- 學位論文
六輕石化工業區附近成人癌症發生之探討
Study on Cancer Incidence Among Adults in the Vicinity of No. 6 Naphtha Cracking Complex
摘要
背景：從過去流行病學研究發現居住在石化工業區附近的居民，其癌症、心血管、呼吸道、泌尿道與造血系統的疾病死亡率較高，且詹等人在2009年以次級資料進行研究也發現到居住在六輕石化工業區附近(台西與麥寮兩鄉鎮)的居民，其惡性腫瘤的年齡標準化發生率與死亡率較其對照鄉鎮(分別為虎尾鎮與莿桐鄉的居民)來得高。 目的：以流行病學研究世代的初級資料依研究對象不同的年齡、性別與和六輕石化工業區之不同距離與運轉期別來探討六輕石化工業區對附近成人之健康效應。 材料與方法：本流行病學研究世代在2009-2011年間招募了35歲以上居民共2,388人，分布在六輕工業區附近10公里內之麥寮與台西鄉(A區)、10至20公里之四湖、東勢、崙背與褒忠鄉(B區)與距離20至40公里之虎尾鎮、二崙、莿桐及元長鄉(C區)。本研究以所收集個案之初級資料比較A, B, C三區個案的基本人口學、居家環境資料、暴露生物指標與生化檢查指標表現是否有差異，以變異數分析(Analysis of variance, ANOVA)進行基本人口學與居家環境資料的統計分析，以及以共變數分析(Analysis of covariance, ANCOVA)經由年齡與性別等相關干擾因子之校正後進行生物暴露與生化健檢指標的統計分析。本研究以回溯性方式串連1998-2010年間全民健保資料的重大傷病檔來探討居民自六輕運轉後的疾病發生狀況，所探討的疾病為全癌症(ICD-9：140-165、170-176、179-208)。以六輕揮發性有機物(Volatile Organic Compounds, VOCs)廠開始運轉的1999開始，將觀察期間分成1999-2007年與2008-2010年兩個時期並以C區做為對照組，進一步探討不同區域與不同期別下的癌症發生率(單位：每千人年)，另外在控制了年齡、性別、身體質量指數、抽菸、C型肝炎與曾在六輕工作等干擾因子後，以卜瓦松回歸(Possion regression)分析居住在不同區域的居民其2008-2010年間之全癌症發生率是否有差異。 結果：此2,388位成人世代分佈於三區域人數，分別為A區：782人、B區：734人以及C區：872人，而住家與六輕之平均距離分別為8.50公里、15.31公里及23.73公里，三區域平均年齡為57.3歲，男性比例為38.40 %。本研究之初級資料比較結果發現A區居民的身體質量指數、吃檳榔與C型肝炎盛行率顯著大於C區居民，還有A區居民在六輕工作比例顯著大於B和C區居民，而生物暴露指標：尿中釩(Vanadium, V)、砷(Arsenic, As)與1-羥基芘(1-hydroxypyrene, 1-OHP)濃度在A區居民中顯著高於B和C區居民，生化健檢指標中的肝功能指標包括天門冬胺酸轉胺酶(GOT)與丙胺酸轉胺酶(GPT)在A區居民中顯著高於B、C兩區居民。而在回溯性研究方面，在排除了抽菸、吃檳榔與C型肝炎等干擾因子後，A區居民的全癌症發生率在1999-2007年間為1.43/1,000人年而在2008-2010年間為4.34/1,000人年，上升達2.82倍；而B區居民則是從1.55/1,000人年變成3.30/1,000人年，上升2.13倍；還有C區居民是從1.92/1,000人年變成3.90/1,000人年，上升2.04倍。在卜瓦松回歸方面，經由控制了干擾因子後，發現60歲以上居住在A區的居民其2008-2010年間的全癌症發生率是C區居民的1.55倍(95 %信賴區間為1.00-2.38)，而在女性部分更達到2.17倍(95 %信賴區間為1.16-4.08)。 結論：在六輕石化工業區10公里內(A區)的居民，身體質量指數與C型肝炎盛行率顯著高於C區居民，而在控制了相關干擾因子後其GOT和GPT等肝功能指標表現較C區居民來的差。A、B、C三區居民的全癌症發生率皆有隨著期別上升的趨勢，而A區居民的全癌症發生率上升比例最大，達2.82倍。居住在A區60歲以上的女性居民其2008-2010年間的全癌症發生率在控制了相關干擾因子後的是C區居民的2.17倍。
並列摘要
Introduction: Many epidemiological studies showed that people who live near a petrochemical complex were with higher mortality rate in cancer, cardiovascular, respiratory, urinary tract, and hematopoiesis diseases. Chan et al., conducted a study by secondary data in 2009 and found that the residents who live near No. 6 Naphtha Cracking Complex (Taishi and Mailiao Townships) have higher aged-standardized incidence and mortality rate in cancer than those residents living in the control areas (Huwei and Yuanchan Townships). Purpose: The purpose of this study is to use the primary data from an epidemiological cohort to investigate the adverse health effects for adults living in the vicinity of No. 6 Naphtha Cracking Complex by their distance to the Complex and the time periods since the operation of the Complex. Material and methods: Our study subjects were 2,388 adults aged above 35 from an epidemiological cohort established in 2009-2011. They lived in three zones neighboring the No.6 Naphtha Cracking Complex, including Taihsi and Mailiao Townships at Zone A with 0-10 km from the Complex; Sihhu, Dongshih, Lunbei, and Baojhong Townships at Zone B with 10-20 km from the Complex and Huwei, Erlun, Cihtong, and Yuanchan Townships at Zone C with 20-40 km from the Complex. We collected primary data of demographic information, risk factors, biomarkers, and biochemical indices from each individual and compared their differences in three