• 沒有找到結果。

1. 受限於在取得世代資料庫時個人資料保護措施,必須將技術士證號資料作編碼處 理,因此無法連結其他資料庫,例如對照族群資料,導致軟體中統計功能只能依 照世代資料庫本身能計算的指標來做設計,例如盛行率。

2. 在計算各項癌症之 SIRs 及 SMRs 時,因為全國人口對照族群資料不齊全導致某 些年度無法進行標準化,因此部分癌症之結果只有一至二年,加上電焊技術士癌 症病例數(160 人)及死亡數(61 人)少,只能看出在特定某些癌症在電焊技術士有 較高的危險趨勢。

3. 因為健保資料庫 90 年以前資料已歸檔磁帶,因此本次研究只有 91-93 年的資料 可供使用,加上與電焊技術士資料比對後,只能計算91 與 92 年之所有疾病之標 準化疾病率比,所以電焊技術士在罹患人體各系統器官疾病方面,只能從 91、

92 兩年資料去看疾病趨勢。而在勞保檔方面因缺乏每ㄧ年度之年齡分層總人口 數,故無法計算所有疾病之標準化疾病率比,也因此在勞保檔部份只計算各年度 門診(70-76 年)及住院(83-84 年)之盛行率。

4. 在傷亡統計方面,以民國 75 年到民國 93 年有接受勞保現金給付為主,其中如災 害類型、受傷部位或者是媒介物變項方面,由於某些電焊技術士無法判斷其媒介 物、災害類型及受傷部位,造成缺值(missing data)太多而可用樣本數較少。

參考文獻

1. 謝俊明:不銹鋼電焊燻煙成分分析研究,行政院勞工委員會勞工安全衛生研究所 研究報告,1998。

2. Stern RM, Berlin A, Fletcher A, Hemminki K, Jarvisalo J, Peto J. International conference on health hazards and biological effects of welding fumes and gases. Int

Arch Environ Health. 1986;57:237-246.

3. Ebran B, Quieffin J, Beduneau G, Guyonnaud CD. Radiological evidence of lung involvement in metal fume fever. Rev Pneumol Clin. 2000;56:361-364.

4. 行政院勞工委員會編印,焊接技術,勞工檢查技術叢書

02-22-01

,1990。

5. Jenkins, N., Moreton, J., Oakley, P. J., & Stevens, S. M. Welding Fume - Sources, Characteristics, Control (Vol. 1-2). Cambridge, England: The Welding Institute,

Abington Hall, Abington. 1981.

6. 蘇文源,杜偉民:工作場所感電災害調查及防止對策研究-製造業,行政院勞工委 員會勞工安全衛生研究所,1996。

7. 楊秀宜:金屬燻煙熱(metal fume fever),勞工安全衛生簡訊第

69

,行政院勞工委 員會勞工安全衛生研究所,2005。

8. Sjogren B, Gustavsson P, Hogstedt C. Neuropsychiatric symptoms among welders exposed to neurotoxic metals. British Journal of Industrial Medicine. 1990;47:704-707.

9. Seidal K, Jorgensen N, Elinder CG, Sjogren B, Vahter M. Fatal cadmium-induced pneumonitis. Scandinavian Journal of Work, Environment & Health. 1993;19:429-431.

10. Liubchenko PN, Vinnitskaia TE. The structure of occupational morbidity in electric welders. Meditsina Truda i Promyshlennaia Ekologiia. 2000:7-10.

11. Buerke U, Schneider J, Rosler J, Woitowitz HJ. Interstitial pulmonary fibrosis after severe exposure to welding fumes. American Journal of Industrial Medicine.

2002;41:259-268.

12. Li GJ, Zhang LL, Wu P, Zheng W. Occupational exposure to welding fume among welders: Alterations of manganese, iron, zinc, copper, and leads in body fluids and the oxidative stress status. J Occup Environ Med. 2004;46:241-248.

13. Groth M, Lyngenbo O. Respiratory symptoms in danish welders. Scandinavian Journal

of Social Medicine. 1989;17:271-276.

14. Hunting KL, Welch LS. Occupational exposure to dust and lung disease among sheet metal workers. British Journal of Industrial Medicine. 1993;50:432-442.

15. Oleru G, Ademiluyi SA. Some acute and long-term effects of exposure in welding and thermal-cutting operations in nigeria. International Archives of Occupational &

Environmental Health. 1987;59:605-612.

