农村孕前妇女职业暴露危险因素的流行病学调查

摘要

目的：了解中国农村地区待孕妇女职业危险因素暴露情况及其影响因素。方法利用2009年11月—2010年3月在山东、河南、云南、重庆、四川等5省农村地区开展的“育龄夫妇孕前健康及危险因素暴露情况调查”数据，采用描述性分析和多因素 Logistic 回归分析，分析中国农村地区待孕妇女职业危险因素暴露情况及其影响因素。结果8575例待孕妇女的问卷分析结果表明，14．7％妇女暴露于各种职业危险因素，约4．0％同时暴露于2种及2种以上职业危险因素。暴露比例依次为农药（6．0％）、噪音（5．4％）、粉尘（3．8％）、化学物质（3．6％）及高温（1．5％）。不同年龄、户籍性质、受教育水平和家庭经济状况的待孕妇女职业暴露水平存在差异，不同类型职业暴露的分布具有不同的特征。教育水平是职业暴露的重要影响因素。农药暴露风险与待孕妇女受教育程度之间呈现剂量反应关系，教育程度越低，农药暴露风险越高，小学及以下、初中、高中待孕妇女的农药暴露的相对危险度分别为7．2、4．1和1．4。初中和高中妇女暴露于粉尘的风险约是大专及以上妇女的2．2倍，初中妇女暴露于化学物质和高温的风险分别为大专及以上妇女的1．7倍和4．2倍。在职业暴露妇女中仅5．3％进行过孕前优生咨询。结论中国农村地区待孕妇女职业危险因素暴露比例较高，暴露风险与受教育水平密切相关，但职业暴露妇女优生咨询比例较低。建议在孕前保健中加强健康教育以降低职业危险因素暴露危害。%Objective To charaterize occupational exposure during the preconceptional period in women in rural China. Methods We carried out a questionnaire survey on occupational exposure during the preconceptional period in seventeen counties between November 2009 and March 2010.Descriptive and regression analyses were used to identify exposures and influencing factors. Results Among the 8 575 women responded,1 257 were exposed to five kinds of occupational risk factors.About 4% of women were exposed to two kinds of occupational risk factors.Pesticide was the most frequently exposed agent (6%),followed by noise (5.5%),dust (3.8%),industrial chemical (3.7%),and high temperature (1.5%).Age,household registration type,education,and economic status were important influence factors. Low educational level was associated with high pesticide exposure.For pesticide exposure,odds ratio (OR)reached to 7.2,4.1,and 1.4 in primary school group,junior high school groups,and high school group,respectively.For dust exposure,there was a over twofold increase in junior high school group than in college group.For chemical exposure and high temperature exposure,the ORs reached to 1.7 and 4.2 respectively.Only 5.3% of exposed women received preconceptional counseling. Conclusion Above 10% of women were exposed to occupational risk factors in rural China, and majority of exposed women had low educational levels.Therefore,it is important to strengthen public health education for women during the periconceptional period in rural China.