| 研究生: |
塗沛潔 Tu, Pei-Chieh |
|---|---|
| 論文名稱: |
台灣公共場所之多重室內環境因子暴露的疾病負荷 The burden of disease attributable to multiple exposure of indoor factors – the case in Taiwan's public places |
| 指導教授: |
蘇慧貞
Su, Huey-Jen |
| 共同指導教授: |
榮建誠
Jung, Chien-Cheng |
| 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: | 2021 |
| 畢業學年度: | 109 |
| 語文別: | 中文 |
| 論文頁數: | 114 |
| 中文關鍵詞: | 失能調整生命年 、多重暴露 、室內空氣污染物 、室內溫度 、疾病負擔 |
| 外文關鍵詞: | disease burden, disability-adjusted life year (DALY), indoor air pollution, indoor temperature, multiple exposure |
| 相關次數: | 點閱:74 下載:1 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
研究背景:據統計,平均每人每天約有 80%以上的時間都待在室內空間中,除了住家,學校和辦公室等公共區域也是民眾主要的活動空間。近年研究已證實室內溫度以及空氣污染物的暴露,特別是細懸浮微粒 (PM2.5) 和臭氧,會增加人體的健康危害風險。然而,過去研究大都以死亡率或是盛行率的相對風險等單一角度來探討室內危害因子的暴露對人體健康的影響,該方法較難直接用以比較不同地區或國家的疾病負擔情況。失能調整生命年 (Disability-Adjusted Life Year, DALY) 可將疾病的發病率和死亡率的影響轉換成具可比較性的健康指標,有利於不同地區因暴露到空氣污染物以及溫度造成的疾病負擔之比較。同時,實際環境中均同時存在多種空氣污染物,而過去研究多僅考量單一污染物的暴露,較少呈現多重空氣污染物暴露之疾病負擔的估算。
研究目的:探討多重暴露「室內空氣污染物和溫度」的暴露對人體造成的健康危害風險,並估算具有「可比較性」和「可用於計算經濟損失成本」的DALY。
研究方法:以多重暴露模型Weighted Exposure Model估算同時暴露PM2.5、臭氧及會造成風險溫度之相對風險,並轉換為人群可歸因分率 (population attributable fraction, PAF) 後用以計算各區域可歸因於多重暴露造成的DALY。空氣污染物的資料來自行政院環境保護署彙整全國以公告方法進行採樣與分析的公共空間之PM2.5和臭氧濃度以及溫度等資料,監測資料的時間為2013-2015年,此資料涵蓋台灣北部、中部及南部的公共空間,採樣之建築物樣本數分別有404、265和180筆。健康資料來自衛生福利部資料科學中心的200萬人抽樣檔 (門急診、住院、死因和癌症登記) 之缺血性心臟病 (ICD-9-CM 410-414、ICD-10-CM I20-I25)、中風 (ICD-9-CM 430-438、ICD-10-CM I60-69)、慢性阻塞性肺病 (ICD-9-CM 490-496、ICD-10-CM J40-44) 和肺癌 (ICD-9-CM 162、ICD-10-CM C33-34)。統計模型中的空氣污染物及溫度對四種疾病的風險值 (relative risk) 取自於過去的文獻。
結果:台灣北中南地區公共空間之室內年平均PM2.5濃度分別為14.97 μg/m3、14.93 μg/m3及16.30 μg/m3,臭氧為12.32 ppb、27.12 ppb及22.48 ppb,年平均室內溫度為24.95°C、28.64°C及27.02°C。全台灣 (排除東部及離島) 民眾因暴露室內PM2.5所損失的缺血性心臟病、中風、慢性阻塞肺疾病及肺癌的DALY平均分別為每百萬人731.08-2761.67、573.02-2411.50、844.10-1286.66及433.53-758.18人年,占了總疾病的6.6-24.8%、4.6-19.5%、9.6-14.6%及4.8-8.4%。研究使用極端值來估算若暴露在極為嚴重的室內臭氧濃度下造成的疾病負擔,估算結果顯示缺血性心臟病、中風及慢性阻塞性肺病分別為每百萬人469.88、38.82和2197.86人年,約占各個疾病的4.2%、0.3%和25.0%。利用多重暴露模型估算出同時暴露室內PM2.5及臭氧僅導致中南部中風及COPD的DALY分別為每百萬人889.66-945.81及1152.00-1223.50人年,分別佔各個疾病的7.2-7.6%及13.1-13.9%,並以南部占有的DALY最高。多重暴露室內空氣污染物共造成疾病負擔介於每百萬人2041.66至2169.31人年。
結論:暴露本研究之室內空氣污染物顯著增加中風盛行及慢性阻塞性肺病死亡風險並加重本國疾病負擔。研究利用已發表之數學統計模式,評估目前環境議題中備受矚目的”多重”空氣污染物之相對風險,並進一步結合公共衛生領域之疾病負擔指標。研究結合各領域的優點,以利估算出更接近真實暴露情況和疾病負擔,並可進一步應用於衛生經濟學的計算,以推估醫療措施成本及價值。
關鍵詞:失能調整生命年、多重暴露、室內空氣污染物、室內溫度、疾病負擔
Epidemiological studies have demonstrated that exposure to multiple air pollutants or extreme temperature was associated with reporting cardiovascular and respiratory disease. However, previous studies mostly focused on single air pollutant or only on temperature. Meanwhile, people often spend over 80% of their time indoors. The study is therefore aimed to investigate adverse health effects linked to multiple exposure to both indoor air pollution and extreme temperature and corresponding disease burden. This study utilized the indoor environmental monitoring data of public places collected in the past and calculated the average concentration of PM2.5 and ozone exposed by the public from 2013 to 2015, as well as the annual average indoor temperature. Multiple exposure model was used to estimate the risk of simultaneous exposure for cardiovascular and respiratory diseases. Exposure to indoor air pollution only is attributable to the disease burden of stroke and COPD in the central and southern regions, the disability-adjusted life year (DALY) were 889.66-945.81 and 1152.00-1223.50, respectively, accounting for 7.2-7.6% and 13.1-13.9% of each disease, respectively. Finally, the total disease burden estimated by multiple exposures ranges between 2041.66-2169.31 DALYs. Estimating the burden of disease associated with exposure to air pollutants can further support the estimation of cost and value of medical measures and will hopefully be applied in developing public health policy in the future.
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