16. Ratner D, Peacocke M, Zhang H, et al. UV-specific p53 and PTCH mutations in sporadic basal cell carcinoma of sun-exposed skin; welding-related parkinsonism:

Clinical features, treatment, and pathophysiology. Journal of the American Academy of

Dermatology; Neurology. 2001; 2001;44; 56:293; 8-297; 13.

17. Magovern M, Wright JD,Jr, Mohammed A. Spheroidal degeneration of the cornea: A clinicopathologic case report. Cornea. 2004;23:84-88.

18. 勞工安全衛生教材編輯委員會,勞工安全衛生教材

.

修正版,台北市:中華民國 工業安全衛生協會,1998。

19. Erkinjuntti-Pekkanen R., Slater T., Cheng S., et al. Two year follow up of pulmonary function values among welders in new zealand. Occup Environ Med. 1999;56:328-333.

20. Ozdemir O, Numanoglu N, Gonullu U, Savas I, Alper D, Gurses H. Chronic effects of welding exposure on pulmonary function tests and respiratory symptoms. Occupational

& Environmental Medicine. 1995;52:800-803.

21. Bradshaw LM, Fishwick D, Slater T, Pearce N. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in new zealand.

Occupational & Environmental Medicine. 1998;55:150-154.

22. Schneider WD. Epidemiological studies on the occurrence of lung diseases in welders.

Zeitschrift fur Erkrankungen der Atmungsorgane. 1983;161:279-282.

23. Sjogren B, Ulfvarson U. Respiratory symptoms and pulmonary function among welders working with aluminum, stainless steel and railroad tracks. Scandinavian

Journal of Work, Environment & Health. 1985;11:27-32.

24. Cotes JE, Feinmann EL, Male VJ, Rennie FS, Wickham CA. Respiratory symptoms and impairment in shipyard welders and caulker/burners. British Journal of Industrial

Medicine. 1989;46:292-301.

25. El-Zein M., Malo JL., Infante-Rivard C., Gautrin D. Incidence of probable occupational asthma and changes in airwary caliber and responsiveness in apprentice welders. Eur Respir J. 2003;22:513-518.

26. Lyngenbo O, Groth S, Groth M, Olsen O, Rossing N. Occupational lung function impairment in never-smoking danish welders. Scandinavian Journal of Social

Medicine. 1989;17:157-164.

27. Chinn DJ., Stevenson IC., Cotes JE. Longitudinal respiratory survey of shipyard workers: Effects of trade and atopic status. Br J Ind Med. 1990;47:83-90.

28. Akbar-Khanzadeh F. Short-term respiratory function changes in relation to workshift welding fume exposures. Int Arch Occup Environ Health. 1993;64:393-397.

29. Coggon D, Inskip H, Winter P, Pannett B. Lobar pneumonia: An occupational disease in welders. Lancet. 1994;344:41-43.

30. Antonini JM, Lewis AB, Roberts JR, Whaley DA. Pulmonary effects of welding fumes:

Review of worker and experimental animal studies. American Journal of Industrial

Medicine. 2003;43:350-360.

31. Becker N. Cancer mortality among arc welders exposed to fumes containing chromium and nickel. results of a third follow-up: 1989-1995. Journal of Occupational &

Environmental Medicine. 1999;41:294-303.

32. Hull CJ, Doyle E, Peters JM, Garabrant DH, Bernstein L, Preston-Martin S.

Case-control study of lung cancer in los angeles county welders. American Journal of

Industrial Medicine. 1989;16:103-112.

33. Danielsen TE, Langard S, Andersen A. Incidence of cancer among welders and other shipyard workers with information on previous work history. Journal of Occupational

& Environmental Medicine. 2000;42:101-109.

34. Jockel KH, Ahrens W, Pohlabeln H, Bolm-Audorff U, Muller KM. Lung cancer risk and welding: Results from a case-control study in germany. American Journal of

Industrial Medicine. 1998;33:313-320.

35. Droste JH, Weyler JJ, Van Meerbeeck JP, Vermeire PA, van Sprundel MP. Occupational risk factors of lung cancer: A hospital based case-control study. Occupational &

Environmental Medicine. 1999;56:322-327.

36. Steenland K. Ten-year update on mortality among mild-steel welders. Scandinavian

Journal of Work, Environment & Health. 2002;28:163-167.

37. Knudsen LE, Burr H. Follow-up examination of danish stainless steel welders previously examined in 1987. Ugeskrift for Laeger. 2003;165:2882-2886.

38. Moulin JJ, Wild P, Haguenoer JM, et al. A mortality study among mild steel and stainless steel welders. British Journal of Industrial Medicine. 1993;50:234-243.

