2008~2012年護理人員罹患癌症相對風險之現況分析

研究背景及目的: 癌症久居台灣十大死因之首多年，欲探討常面臨工作時間過長、高壓力及輪班工作環境的護理人員，是否會因職業的特性而有較高的罹癌風險。研究方法: 本研究以國家衛生研究院2008年至2012年中華民國全民健保資料庫「醫事人員基本資料檔(PER)」「醫事機構基本資料檔HOSB」及、「重大傷病證明明細檔(HV)」進行串檔分析。應用標準化發生率(SIR)模型分析女性護理人員與全國女性人口罹患癌症之相對風險，及罹患癌症之種類與平均年齡，並以羅吉斯迴歸探討人口屬性之罹癌勝算比。結果: 整體女性護理人員罹癌風險與全國女性人口相同(SIR=1，95%CI=0.96∼1.03)。女性護理人員罹癌平均年齡42.7歲±10.8，小於30歲(SIR=1.4，95%CI=1.24∼1.51)、50-59歲(SIR=1.1，95%CI=0.97∼1.13)罹癌風險皆高於小於30歲、50-59歲全國女性人口。護理人員SIR 高於全國人口的有乳癌(SIR:1.2)、甲狀腺癌(SIR:2.2)、卵巢癌(SIR:1.8) 、及鼻咽癌(SIR:1.4)。在醫療機構上，區域醫院罹癌機率比醫學中心高；每增加一個工作年資，罹癌機率就越高；年齡越增長，罹癌機率就越高。結論與建議: 女性護理人員是乳癌、甲狀腺癌、鼻咽癌的高危險群，因此建議護理人員健康檢查項目應包含乳房攝影、甲狀腺超音波及定期做耳鼻喉科檢查。同時在執行醫學輻射相關檢查時，應針對頸部及腹部之防護建立更完整之標準作業流程，或者「提供偵測輻射線徽章」可減少輻射的危害，早期預防並降低降低罹癌風險，以營造安全之職業場所。

關鍵字

護理人員；癌症；工作環境

並列摘要

Research Background and purpos： Cancer has long been one the top ten causes for people’s death in Taiwan and the odds of people having cancers has also increased over the years. The nursing staffs whom often face long work hours, high pressure environment, and the need to switch between shifts, expose themselves to be among the high-risk groups. In this research, we explore if people who work in the nursing sector would have a higher-than-average chance of getting cancer due to the nature of their work. Research Methods： Our study is enabled by drawing reference data pulled from Taiwan national health care –「Registry for medical personnel (PER)」「 Registry for contracted medical facilities (HOSB)」及、「Registry for catastrophic illness patients (HV)」during the 2008 to 2012 time period. Its analysis utilizes the SIR (Standardized Incidence Ratio, SIR) to examine the relative risk of female nursing staffs getting cancer and how their odds compare to the national average of female population. It helps us to understand the types of cancer and the average age in the female nursing demographic suffering from cancer. And it also explores the odds of female nurses beating cancer by using the Multinomial logistic regression method. Results： We found the odds of getting cancer to be virtually the same between the female nursing staffs and the national average of female population (SIR=1, 95% CI=0.93~1.03). Looking closely, within the below 30 and the 50~59 age groups, female nurses have a higher odds of getting cancer than the national average of these two specific age groups. The four kinds of cancers within the female nursing group that have a SIR higher than the national average are breast cancer (SIR:1.2), Thyroid cancer (SIR:2.2)、Ovarian Cancer (SIR:1.8) and Nasopharynx Cancer (SIR:1.4). In terms of the medical institutions that nurses work in, the group who work in local hospitals has a higher chance of getting cancer than the group that works in medical centers. In terms of age groups, the odds of getting cancer naturally increase when these nursing workers age . Conclusion/Suggestion： Female nurses are particularly vulnerable to suffer from breast cancer, thyroid cancer、and nasopharynx cancer. Therefore, it is highly recommended that all female nursing workers regularly schedule health checkups and mammography screening. Continuously monitor the health of thyroid through Ultrasound screening，and regularly Ear, Nose and Throat(ENT) examination are also important. We suggest to develop a more thorough and well-rounded testing standards during Radiation related medical examination for nursing workers in the body areas (such a neck and stomach) that are more risky to be inflicted with cancer. Another suggestion would be to consider providing radiation detection badge and setting up specially-equipped rooms with cliche to reduce the harmful side effects of radiation. Measures that are implemented early to prevent cancer are really the best kind of treatment. The sum of these efforts should significantly reduce the risk of getting cancer for our nursing staffs, and therefore promote a safer and healthier work environment.