zones by analysis of variance (ANOVA) and analysis of covariance (ANCOVA) tests adjusting for sex, age, and related confounding factors. We also performed a retrospective study to investigate the incidence of all cancers (ICD-9: 140-165, 170-176, 179-208) among our study subjects by linking Taiwan Health Insurance Database (Registry for catastrophic illness patients) in two periods after the operation of No.6 Naphtha Cracking Complex during 1999-2010. The first period was the first 9 years, 1999-2007, since the operation of complex with reported emissions of volatile organic compounds, and the second period was the three years during 2008-2010. Study subjects in Zone C were used as a reference group for spatial comparisons to Zone A and Zone B. Temporal comparisons of incidence rates for all cancers (unit: 1,000 person year, 1,000 PY) were analyzed within each study zones. Spatial comparisons of incidence rates for all cancers were conducted by Poisson regression across there zones adjusting for age, sex, body mass index (BMI), smoking, hepatitis C, and working in the Complex. Results: The 2,388 study subjects included 782 persons in Zone A, 734 persons in Zone B, and 872 persons in Zone C, with averaging distances to No. 6 Naphtha Cracking Complex at about 8.50 km, 15.31 km, and 23.73 km for subjects in each zone, respectively. The average age of our study subjects was 57.3 years and the male/female ratio was 38/62. The BMI and prevalence of nuts chewing and hepatitis C of the study subjects in Zone A were significantly higher than those in Zone C. More subjects worked in No.6 Naphtha Cracking Complex in Zone A than those in Zone B and Zone C. Study subjects in Zone A had significantly higher urinary vanadium (V), arsenic (As), and 1-hydroxypyrene (1-OHP) levels than those in Zone B and Zone C. Study subjects in Zone A had significantly higher levels of aspartate aminotransferase (GOT) and alanine aminotransferase (GPT) than those in Zone B and Zone C. Incidence rates of all cancers were 1.43/1,000 PY from 1999-2007, and 4.34/1,000 PY from 2008-2010, which is approximately 2.82 times increase over the two periods for study subjects in Zone A after excluding subjects with smoking, nuts chewing, and hepatitis C. Incidence rates of all cancers changed from 1.55/1,000 PY during 1999-2007 to 3.30/1,000 PY during 2008-2010 is about a 2.13 times increase for study subjects in Zone B. Incidence rates of all cancers changed from 1.92/1,000 PY during 1999-2007 to 3.90/1,000 PY during 2008-2010 is about a 2.04 times increase, for study subjects in Zone C. After adjusting related confounders, Poisson regression analyses showed that incidence rate of all cancers in Zone A was 1.55 times higher than that in Zone C (95% CI: 1.00-2.38) for study subjects above 60 years olds during 2008-2010. Incidence rate of all cancers in Zone A was 2.17 times (95% CI: 1.16-4.08) higher than that in Zone C for females above 60 years olds during 2008-2010. Conclusion: Adult residents in Zone A had significantly higher abnormal rates of BMI, prevalence of hepatitis C, and hepatic function than those in Zone C during 2009-2011. Female residents aged above 60 in Zone A had significant higher incidence rate of all cancers than those in Zone C during 2008-2010.