39. Lubianova IP., Novichenko NL. The carcinogenic risk factor in the job of a steel welder.

Likarska Sprava. 1995;1-2:88-91.

40. Ronco G, Ciccone G, Mirabelli D, Troia B, Vineis P. Occupation and lung cancer in two industrialized areas of northern italy. International Journal of Cancer.

1988;41:354-358.

41. Lerchen ML, Wiggins CL, Samet JM. Lung cancer and occupation in new mexico.

Journal of the National Cancer Institute. 1987;79:639-645.

42. Steednland K., Beaumont J., Elliot L. Lung cancer in mild steel welders Am J

Epodemiol. 1991;133:220-229.

43. Andreotti G, Lange JL, Brundage JF. The nature, incidence, and impact of eye injuries among US military personnel: Implications for prevention. Archives of Ophthalmology.

2001;119:1693-1697.

44. Norn M, Franck C. Long-term changes in the outer part of the eye in welders.

prevalence of spheroid degeneration, pinguecula, pterygium, and corneal cicatrices.

Acta Ophthalmologica. 1991;69:382-386.

45. Narda R, Magnavita N, Sacco A, Sarnari L, Sani L. Eye diseases in welders: A longitudinal study. Medicina del Lavoro. 1990;81:399-406.

46. Gustavsson P, Jakobsson R, Johansson H, Lewin F, Norell S, Rutkvist LE.

Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: A case-control study in sweden. Occupational &

Environmental Medicine. 1998;55:393-400.

47. Gordon T., Fine J. Metal fume fever. Occop Med. 1993;8:505-517.

48. Erhabor GE., Fatusi S., Obembe OB. Pulmonary functions in ARC-welders in ile-ife, nigeria. East Afr Med J. ;78:461-464.

49. Toibana N, Ishikawa N, Sakakibara H, Yamada S. Raynaud's phenomenon of fingers and toes among vibration-exposed patients. Nagoya Journal of Medical Science.

1994;57:121-128.

50. Racette BA, McGee-Minnich L, Moerlein SM, Mink JW, Videen TO, Perlmutter JS.

Welding-related parkinsonism: Clinical features, treatment, and pathophysiology.

Neurology. 2001;56:8-13.

51. Matsko NV. The working, life style and health conditions of welders (social hygiene research). Likarska Sprava. 1998:133-135.

52. Sjogren B, Fossum T, Lindh T, Weiner J. Welding and ischemic heart disease.

International Journal of Occupational & Environmental Health. 2002;8:309-311.

53. Suadicani P, Hein HO, Gyntelberg F. Strong mediators of social inequalities in risk of ischaemic heart disease: A six-year follow-up in the copenhagen male study.

International Journal of Epidemiology. 1997;26:516-522.

54. Persson B, Dahlander AM, Fredriksson M, Brage HN, Ohlson CG, Axelson O.

Malignant lymphomas and occupational exposures. British Journal of Industrial

Medicine. 1989;46:516-520.

55. Hilt B, Leira HL, Hjelde H, Sundstrom S, Brynildsen E. Incidence and physicians' registration of assumed occupational lung cancer in norway. Tidsskrift for Den Norske

Laegeforening. 1997;117:203-207.

56. 中央社,中時電子報,2005/4/4

http://news.chinatimes.com/Chinatimes/newslist/newslist-content/0,3546,110107+1120 05040400906,00.html(2005/5/10)

57. Wang Z.P, Larsson K, Malmberg P, Sjogren B, Hallberg B.O, Wrangskog K. Asthma, ling function, and bronchial responsiveness in welders. Am J Ind Med.

1994;26:741-754.

附表

表1、電焊技術士證照別樣本數及百分比

證照別 全部樣本 百分比(%)

