The interactive effects of occupational noise exposure and high temperature on cardiovascular system
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摘要:
目的 分析不同职业性噪声暴露水平对心血管系统的影响，探讨噪声与其他职业性有害因素（高温、有害气体）之间是否存在交互作用。 方法 采用回顾性队列研究设计方法，收集安徽省某特大型化工企业2014―2018年的职业健康检查结果。根据噪声暴露评估情况将研究人群分为高暴露组（≥80 dB（A））、中暴露组（70~79 dB（A））和低暴露组（< 70 dB（A））；参考高温作业分级标准，对环境温度进行分级（I~IV级）。应用SPSS 23.0软件，采用χ2检验比较作业人员吸烟、饮酒、规律运动等因素在不同暴露组的构成，建立Cox回归模型分析暴露与效应关系。 结果 与低暴露组相比，暴露于≥80 dB（A）和70~79 dB（A）的职业噪声会增加高血压的发病风险，其风险比（hazard ratio，HR）和95%置信区间分别为1.85（95%CI：1.36~2.52）和1.29（95%CI：1.03~1.60）。暴露于≥80 dB（A）的职业噪声会增加心电图异常的发生风险（HR=1.31，95% CI：1.06~1.63）。共同暴露于高温和≥80 dB（A）职业噪声，高血压的发病风险进一步增加（HR=8.98，95% CI：3.25~24.86）。 结论 职业性噪声暴露可增加职业人群高血压和心电图异常的发生风险，且职业性噪声与高温存在交互作用。 Abstract:Objective To investigate the effects of different noise exposure levels on the cardiovascular system, so as to evaluate whether there was an interactive effect between occupational noise exposure and other exposures (ambient temperature or harmful gas exposure). Methods Retrospective cohort study designs were used. Occupational health examination results from 2014 to 2018 in the largest chemical enterprise in Anhui, China, were collected. According to the noise exposure assessment, selected subjects were divided into high-exposure group (≥ 80 dB(A)), medium-exposure group (70-79 dB(A)) and low-exposure group (< 70 dB(A)). The ambient temperature was graded (Grade I-IV) according to the high temperature operation classification standard. SPSS 23.0 software was used to establish the Cox regression models to analyze exposure-effect relationship. χ2 test was applied to compare the constitution of cigarette usage, alcohol intake, regular exercise and others among the three exposure groups. Results Compared with the low-exposure group, workers exposed to occupational noise ≥ 80 dB(A) and 70-79 dB(A) were at risk for hypertension, respectively, with hazard ratio(HR)and 95% confidence interval of 1.85 (95% CI:1.36-2.52) and 1.29 (95% CI:1.03-1.60). Occupational exposure to noise levels above 80 dB(A) could increase the risk of electrocardiogram abnormality (HR=1.31, 95%CI:1.06-1.63). In addition, workers exposed to both high temperature and occupational noise ≥ 80 dB(A) exhibited a further increased risk of hypertension (HR=8.98, 95% CI:3.25-24.86). Conclusions Occupational noise exposure can increase the risk of cardiovascular disease in occupational population, and there is an interactive effect between occupational noise exposure and high temperature. -
表 1 安徽省2014年至2018年化工企业中噪声暴露人群的一般人口学特征(x±s)
Table 1. Demographic characteristics of chemical enterprise employees by workplace noise exposure in Anhui from 2014 to 2018 (x±s)
特征 噪声暴露组别(x±s)/[n(%)] 合计(n=2 188) P值 高暴露(n=325) 中暴露(n=1 204) 低暴露(n=659) 年龄(岁) 39.6±6.7 41.8±7.4 44.2±6.8 42.3±7.3 < 0.001a 暴露时间(岁) 18.8±7.7 23.1±9.1 26.0±7.6 23.3±8.8 < 0.001a BMI(kg/m2) 24.1±3.7 24.3±3.8 23.8±3.7 24.1±3.7 0.133a 性别(男%) 272(83.7) 851(70.7) 400(60.7) 1 523(69.6) < 0.001b 吸烟(是%) 120(36.9) 369(30.6) 178(27.0) 667(30.5) 0.006b 饮酒(是%) 76(23.4) 268(22.3) 144(21.9) 488(22.3) 0.861b 规律运动(是%) 75(23.1) 311(25.8) 185(28.1) 571(26.1) 0.233b 婚姻状况(已婚%) 302(92.9) 1 138(94.5) 622(94.4) 2 062(94.2) 0.134b 高等教育(是%) 128(39.4) 486(40.4) 254(38.5) 868(39.7) 0.739b 高血压家族史(是%) 142(43.7) 504(41.9) 265(40.2) 911(41.6) 0.566b 舒张压(mmHg) 145.7±8.5 143.1±8.8 141.4±6.7 143.2±7.3 0.013a 收缩压(mmHg) 92.4±8.0 91.2±7.2 90.1±6.2 91.4±7.5 0.033a 高血压(是%) 108(33.2) 326(27.1) 146(22.2) 580(26.5) 0.032b 心电图异常(是%) 193(59.4) 559(46.4) 272(41.3) 1 024(46.8) 0.041b 注：a表示Kruskal-Wallis检验，b表示χ2检验。 
