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研究生：	鄭夢婷 Cheng, Meng-Ting
論文名稱：	電磁波敏感症之盛行率及其相關因素之探討 The prevalence and related factors of electromagnetic hypersensitivity
指導教授：	郭浩然教授 Guo, How-Ran
學位類別：	碩士 Master
系所名稱：	醫學院 - 環境醫學研究所 Department of Environmental and Occupational Health
論文出版年：	2014
畢業學年度：	102
語文別：	英文
論文頁數：	60
中文關鍵詞：	電磁場、數位隨機撥號、電磁波敏感症、自我報告、盛行率
外文關鍵詞：	electromagnet field, random digit dialing, electromagnetic hypersensitivity, self-report, prevalence
相關次數：	點閱：132 下載：3
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背景: 隨著科技發展，人們普遍使用電子設備和電器產品皆提高生活品質，導致電磁場暴露無所不在，其來源包括家用電器、無線電通訊系統、高壓電線等。因暴露來源廣泛，人們對此科技在健康上影響深切關注。目前世界各國的研究，已經發現到有一群人遭受電磁波暴露源影響且擁有非特異性症狀，他們被稱為電磁波敏感症患者。根據世界衛生組織定義，電磁波敏感症患者主要特徵是具有各種非特異性症狀(皮膚發紅和刺痛、頭暈、精神難以集中等)，且將這些症狀歸因於電磁波暴露所造成。近期，透過Hallberg 和 Oberfeld的研究，預測未來各國電磁波敏感症盛行率將持續上升，而在2007年調查結果，台灣電磁波敏感症盛行率已是世界上最高的國家之一。另外，根據國外研究指出，在這些醫療上不能解釋的疾病(電磁波敏感症、病態建築症候群、慢性疲勞症候群等)，治療症狀的醫療花費並無妥善運用，所以我們必須持續關注電磁波敏感症相關議題，儘早釐清致病的相關因素，以減少醫療資源的浪費。因此，本篇研究目的在於估評目前臺灣電磁波敏感症盛行率和電磁場相關認知，將調查結果與2007年的研究結果進行比較，並探討各國研究中影響盛行率的相關因素。

材料方法: 本研究採橫斷型研究設計，參照2007年研究方法使用電腦輔助電話系統之隨機撥號法，進行臺灣全國的電話訪問調查，並計算出目前盛行率分布情形、整理出影響電磁波敏感者可能的暴露來源。此外，運用系統性文獻回顧方式，彙整出影響盛行率之相關因素。統計分析中，使用17.0版SPSS執行t檢定、卡方檢定和邏輯斯回歸分析評估敏感者和非敏感者人口學變項的差異，並以2.0版MIX進行統合分析以探討影響盛行率之相關因素。

結果: 電話訪問結果顯示不論未經加權的資料或經過加權後的分析，在電磁波敏感者和非敏感者的人口學變項中，其年齡、性別、教育程度、受雇狀況和健康相關認知的差異，皆沒有達統計上顯著意義；只有日常生活受限制的部分，未經加權和加權後的分析中，勝算比分別2.44(95%CI:1.66-3.59)、2.38(95%CI:1.60-3.53)，達統計上顯著意義(P<0.001)。本研究中，依性別、年齡加權後，推估出2012年臺灣電磁波敏感症盛行率為4.6%(95% CI:3.9-5.4)，手機(23.5%)為敏感者最常見的電磁波來源波來源過敏，其次是基地台(21.5%)和電塔(9.4%)。經由比較後發現，2007年研究中電磁波敏感症的盛行率男性高於女性(14.0對比12.6%)，教育程度則是以高中分部居多；然而，本篇研究中，電磁波敏感症盛行率則是女性高於男性(5.1對比4.2%)，教育程度以大學以上居多。為了評估不同年代中，性別上的風險差異，本研究採用同質性檢定後未達統計上顯著差異(P = 0.15)，因此採用共同的風險值(OR=1.05, 95%CI: 0.83-1.31)；而年齡(中年人)分層比較的盛行率較類似。回顧的13篇期刊研究論文和2篇政府組織報告中，在2009年以前，各國盛行率有持續上升的趨勢；但是在2009以後，台灣、瑞典、和荷蘭的電磁波敏感症盛行率有下降的情形出現。此外，彙整各國研究發現女性、中年人(35-50歲)、高教育程度(大學以上)、單身或是獨居、皆是影響盛行率的可能相關因素。

