高砷污染地区慢性砷中毒发病及死亡率不同民族比较研究

Comparative study on incidence of arseniasis and mortality among residents of different ethnics

目的探讨在一个多民族聚居的高砷污染地区中慢性砷中毒(以下简称慢砷)发病和居民死亡的民族分布特点。方法以2006年人口加上1985-2006年的死亡人数建立近似的1985-2006年人口队列,1991年调查的全部慢砷确诊病人(分重、中和轻症3组)为慢砷人群,其余为非慢砷人群。全队列与非慢砷人群内各民族各性别作各症状型慢砷发病(仅限全队列)和癌因及非癌因死亡的SIR或SMR分析,并进行性别和民族比较。截取1992-2004年为观察期,对慢砷病人和非慢砷人群作死因分析。结果男性各型慢砷发病以及两类死因的死亡均显著高于女性。两性各型慢砷发病和男性与非慢砷人群的非癌因死亡由高到低的民族排序为回、汉、布依、苗族;男性与非慢砷人群癌因死亡的排序则为汉、回、布依、苗族。男性慢砷病人中非黑色素瘤皮肤癌列癌因首位,粗死亡率达到128.66/105,在非慢砷人群中列次位,而在女性非慢砷人群中突出地列首位。男性慢砷病人的肺癌和喉癌死亡显著超高。结论妇女对重症型慢砷可能不太敏感。回族对慢砷的敏感性以及非癌因死亡领先于其他民族,但由于汉族对重症型慢砷的易感性显著高于其他民族,造成癌因死亡呈回汉族颠倒的现象。

Objective To analyze the ethnic distributive characteristics of prevalence of arseniasis and resident mortality in an area contaminated with arsenic,where multiple ethnic residents were living together.Methods A cohort was established with the proportion of population distribution of year 1985-2006 in the area and divided into arseniasis patients（registration of 1991 as severe,medium and mild skin lesion symptoms） and asymptomatic individuals.The standard incidence rate（SIR） of arseniasis was used for analysis of epidemiological characteristics.The standard mortality rates（SMR） of both categories of malignant and non-malignant death causation were also compared for arseniasis status,genders and ethnic groups for the period of 1992-2004.Results The SIR of arseniasis and the SMR of the two categories of death causation in male were significantly higher than those in female.The SIR of arseniasis and the SMR of non-malignant causation decreased in the order of ethnic group of Hui,Han Bouyei and Miao,while which of malignant causation decreased in the order of ethnic group of Han,Hui,Bouyei and Miao in male patients of arseniasis and asymptomatic individuals.Non-melanotic skin cancer was the most frequently observed death causation（the crude mortality rate was 128.66/105 person years） in male arseniasis patients and female asymptomatic population,and also the second most frequently one in general asymptomatic population.The mortality rate of lung cancer and larynx cancer were significantly higher in male patients.Conclusion Women might be less sensitive than their counterparts in arseniasis.The ethnic Hui and Han had higher SIR in arseniasis and SMR of malignant and non-malignant tumors.