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表 2 安徽省2014至2018年调整不同因素后不同噪声暴露人群高血压患病风险
Table 2. Risk of incident hypertension according to occupational noise exposure and different adjusted factors in Anhui from 2014 to 2018
变量 模型1a 模型2b 模型3c HR (95% CI)值 P值 HR (95% CI)值 P值 HR (95% CI)值 P值 噪声水平[dB(A)] < 70 1.00 1.00 1.00 70~ 1.47(1.21~1.80) < 0.001 1.30(1.04~1.60) 0.020 1.29(1.03~1.60) 0.025 ≥80 2.22(1.72~2.87) < 0.001 2.18(1.61~2.93) < 0.001 1.85(1.36~2.52) < 0.001 性别(男) 0.53(0.43~0.66) < 0.001 0.68(0.51~0.92) 0.011 0.66(0.49~0.88) 0.006 吸烟 2.16(1.62~2.87) < 0.001 2.22(1.66~2.96) < 0.001 饮酒 2.20(1.75~2.74) < 0.001 2.21(1.76~2.77) < 0.001 规律运动 0.59(0.43~0.80) < 0.001 0.64(0.47~0.87) 0.004 BMI≥24 (kg/m2) 1.35(1.28~1.43) < 0.001 1.37(1.30~1.45) < 0.001 高血压家族史 1.70(1.36~2.11) < 0.001 1.80(1.44~2.24) < 0.001 高温 1.27(1.01~1.60) 0.042 氨气 1.48(1.10~1.85) 0.007 注：dB(A)表示A加权分贝；a表示调整年龄和性别变量；b表示在模型1基础上增加调整噪声暴露时间、吸烟、饮酒、规律运动、BMI、婚姻状况、教育程度和高血压家族史变量；c表示在模型1和模型2增加调整高温、氨气、丙烯腈、粉尘、苯及苯系物、SO2、CO和煤尘变量。
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表 3 安徽省2014至2018年调整不同因素后不同噪声暴露人群心电图异常风险
Table 3. Risk of incident electrocardiogram according to occupational noise exposure and different adjusted factors in Anhui from 2014 to 2018
变量 模型1a 模型2b 模型3c HR (95% CI)值 P值 HR (95% CI)值 P值 HR (95% CI)值 P值 噪声水平(dB(A)) < 70 1.00 1.00 1.00 70~ 1.01(0.88~1.16) 0.950 0.98(0.85~1.12) 0.720 1.01(0.86~1.17) 0.960 ≥80 1.34(1.12~1.62) 0.002 1.22(1.01~1.48) 0.044 1.31(1.06~1.63) 0.012 性别(男) 1.23(1.08~1.56) < 0.001 1.42(1.12~1.84) 0.013 1.48(1.17~2.15) 0.007 吸烟 1.65(1.37~2.01) < 0.001 1.63(1.34~1.98) < 0.001 规律运动 0.18(0.13~0.23) < 0.001 0.17(0.13~0.23) < 0.001 BMI≥24 (kg/m2) 1.04(1.01~1.08) 0.042 1.03(1.01~1.07) 0.043 高血压家族史 2.35(2.03~2.72) < 0.001 2.36(2.04~2.74) < 0.001 注：dB(A)表示A加权分贝；a表示调整年龄和性别变量；b表示在模型1基础上增加调整噪声暴露时间、吸烟、饮酒、规律运动、BMI、婚姻状况、教育程度和高血压家族史变量；c表示在模型1和模型2增加调整高温、氨气、丙烯腈、粉尘、苯及苯系物、SO2、CO和煤尘变量。
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表 4 安徽省2014至2018年职业噪声暴露与高温的交互作用对高血压的影响
Table 4. Interactive effects between occupational noise exposure and high temperature in Anhui from 2014 to 2018
噪声 模型1a 模型2b 接触高温 未接触高温 接触高温 未接触高温 HR (95% CI)值 HR (95% CI)值 HR (95% CI)值 HR (95% CI)值 低暴露组 < 70 1.00 1.00 1.00 1.00 中暴露70~ 1.51(0.91~2.51) 1.20(0.93~1.55) 2.84(1.22~6.60) 1.19(0.90~1.57) 高暴露组≥80 4.02(2.30~7.03) 1.63(1.12~2.38) 8.98(3.25~24.86) 1.46(0.97~2.21) 注：dB(A)表示A加权分贝；a表示调整年龄、性别、噪声暴露时间、吸烟、饮酒、规律运动、BMI、婚姻状况、教育程度和高血压家族史变量；b表示在模型1基础上增加调整高温、氨气、丙烯腈、粉尘、苯及苯系物、SO2、CO和煤尘变量。
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表 5 模型中不同变量的多重共线性诊断
Table 5. Multicollinearity diagnosis of variables in modelsa
变量 共线性诊断 容忍度 VIF 噪声 0.737 1.357 噪声暴露时间 0.410 2.441 性别 0.728 1.374 年龄(岁) 0.394 2.540 吸烟 0.471 2.122 饮酒 0.629 1.589 规律运动 0.802 1.246 BMI (kg/m2) 0.819 1.221 婚姻状况 0.779 1.284 受教育程度 0.864 1.157 高血压家族史 0.700 1.429 氨气 0.715 1.398 丙烯腈 0.757 1.321 高温 0.715 1.398 粉尘 0.779 1.283 苯及苯系物 0.933 1.071 二氧化硫 0.578 1.730 一氧化碳 0.608 1.646 煤尘 0.897 1.115 注：VIF表示方差膨胀因子。a表示因变量为高血压。
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