結論: 經過一段調查時間後，臺灣電磁波敏感症盛行率有顯著下降的情形，此結果與瑞典和荷蘭的研究一致。透過文獻回顧，我們發現女性、中年、高教育程度、單身或是獨居，是電磁波敏感症可能的影響因素。此外，納入的文獻中，可能因國情或是方法學上的差異使分析資料存在異質性，因此解釋統合分析結果時應謹慎。

Background: Because of advances in science and technology, electronic equipment and products are being widely used to improve the quality of life. Consequently, electromagnetic field (EMF) is all over our environment, and the sources include household appliances, radio communication systems, and high voltage power lines, among others. Due to the wide range of sources, many people are concerned about exposure to EMF and its potential effects on health. Studies all over the world have found some people who suffer effect from EMF exposures and have non-specific symptoms. They are called to have “electromagnetic hypersensitivity” (EHS). According to World Health Organization (WHO), EHS is characterized by a variety of non-specific symptoms (redness and tingling on skin, fatigue, concentration difficulties, etc.) which afflicted individuals attribute to exposure to EMF. A study by Hallberg and Oberfeld predicted that the prevalence of EHS would increase all over the world. According to a Taiwan study in 2007, the prevalence of EHS (13.3%) was among the highest in the world. Studies have shown that the medical costs on these medically unexplained diseases (MUD) such as EHS, sick building syndrome and chronic fatigue syndrome were not properly used. Therefore, we need to pay attention to related issues of EHS and clarify the etiology and related factors, so that the waste in medical expenditure can be minimized. This study aimed to assess the changes in the prevalence of EHS in comparison with the 2007 study and to evaluate the factors related to the prevalence all over the world.

Methods: This is a cross-sectional study that adopts the same methods used in the 2007 study, which was a computer aided telephone interview that used random digit dialing telephone survey evaluating the prevalence of EHS in Taiwan. In addition, we systematically reviewed the published literature to identify factors related to EHS. We performed t -test, chi-square test, and logistic regression using SPSS 17.0 software to evaluate the differences in demographic variables between EHS and Non-EHS participants and used Mix 2.0 to perform meta-analyses of the literature.

Results: In the telephone survey, both the crude data and the weighted data showed no statistically significant differences in age, gender, education, and employment status between the EHS and Non-EHS groups. The only significant variables was restriction of daily activities, the odds ratios associated with EHS was 2.44 (95% confidence interval [CI]: 1.66-3.59) from crude data and 2.38 (1.60-3.53) from weighted data (P < 0.001).The prevalence weighted according to gender and age was 4.6% (3.9%-5.4%). The most commonly reported EMF source was mobile phone (23.5%), followed by base station (21.5%) and power line tower (9.4%). In the 2007 study, the prevalence of EHS was higher in men (14.0% vs. 12.6%) and in participants at the education level of high school, but in the current study the prevalence was higher in women (5.1% vs. 4.1%) and in participants with higher education (college and above). In order to estimate the risk difference between the two genders in different years, we used the test of homogeneity of the odds ratio and found no statistically significant differences (P = 0.15). Hence, we obtained common odds ratio of 1.05 (95%CI: 0.83-1.31). The two studies observed similar distributions of prevalence in the middle aged participants. In the 13 journal articles and 2 governmental reports included in the meta-analyses, the prevalence of EHS had an increasing trend by 2009, but decreased in Taiwan, Sweden, and Netherlands afterwards. In addition, female gender, middle-age, higher education, and single or widowed marital status were found to be risk factors.

Conclusions: The prevalence of EHS in Taiwan decreased since 2007, and this is consistent with the trends observed in Sweden and Netherlands. The risk factors for EHS include female gender, middle-age, higher education, and single or widowed marital status. However, high levels of heterogeneity were observed among studies, probably due to the differences in the general condition of the nations or research methods. Therefore, interpretation of the results of meta-analyses should be conservative.

