2000 but the year period-specific YLL increased gradually over the follow-up period,with the highest of 1956.35 person-years for the years from 2011 to 2021.Conclusion The prevalence of pneumoconiosis among workers in Nanjing city was generally under control during 1956-2021 but the disease burden caused by the occupational disease still needs to be concerned,especially among groups at higher risk of the disease.