目标:制定职业健康风险指数,以帮助将职业风险成分引入流行病学研究,并评估意大利城市的职业风险水平,以支持预防措施。
方法:定义市政指标,该指标是由国家职业数据和环境档案登记册得出的职业和地域指标的组合。
方法:指数构成基于工伤数据,2015-2019年,市一级的职业病和接触致癌物的工人,以及有关拥有国家利益的环境修复站点(SIN)和大型工业设施(GIE)的城市的数据,登记为污染物排放者,位于。
方法:根据意大利国家工伤事故保险研究所(Inail)收集的与工作年龄人口有关的数据,计算了意大利城市发生的职业伤害和职业病的标准化比率(15-69和15,分别),由意大利国家统计研究所(Istat)于2018年估算。此外,包括来自国家职业暴露于致癌物信息系统(SIREP)的数据,从中计算市政一级的原始利率。最后,包括另外两个指标,描述SIN的存在/不存在以及每个城市的GIE工业设施的数量。职业健康风险指数(INDORS)是通过将上述指标的标准化值求和为连续变量来计算的,并且还按人口的五分之一分类为分类变量。使用2015年发生的死亡率数据评估了特定原因死亡率和INDORS水平之间的关联。
结果:在观察期间,记录了2,011,457、131,353和140,183个受伤事件,职业病和接触致癌物的工人,主要是男性工人。指数等级(1-5)的市政地图显示了强烈的南北梯度,符合意大利工业地理环境。在南部地区和岛屿的热点城市,SIN和GIE指标的贡献更高。在分析的1,099个城市中,风险级别最低,1,331处于中低水平,1,619处于中等水平,2,621处于中高水平,1,284处于最高风险水平。该指数显示与意外死亡率直接相关,与全因死亡率和恶性肿瘤死亡率呈负相关。
结论:拟议的指数有助于在生态学研究和结果中引入职业风险维度,作为根据职业风险对意大利市政当局进行排名的灵活工具。
OBJECTIVE: to develop an occupational health risk index that can help to introduce the occupational risk component into epidemiological studies and assess the level of occupational risk in Italian municipalities useful for supporting prevention measures.
METHODS: defi nition of a municipal index as a combination of occupational and territorial indicators derived from national registers of occupational data and environmental archives.
METHODS: the index composition is based on data on work injuries, occupational diseases and workers exposed to carcinogens in the years 2015-2019 available at the municipal level, as well as data on municipalities hosting sites of national interest for environmental remediation (SIN) and those in which big industrial facilities (GIE), registered as pollutant emitters, are located.
METHODS: standardized rates of occupational injuries and occupational diseases occurred in Italian municipalities were calculated from data collected by the Italian National Institute for Insurance against Accidents at Work (Inail) in relation to the working-age population (15-69 and 15+ for injuries and occupational diseases, respectively), estimated by the Italian National Statistical Institute (Istat) in 2018. In addition, data from the National Information System on Occupational Exposure to carcinogens (SIREP) were included, from which raw rates were calculated at municipal level. Finally, two other indicators were included, describing the presence/absence of a SIN and the number of GIEs industrial facilities in each municipality. The index of occupational health risk (INDORS) is calculated by summing standardised values of the above fi ve indicators as a continuous variable and it was also classifi ed by quintiles of population as a categorical variable. The association between cause-specific mortality and INDORS levels was evaluated using data on mortality occurring in 2015.
RESULTS: during the observation period 2,011,457, 131,353 and 140,183 events were recorded for injuries, occupational diseases and workers exposed to carcinogens, mainly among male workers. A municipal map of INDORS levels (1-5) shows a strong South-North gradient, in line with the Italian industrial geographical context. The contributions of the SIN and GIE indicators are higher in the hot spot municipalities located in the Southern regions and islands. Among the municipalities analysed 1,099 were classifi ed in the lowest risk level, 1,331 in the low-medium level, 1,619 in the medium level, 2,621 in the medium-high level and 1,284 in the highest risk level. The index shows a direct correlation with accidental mortality and an inverse correlation with all-cause and malignant neoplasm mortality.
CONCLUSIONS: the proposed index can be useful to introduce the occupational risk dimension in ecological studies and results as a flexible tool to rank Italian municipalities in terms of occupational risk.