基于限制性立方样条模型分析某大型钢厂工人粉尘累积暴露量和高血压关联性研究

Association of cumulative dust exposure with hypertension among workers in a large steel mill:an analysis with restricted cubic spline model

目的分析钢铁工人粉尘累积暴露量和人群高血压之间的关系。方法收集某钢铁集团生产部门2017年2月到6月间和2018年3月到7月间进行职业健康体检的7660名工人基本信息、血压、职业史信息,检测作业场所粉尘暴露数据。使用限制性立方样条模型分析粉尘累积暴露量和高血压的剂量反应关系,基于模型结果对暴露量进行分组,通过logistic回归分析粉尘累积暴露量和工人高血压的关联性。结果调查共计7660名工人,其中男性7023人,女性637人;粉尘累积暴露量中位数26.15(mg/m^3·年);有64.70%的工人处于粉尘暴露环境。钢铁工人高血压的患病率为25.60%,性别、年龄、婚姻状态、文化程度、BMI、吸烟、饮酒、高血压家族史和粉尘累积暴露等因素都和工人高血压有关。粉尘累积暴露量和钢铁工人高血压间存在非线性剂量反应关系,根据样条模型分析结果分为<18.78(mg/m^3·年),18.78(mg/m^3·年)~,和≥58.74(mg/m^3·年)三组。在调整了可能的混杂因素后,粉尘累积暴露量≥58.74(mg/m^3·年)时钢铁工人高血压的患病风险是低剂量参照组的1.74(95%CI=1.28~2.36)倍。结论钢铁工人的高血压和多种影响因素有关,高粉尘累积暴露量组钢铁工人患病风险是低剂量参照组的1.74倍。

Objective To analyze the relationship between cumulative dust exposure(CDE)and hypertension among steel workers.Methods We conducted a survey among 7660 production workers(7023 males and 637 females)in a large steel mill during February–June 2017 and March–July 2018.The workers'information on demographics,occupation history,and blood pressure were collected when the workers had their routine physical examination.CDE values were estimated for all the workers based on workplace dust monitoring data.Restrictive cubic spline model was used to assess the dose-response relationship between CDE and hypertension;the correlation between CDE and hypertension was analyzed with logistic regression model.Results Of all the workers,64.70%had exposed to dust and the CDE median was 26.15 mg/m3·year for the exposed workers.The hypertension prevalence rate was 25.60%among the workers.Factors including gender,age,marital status,education level,body mass index(BMI),smoking,alcohol drinking,family hypertension history,and cumulative dust exposure were all related to hypertension among the workers.There was a nonlinear dose-response relationship between CDE and hypertension for the workers with various dust exposure at the CDE values of<18.78 mg/m^3·year,18.78 mg/m^3·year–,and≥58.74 mg/m^3·year based on restricted cubic spline model analysis.The workers with the CDE value of≥58.74 mg/m^3·year were at a significantly increased risk of hypertension(odds ratio=1.74,95%confidence interval:1.28–2.36)compared to those with the CDE value of<18.78 mg/m^3·year after adjusting for potential confounders.Conclusion Among steel workers,hypertension is related to a variety of factors and the workers with high occupational dust exposure have an increased hypertension risk compared to the workers with low occupational dust exposure.