Table of contents
中文摘要 I
Abstract III
Acknowledgement V
Table of contents VI
List of tables VIII
List of figures IX
List of appendixes X
Chapter 1 Introduction 1
1.1 Background 1
1.2 Objectives 2
Chapter 2 Review of literature 3
2.1  The definition of electromagnetic field 3
2.2  Health impact of electromagnetic field 4
2.2.1 Allergic reactions 4
2.2.2 Definition of electromagnetic hypersensitivity 4
2.2.3 Medically unexplained illnesses 5
2.2.4 Fact or fiction 5
2.3  The study of epidemiology on electromagnetic hypersensitivity 6
2.3.1 Provocation study 6
2.3.1.1 Skin redness, itching or throbbing 6
2.3.1.2 Heart rate, blood pressure, and heart variability 7
2.3.1.3 Sleep disorders 7
2.3.2 The prevalence of electromagnetic hypersensitivity in each county 7
2.3.3 The main source of exposure 7
Chapter 3 Materials and methods 9
3.1 Study design and structure 9
3.2 Source of participants and selection criteria 9
3.2.1 Study population 9
3.2.2 Questionnaire 9
3.2.3 Study process 10
3.3 Representative sample test 11
3.4 Systematic review 11
3.4.1 Literature search strategy 11
3.4.2 Criteria for inclusion and exclusion 11
3.4.3 Data extraction and analyses 12
3.5 Statistical analysis 12
Chapter 4 Results 13
4.1 Demographic characteristics and health status 13
4.1.1 Sources of exposure related to electromagnetic hypersensitivity 13
4.1.2 The prevalence of electromagnetic hypersensitivity in Taiwan 14
4.2 The results of the systematic review and meta-analyses 14
4.2.1 The prevalence of electromagnetic hypersensitivity worldwide 15
4.2.2 Study characteristics 15
4.2.2.1 Sample size 15
4.2.2.2 Published research in other countries 15
4.3 The effects of possible risk factors 15
4.3.1 Gender 15
4.3.2 Age 16
4.3.3 Education level 16
4.3.4 Marital-status 16
Chapter 5 Discussions 18
5.1 Strengths and limitations 18
5.2 The prevalence of electromagnetic hypersensitivity in each country 19
5.3 Demographic variables 20
5.4 Possible etiology of electromagnetic hypersensitivity 20
Chapter 6 Conclusions 22
References 23

List of tables
Table 1 The results of telephone survey 30
Table 2 The goodness of fit test on general characteristics of the 2012 survey compared to the 2011 Taiwanese population 31
Table 3 The weighted values of sample for gender and age 32
Table 4 The goodness of fit test for weighted data 33
Table 5 Crude data on demographic characteristics by electromagnetic hypersensitivity 34
Table 6 Weighted data on demographic variables by electromagnetic hypersensitivity 35
Table 7 Crude prevalence of electromagnetic hypersensitivity reported 36
Table 8 Weighted prevalence of electromagnetic hypersensitivity reported 37
Table 9 Test of homogeneity of the odds ratio on gender 38
Table 10  Studies on prevalence (%) of electromagnetic hypersensitivity 39

List of figures

Figure 1 Frequencies of electromagnetic fields 43
Figure 2 The prevalence (%) of people around the world who consider themselves to be electromagnetic hypersensitivity, plotted over time in a normal distribution graph 44
Figure 3 The major exposure sources of electromagnetic reported by people with electromagnetic hypersensitivity 45
Figure 4 Study design and structure 46
Figure 5 Exposure sources most commonly linked to electromagnetic 47
Figure 6 Flow chart of the study selection process 48
Figure 7 The comparison of prevalence of electromagnetic hypersensitivity in each country 49
Figure 8 Prevalence of electromagnetic hypersensitivity by gender 50
Figure 9 Forest plot of random effect meta-analyses of studies on the effect of gender on electromagnetic hypersensitivity 51
Figure 10 Prevalence of electromagnetic hypersensitivity by age in each study 52
Figure 11 Forest plot of fixed effect meta-analyses of studies on the effect of age on electromagnetic hypersensitivity 53
Figure 12 Prevalence of electromagnetic hypersensitivity by education level in each study 54
Figure 13 Forest plot of random effects meta-analyses of studies on the effect of education level on electromagnetic hypersensitivity 55
Figure 14 Prevalence of electromagnetic hypersensitivity by marital status in each study 56
Figure 15 Forest plot of fixed effects meta-analyses of studies on the effect of martial statues on electromagnetic hypersensitivity 57

List of appendixes

Appendix A: Questionnaire of telephone interview on environmental and health-related issues 58


                                    

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