一般手工電焊 13,979 84.66

氬氣鎢極電焊 1,741 10.54

半自動電焊 792 4.8

樣本數 16,512 100

表2、電焊技術士癌症發生人數及百分比—與台灣地區全體比較 癌症名稱 人數 百分比 台灣地區百分比*

肝癌 32 20.0% 17.8%

鼻咽癌 20 12.5% 4.4%

口腔癌 19 11.9% 7.7%

結腸、直腸癌 18 11.3% 11.9%

造血系統及網內皮系統癌 13 8.1% 0.9%

皮膚癌 8 5.0% 2.8%

肺癌 8 5.0% 14.8%

結締組織癌 7 4.4% 0.7%

胃癌 6 3.8% 9.5%

腦癌 5 3.1% 1.3%

甲狀腺癌 4 2.5% 0.8%

膀胱癌 4 2.5% 3.9%

小腸癌 2 1.3% 0.4%

淋巴結癌 2 1.3% 1.6%

鼻腔癌 2 1.3% 0.5%

不明原發部位癌 2 1.3% 1.8%

主唾腺癌 1 0.6% 0.3%

泌尿器官癌 1 0.6% 6.1%

食道癌 1 0.6% 3.3%

胰臟癌 1 0.6% 1.7%

胸腺癌 1 0.6% 0.4%

腎癌 1 0.6% 1.1%

膽囊癌 1 0.6% 0.9%

攝護腺癌 1 0.6% 4.5%

全部樣本數 160

*資料為台灣地區民國 72-90 年所有男性(因電焊族群皆為男性)

表3、電焊技術士各項癌症之標準化發生率比—依年度分

癌症名稱

1987 1988 1989 1990 1991 1992 1993 1994 1995

肝癌 0.36 - 0.31 - 0.28 - - - 0.32 鼻咽癌 - 1.02 0.83 - - 0.74 2.45 - 2.63

口腔癌 - - - 0.50 - -

結腸、直腸癌 - 2.10 - - - - 1.20 1.66 - 造血系統及網內皮系統癌 3.99 - - - - 5.41 5.04 -

皮膚癌 - - - -

肺癌 - - 0.67 - - - -

結締組織癌 - - - -

胃癌 2.99 - - - - 0.76 1.00

腦癌 - - - -

甲狀腺癌 - - - -

膀胱癌 - - - -

小腸癌 - - - 22.97 - - - 淋巴結癌 - - - - 4.97 - - - -

鼻腔癌 - - - -

不明原發部位癌 - - - - 唇、口腔及咽之惡性腫瘤 - - - - 消化器及腹膜之惡性腫瘤 - - - - 骨、結締組織、皮膚及乳房

之惡性腫瘤 - - - -

表3、電焊技術士各項癌症之標準化發生率比—依年度分(續完)

癌症名稱

1996 1997 1998 1999 2000 2001 2002 2003

肝癌 0.21 - 1.10 0.75 0.28 0.18 0.15 - 鼻咽癌 0.63 - 0.54 3.47 10.84 - 0.09 - 口腔癌 0.15 0.13 0.33 0.19 0.09 0.14 - 0.23 結腸、直腸癌 0.44 1.21 0.35 - - 0.11 - 0.08 造血系統及網內皮系統癌 1.89 6.01 1.69 3.53 - - - -

皮膚癌 - 11.08 1.54 - - - - -

肺癌 - - 0.45 - 0.41 - - 0.41

結締組織癌 34.50 - 4.49 - - - - -

胃癌 - - - - 0.69 - - -

腦癌 3.72 - 3.31 - - - - -

甲狀腺癌 12.92 - - - - - - -

膀胱癌 - - - - 1.33 0.17 - 0.32

小腸癌 - - - - - - - -

淋巴結癌 - - - 0.31 - -

鼻腔癌 - - - - 16.64 - - -

不明原發部位癌 - 2.11 - - 1.83 - - -

唇、口腔及咽之惡性腫瘤 - - - 0.32 0.12 0.13 0.06 0.21 消化器及腹膜之惡性腫瘤 - - - 0.11 0.07 0.21 0.13 0.04 骨、結締組織、皮膚及乳房之惡

性腫瘤 - - - 0.36 0.00 0.00 0.19 0.00

表4、電焊技術士各項癌症之發生率勝算比—依年度分

表4、電焊技術士各項癌症之發生率勝算比—依年度分(續)

註:數值代表各項癌症之發生率勝算比(odds ratio),刮號內為 95%信賴區間

表 4、電焊技術士各項癌症之發生率勝算比—依年度分(續)

註:數值代表各項癌症之發生率勝算比(odds ratio),刮號內為 95%信賴區間

表 4、電焊技術士各項癌症之發生率勝算比—依年度分(續完)

表 5、電焊技術士各項癌症死亡人數百分比

癌症名稱 人數 百分比(%)

