2015—2022年南京市疑似职业性噪声聋发病特征及诊断情况分析

Analysis on the incidence and diagnosis of suspected occupational noise-induced deafness in Nanjing from 2015 to 2022

目的:分析南京市疑似职业性噪声聋病例的流行病学特征及后续诊断情况,为医疗机构报告疑似职业性噪声聋提供参考,也为行政部门制定预防控制措施、监督执法提供依据。方法:通过《中国疾病预防控制信息系统》收集2015—2022年南京市上报的疑似职业性噪声聋病例为研究对象,并比对2015-01-01/2023-03-31《职业病报告卡》的上报情况,对疑似职业性噪声聋病例及后续诊断情况进行统计分析。结果:2015—2022年南京市共报告疑似职业性噪声聋266例,基本呈逐年上升的趋势;以男性病例为主(93.98%);41~50岁年龄组及接害工龄≤15年的人群发病率高,占比分别为39.47%、70.68%;疑似病例信息主要来自职业健康检查机构(90.98%)、公立机构(51.88%);疑似病例申请诊断率为27.82%,不同年份间申请诊断率差异有统计学意义(P<0.05);不同经济类型企业间平均发病年龄、确诊率差异有统计学意义(P<0.05);不同规模企业间平均发病工龄、申请诊断率、确诊率差异均有统计学意义(P<0.05);不同行业的平均发病年龄、申请诊断率差异有统计学意义(P<0.05)。回归分析显示,企业规模、报告单位性质为影响疑似职业性噪声聋进一步诊断的独立因素。小微型企业、大型企业疑似职业性噪声聋病例未诊断率高于中型企业(OR为2.739、2.655,95%CI 1.278~5.868、1.197~5.887,P<0.05);民营职业健康检查机构报告的病例未诊断率高于公立职业健康检查机构(OR=2.066,95%CI 1.062~4.019,P<0.05)。结论:南京市的疑似职业病病例以疑似职业性噪声聋为主,发病受性别、年龄、接害工龄、行业分类、企业规模、经济类型等因素影响,疑似病例的申请诊断率、确诊率均较低,企业规模、报告单位性质为影响疑似职业性噪声聋进一步诊断的独立因素。建议大力加强《中华人民共和国职业病防治法》的宣传,明确用人单位的主体责任,及时安排疑似职业病病例进行职业病诊断;提高职业健康检查机构的技术服务水平,准确筛查疑似职业病;主管部门须进一步加强对重点人群、重点行业的监管。

Objective:To analyze the epidemiological characteristics and subsequent diagnosis of suspected occupational noise-induced deafness cases in Nanjing,and to provide reference for medical institutions to report suspected occupational noise-induced deafness,as well as for administrative departments to formulate prevention and control measures,supervision and law enforcement.Methods:The suspected cases of occupational noise-induced deafness reported in Nanjing from 2015 to 2022 were collected by the Chinese Disease Prevention and Control Information System as the research objects,and the suspected cases and subsequent diagnosis were statistically analyzed by comparing the reported cases in the Occupational Disease Report Card on 2015-01-01/2023-03-31.Results:From 2015 to 2022,266 cases suspected occupational noise-induced deafness were reported in Nanjing,which showed an increasing trend year by year.Most cases were male(93.98%);The incidence was higher in the age group of 41-50 years and the population with the age of exposure≤15 years,accounting for 39.47%and 70.68%,respectively;The suspected cases were mainly from occupational health institutions(90.98%)and public institutions(51.88%).The diagnosis application rate of suspected cases was 27.82%,and the difference between different years was statistically significant(P<0.05).There were statistically significant differences in the average age of onset and diagnosis rate among enterprises of different economic types(P<0.05);There were statistically significant differences in the average age of onset,diagnosis application rate and diagnosis rate among enterprises of different sizes(P<0.05);There were significant differences in average age of onset and diagnosis application rate among different industries(P<0.05).Regression analysis showed that the size of the enterprises and the nature of the occupational health inspection institutions were independent factors affecting the further diagnosis of suspected occupational noise-induced deafness.The undiagnosed rate of suspected occupational noise-induced deafness in small,micro and large enterprises was higher than that in medium-sized enterprises(OR was 2.739,2.655,95%CI 1.278-5.868,1.197-5.887,P<0.05).The undiagnosed rate reported by private occupational health inspection institutions was higher than that reported by public occupational health inspection institutions(OR=2.066,95%CI 1.062-4.019,P<0.05).Conclusion:The cases of suspected occupational diseases in Nanjing are mainly suspected occupational noise-induced deafness,and the incidence is affected by gender,age,age of exposure,classification of industry,enterprises scale,economic type factors.The diagnosis application rate and diagnosis rate of suspected cases are both low.The size of enterprise and the nature of reporting occupational health inspection institutions are independent factors affecting the further diagnosis of suspected occupational noise-induced deafness.It is suggested to strengthen the publicity of the Law of the People’s Republic of China on the Prevention and Treatment of Occupational Diseases,and make clear the main responsibility of employers.Timely arrange the diagnosis of occupational diseases for suspected cases of occupational diseases;Improve the technical service level of occupational health inspection institutions to accurately screen suspected occupational diseases;The competent authorities need to further strengthen the supervision of key groups and key industries.