青海省2015—2019年职业性尘肺病现况与疾病负担

Status quo and disease burden of occupational pneumoconiosis in Qinghai Province from 2015 to 2019

[背景]职业性尘肺病是我国,同时也是青海省最主要的职业病,采用伤残调整寿命年(DALY)和经济损失评估疾病负担,具有较强的公共卫生学意义。[目的]评估青海省职业性尘肺病所致疾病负担,为尘肺病防治策略的制定和实施提供依据。[方法]基于职业性尘肺病诊断资料,建立青海省历年确诊并报告的职业性尘肺病数据库。采用现场走访、电话调查、匹配检索人口死亡信息登记管理系统以及向其他部门协查等多种方式,随访和回顾性调查2015—2019年职业性尘肺病患者存活状况和死亡日期等信息。采用全球疾病负担2019(GBD 2019)的方法,以DALY为指标,评估2015—2019年青海省职业性尘肺病所致寿命损失。以2019年在青海省某医院住院时主要诊断为尘肺病且同时为职业病诊断机构已确诊的职业性尘肺病患者为研究对象,以住院产生的总费用为指标评估直接经济损失;采用人力资本法测算2019年青海省职业性尘肺病所致间接经济损失。[结果]青海省2015—2019年新诊断职业性尘肺病报告病例505例,死亡348例;该阶段现患病例数、伤残所致寿命年损失(YLD)呈增长现象,DALY、早死所致寿命年损失(YLL)呈先降后升现象;其间,各年份87%以上的DALY、YLL、YLD均源于矽肺和煤工尘肺。2019年职业性尘肺病所致DALY为2173.55人年;42例住院尘肺病患者住院总费用为1256345.19元,贰、叁期尘肺病患者的个人住院总费用和日均费用均高于壹期患者(P<0.05),60岁及以上尘肺病患者的个人住院总费用高于60岁以下者(P<0.05);2019年青海省尘肺病所致间接经济损失为44108581.65元,占全省当年国内生产总值(GDP)的0.15‰。[结论]青海省尘肺病疾病负担较重,以矽肺和煤工尘肺为主要病种。应进一步加大粉尘危害治理和控制,督促用人单位全面落实职业病防治责任,做好职业性尘肺病患者的随访和康复管理,预防尘肺病发生和病情进展,以减轻尘肺病负担。

[Background]Occupational pneumoconiosis is the most common occupational disease in Qinghai Province and China.From the perspective of public health,it is important to assess the disease burden using disability-adjusted life years(DALY)and economic losses.[Objective]To evaluate the disease burden of occupational pneumoconiosis in Qinghai Province,and to provide a basis for the formulation and implementation of relevant prevention and control strategies.[Methods]Based on the registered data,a database of occupational pneumoconiosis cases confirmed and reported in Qinghai Province was established.The survival status and death date of occupational pneumoconiosis patients from 2015 to 2019 were confirmed by on-site visit,telephone survey,matching search of Death Information Registration and Management System,and consulting other departments.The life loss due to occupational pneumoconiosis in Qinghai Province from 2015 to 2019 was assessed using DALY as an indicator and data from the Global Burden of Disease 2019(GBD 2019)study.Inpatients with officially diagnosed occupational pneumoconiosis from a hospital in Qinghai Province in 2019 were selected as study subjects,the direct economic loss was evaluated with hospitalization expenses,and the indirect economic loss due to occupational pneumoconiosis in Qinghai Province in 2019 was calculated by human capital approach.[Results]From 2015 to 2019,505 new cases of occupational pneumoconiosis were reported in Qinghai Province,and there were 348 death cases.Prevalent cases and years lost due to disability(YLD)due to occupational pneumoconiosis were increased,while DALY and years of life lost(YLL)due to occupational pneumoconiosis decreased firstly and then increased.In each year,there were more than 87%of the DALY,YLL,or YLD attributed to silicosis and coal workers'pneumoconiosis.In 2019,the occupational pneumoconiosis-associated DALY was 2173.55 person years.The total hospitalization expense incurred by 42 inpatients with occupational pneumoconiosis was 1256345.19 yuan.The individual total hospitalization expense and average daily cost of the inpatients with stageⅡandⅢpneumoconiosis were higher than that of the inpatients with stageⅠ(P<0.05),and the individual total hospitalization expense was higher in the≥60 years age group than in the<60 years age group(P<0.05).In 2019,the indirect economic loss incurred by occupational pneumoconiosis in Qinghai Province was 44108581.65 yuan,and accounted for 0.15‰of the gross domestic product(GDP)of the province.[Conclusion]The disease burden associated with occupational pneumoconiosis in Qinghai Province are outstanding.Silicosis and coal workers'pneumoconiosis are the key contributors.Targeted intervention measures including dust hazard control,enterprise management,follow-up and rehabilitation management of pneumoconiosis should be taken to prevent and control the occurrence and progression of pneumoconiosis and alleviate disease burden of pneumoconiosis.