極端溫度對特定職業族群健康風險及可歸因分析

Health and Attributable Risks for Specific Occuputional Subpopulations Associated with Extreme Temperatures

林旻君(Min-Chun Lin)

指導教授 ： 王玉純

中原大學/工學院/環境工程學系/碩士(2020年)

https://doi.org/10.6840/cycu202000556

摘要

隨著世界各地平均溫度上升與極端溫度發生頻率增加，勞工於工作時暴露在極端溫度下之健康與安全問題也面臨挑戰，然而臺灣極端溫度與民眾的健康關聯性研究多著重在年長者及兒童族群，較少針對勞工族群進行分析，更無明確量化極端溫度造成的損失數據，但極端溫度對不同職業族群之健康風險、可歸因人數及分率亦值得關切。
本研究使用衛生福利資料科學中心2300萬全人口死因統計檔及健保就醫資料，評估2013-2017年極端溫度對不同職業族群死亡與門急診就醫風險之相關性，將勞工依據年齡(15-64歲及65歲以上)、性別(男性及女性)、職業(軍公教人員、民營事業機構受雇者、職業工會會員及農民)、地區(北部、竹苗、中部、雲嘉南、高屏、花東及宜蘭)及疾病(全病因、循環系統疾病及呼吸道疾病)透過遞延非線性模型(distributed lag non-linear models, DLNM)分層分析，並以AIC值評估平均溫(Tmean)、最高溫(Tmax)、最低溫(Tmin)及綜合溫度熱指數(wet bulb globe temperature, WBGT)四種溫度指標應用於極端溫度對特定職業族群健康風險分析的適用性，而後比較不同職業族群極端溫度下的健康風險差異，最後則推估2013-2017年極端溫度對15-64歲不同職業族群之族群可歸因分率及可歸因人數。
性別分層的研究結果中，除了極端高溫死亡以女性勞工受到影響的子群數較多外，其餘極端溫度下死亡與門急診就醫皆以男性勞工受到衝擊較大。職業分層下，探討15-64歲族群全職業別與極端溫度相關性，極端低溫下門診及急診就醫均以民營事業機構受雇者受到影響的子族群數最多，而極端高溫下死亡與急診就醫亦是民營事業機構受雇者最易受影響。65歲以上族群則是僅討論民營事業機構受雇者及農民，結果以農民職業的健康最易受影響。當極端溫度發生時，15-64歲民營事業機構受雇者與職業工會會員為最需關切之職業族群，民營事業機構受雇者以北部、中部及雲嘉南地區受到影響最大，職業工會會員則以北部、中部、雲嘉南及花東地區較受影響，故建議上述地區行政單位在民營事業機構受雇者與職業工會會員之職業族群暴露於極端溫度下工作時，應優先採取因應措施以減低溫度對健康的負面影響。此外，高屏及花東地區男性勞工族群全病因與呼吸道疾病的整體溫度族群可歸因分率大多超過80%，相關單位亦應特別注意。
本研究綜整年齡、性別、職業與地區分層下存在溫度對健康中高風險與影響較多之勞工族群，包含15-64男性歲民營事業機構受雇者及職業工會會員及65歲以上男性農民，本研究鑑別之風險族群資訊可提供未來相關行政單位能針對該族群優先採取預防及因應措施，保障勞工暴露於極端溫度下的健康與安全，降低其死亡或就醫對社會所造成的負擔與衝擊。

關鍵字

極端溫度 ； 勞工 ； 職業 ； 死亡 ； 門診就醫 ； 急診就醫 ； 相對風險 ； 可歸因

並列摘要

Over the past few years, as the average temperature rises and the frequency of extreme temperatures increases around the world, the health and safety status of workers who are exposed to extreme temperatures at work has been challenged. However, studies on the correlation between extreme temperatures and public health in Taiwan have mostly focused on the elderly and children populations, and rare studies have been conducted to identify the vulnerability and quantify the effects of extreme temperatures on the health risks of workers.
This study evaluated the associations between extreme temperatures and the risks of mortality, emergency room visits (ERVs) and outpatient visits for various occupational subgroups (civil servants, volunteer servicemen, public office holders and teacher; employees of private owned enterprises; employers self-employed independent professionals and members of farmers) by age stratification (15-64 and over 65 years old), sex (male and female), study area (North, Chu-Miao, Central, Yun-Chia-Nan, Kao-Ping, Hua-Tun and Yilan) and diseases (all causes, circulatory diseases, and respiratory diseases) using a distributed lag non-linear model (DLNM) from 2013 to 2017. The Akaike’s information criterion (AIC) values were used to evaluate the model fitting of four temperature indicators, including maximum temperature, minimum temperature, average temperature and wet bulb globe temperature (WBGT) in the health risk associations analysis for specific occupational subpopulations. The difference of health risk associated with the extreme temperatures among various occupational subpopulations will be compared, and finally, the extreme temperatures related attributable fraction and the attributable number of health loss in different occupational subpopulations aged 15-64 years will be estimated from 2013 to 2017.
In the results of the sex stratification, extreme high temperature only increased the risk of mortality for female population, while extreme temperatures increased the risk of mortality, ERVs, and outpatient visits for the male population. For the occupational subpopulations aged 15-64 years, the extreme low temperature increased the risk of ERVs and outpatient visits, while extreme high temperature elevated the risk of mortality and ERVs for the employees of private owned enterprises. The famers aged 65 years and above is most vulnerable to extreme temperatures. When extreme temperatures occur, employees of private owned enterprises and employers self-employed independent professionals between the ages of 15 and 64 years are the occupational subpopulations that need more care. Employees of private owned enterprises are most affected by extreme temperatures in the North, Central and Yun-Chia-Nan areas, while employers self-employed independent professionals are more affected in the North, Central, Yun-Chia-Nan and Hua-Tun areas. In addition, in the Kao-Ping and Hua-Tun areas, the temperature-attributable fraction for all causes and respiratory diseases for male workers are mostly over 80% indicating that these subpopulations are the highest priority to take measures to reduce the adverse effects of temperature.
This study summarized the extreme temperatures related risk and impact on workers by age, sex, occupation, and area. Findings indicate employees of private owned enterprises and employers self-employed independent professionals aged 15-64 years and elderly male farmers were at moderate to higher risk. This study provides information for the relevant authorities to set out the priority on preventive and responsive measures to protect the health and safety of workers as exposed to extreme temperatures, and reduce the burden and impact of the death or medical treatments.

並列關鍵字

extreme temperature ； worker ； occupational ； mortality ； emergency room visits ； relative risk ； attributable fraction

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