肝癌 16 23.19

結腸直腸癌 8 11.59

皮膚癌 7 10.14

白血癌 7 10.14

胃癌 5 7.25

非何杰金淋巴癌 4 5.8

口腔癌 3 4.35

鼻咽癌 3 4.35

肺癌 2 1.45

食道癌 1 1.45

膽囊和肝外膽管癌 1 1.45

胰臟癌 1 1.45

腹膜癌 1 1.45

結締組織癌 1 1.45

不明原發部位 1 1.45

全部樣本數 61 100

表6、電焊技術士各項癌症之標準化死亡率比—依年度分

癌症名稱 1991 1992 1993 1994 1995 1996 1997

唇、口腔及咽之惡性腫瘤 - - - 0.57 -

口腔癌 - - - -

鼻咽癌 - - - 3.11 -

消化器及腹膜之惡性腫瘤 - - - 0.14 - 0.13 -

食道癌 - - - -

肝癌 - - - 0.21 -

胃癌 - - - -

結腸直腸癌 - - - 3.81 - - -

膽囊癌 - - - -

胰臟癌 - - - -

腹膜癌 - - - -

呼吸及胸內器官之惡性腫瘤 - - - -

肺癌 - - - -

骨、結締組織、皮膚及乳房之惡性腫 瘤

- - - -

結締組織癌 - - - -

表6、電焊技術士各項癌症之標準化死亡率比—依年度分(續完)

癌症名稱 1998 1999 2000 2001 2002 2003

唇、口腔及咽之惡性腫瘤 - 0.29 - 0.57 - -

口腔癌 - 110.49 - 95.67 - -

鼻咽癌 - - - -

消化器及腹膜之惡性腫瘤 0.38 0.25 0.36 0.22 0.21 0.32

食道癌 1.43 - - - - -

肝癌 - 0.43 0.91 19.97 14.41

胃癌 - - 1.28 1.23 - -

結腸直腸癌 1.51 1.50 2.59 1.22 - 1.34

膽囊癌 - - - - 3.27 -

胰臟癌 - - - 2.32

腹膜癌 87.42 - - - - -

呼吸及胸內器官之惡性腫瘤 0.46 - - - 0.40 -

肺癌 0.52 - - - 0.45 -

骨、結締組織、皮膚及乳房之惡性 腫瘤

- - 27.47 4.12 - -

結締組織癌 - - - 14.12 - -

表 7、電焊技術士各項癌症之死亡率勝算比—依年度分

癌症名稱 1991 1992 1993 1994

唇、口腔及咽之惡性腫瘤 - - - -

口腔癌 - - - -

鼻咽癌 - - - -

消化器及腹膜之惡性腫瘤 - - - 0.15

(0.02-1.06)

食道癌 - - - -

肝癌 - - - -

胃癌 - - - -

結腸、直腸癌 - - - 3.08

(0.77-12.35)

膽囊癌 - - - -

胰臟癌 - - - -

腹膜癌 - - - -

呼吸及胸內器官之惡性腫瘤 - - - -

肺癌 - - - -

骨、結締組織、皮膚及乳房之惡 性腫瘤

- - - -

結締組織癌 - - - -

註:數值代表各項癌症之死亡率勝算比(odds ratio),刮號內為 95%信賴區間

表 7、電焊技術士各項癌症之死亡率勝算比—依年度分(續)

表 7、電焊技術士各項癌症之死亡率勝算比—依年度分(續完)

表8、電焊技術士各項系統器官疾病之標準化疾病發生率比—依住院、門診、年度分

表9、電焊技術士 91 年健保各疾病別西醫門診盛行率—依證照別分

表10、電焊技術士 91 年健保各疾病別中醫門診盛行率—依證照別分

表11、電焊技術士 91 年健保各疾病別住院盛行率—依證照別分

表12、電焊技術士 92 年健保各疾病別西醫門診盛行率—依證照別分

表13、電焊技術士 92 年健保各疾病別中醫門診盛行率—依證照別分

表14、電焊技術士 92 年健保各疾病別住院盛行率—依證照別分

表15、電焊技術士 93 年健保各疾病別西醫門診盛行率—依證照別分

表16、電焊技術士 93 年健保各疾病別中醫門診盛行率—依證照別分

表17、電焊技術士 93 年健保各疾病別住院盛行率—依證照別分

表18、電焊技術士 83 年勞保各疾病別西醫門診盛行率—依證照別分

表19、電焊技術士 84 年勞保各疾病別西醫門診盛行率—依證照別分

表20、電焊技術士 70-76 年勞保各疾病別西醫住院盛行率

表21、各傷病分類之樣本數及百分比—依證照別分

電 焊 證 照 別 (%) 傷病分類 樣本數

一般手工電焊 氬氣鎢極電焊 半自動電焊

一般手工電焊 氬氣鎢極電焊 半自動電焊