探討國內營造業職場健康因素與職災相關性

Abstract

背景：營造業因工作環境複雜且具高度危險性，在各行業中職災發生率居高不下。臺灣營造業工作者多為無固定雇主的自營業者，難以獲得完整的職場健康服務。過去臺灣對營造業職災的研究主要聚焦於工安法規、安全行為和管理制度層面，較少探討執業環境條件及工作者個人健康狀況對職災發生的影響。因此本研究主要目的為瞭解臺灣營造業工作者的執業環境與個人健康現況，並探討這些因素與職業災害之間的相關性。

方法：本研究採用橫斷性研究設計，研究對象為年滿18歲以上的營造業工作者。透過自填式問卷調查，蒐集受訪者的執業環境暴露現況、生理及心理社會健康、以及職業災害經驗等資料。本研究使用多變項羅吉斯迴歸探討執業環境暴露、個人身心健康社會狀況對職災發生的影響，此外亦透過中介效應分析，檢視研究對象的個人健康狀況是否在執業環境暴露與職災發生之間具有中介作用。最後在以雇用關係進行分層分析，探討影響不同雇用關係的工作者發生職災的危害因子。

結果：總共回收1,010份問卷，經排除填答不完整者，最終納入816位營造業工作者進行分析。其中57%為無固定雇主及受僱於自然人雇主之工作者，30%為受僱於公司者，及13%為工程師。研究對象以男性為主（78%）、平均年齡為46.1歲（標準差± 12.9）、工作年資平均為13.3年（標準差± 12）。研究結果顯示，營造業工作者有暴露於粉塵（aOR2=1.92，95% CI: 1.18- 3.13）及個人疲勞得分高（aOR2=1.87，95% CI: 1.30- 2.69）者有較高發生職災的風險。另外，在中介效應分析中，工作環境的粉塵暴露對於職災發生達統計顯著之正向直接效果量（Estimated direct effect=0.67，95% CI: 1.02- 1.31），並且高個人疲勞對於粉塵暴露與職災發生之間接效果量達統計上正向顯著（Estimated indirect effect=0.19，95% CI: 0.09- 0.30），顯示高個人疲勞對於有粉塵暴露與職災發生之間具中介效應。進一步以雇用關係進行分層分析，發現影響無固定雇主及受僱於自然人雇主之工作者發生職災風險的因素有：在工作日睡眠時長<6小時（aOR2=2.43，95% CI: 1.02- 5.78）、有粉塵暴露（aOR2=1.94，95% CI: 1.08- 3.49）及個人疲勞得分（aOR2=2.38，95 % CI: 1.48- 3.85）；受僱公司之營造業工作者的職災危害因子有大學及以上之學歷背景（aOR2=2.14，95 % CI: 1.10- 4.18）和噪音暴露（aOR2=2.35，95% CI: 1.19- 4.63）；工程師則是有粉塵的人有較高的風險發生職災（aOR2=4.90，95% CI: 1.28- 18.81）。

結論：本研究發現粉塵暴露、噪音暴露，睡眠少於六小時，與高個人疲勞與營造業工作者的職災發生有關，建議未來可透過教育訓練、積極推動健康促進，與定期健康檢查、以改善營造業者執業環境健康，以降低職災發生。

Background: The construction industry has one of the highest occupational accident rates across all industries due to hazardous working conditions. In Taiwan, construction workers are predominantly self-employed without fixed employers, limiting their access to occupational health care services. While previous studies on occupational accidents in Taiwan’s construction industry have mainly focused on occupational safety regulations, safety behaviors, and management systems, there has been limited investigation into how the working environment and workers’ health status influence occupational accidents. This study examines the working environment and personal health status of Taiwan’s construction workers and investigates their relationship with occupational accidents. Methods: This cross-sectional study targeted employed construction workers aged 18 and above in Taiwan. Data were collected through a self-administered questionnaire that assessed participants’ exposure to their working environment, physiological and psychosocial health status, and history of occupational accidents. Multiple logistic regression was applied to identify factors influencing occupational accidents. Additionally, mediation analysis was performed to evaluate whether personal health mediated the relationship between the working environment and the occurrence of occupational accidents. Finally, stratified analyses based on employment relationships were conducted to explore the risk factors contributing to occupational injuries among workers in different types of employment. Result: A total of 1,010 questionnaires were collected. After excluding incomplete responses, 816 construction industry workers were included in the analysis. Among the participants, 57% were workers without a fixed employer or employed by individual employers, 30% were employed by companies, and 13% were engineers. The majority of participants were male (78%), with a mean age of 46.1 years old (SD ± 12.9) and a mean work tenure of 13.3 years (SD ± 12). The study revealed that individuals exposed to dust (aOR2=1.92, 95% CI: 1.18- 3.13) and those with high personal burnout scores (aOR2=1.87, 95% CI: 1.30- 2.69) had a significantly higher risk of occupational accidents. Dust exposure showed a statistically significant positive direct effect on occupational accidents (Estimated direct effect=0.67, 95% CI: 1.02- 1.31). Furthermore, high personal burnout had a statistically significant positive indirect effect on the relationship between dust exposure and occupational accidents (Estimated indirect effect=0.19, 95% CI: 0.09- 0.30), indicating that personal burnout mediates the association between dust exposure and occupational accidents. A stratified analysis based on employment type identified the following: workers without fixed employers or employed by individual employers, factors associated with a higher risk of occupational accidents included sleeping less than six hours on workdays (aOR2=2.43, 95% CI: 1.02- 5.78), exposure to dust (aOR2=1.94, 95% CI: 1.08- 3.49), and high burnout (aOR2=2.38, 95% CI: 1.48- 3.85). Construction workers employed by companies, significant factors included having a college-level education or higher (aOR2=2.14, 95% CI: 1.10- 4.18) and noise exposure (aOR2=2.35, 95% CI: 1.19- 4.63). Engineers, only exposure to dust was significantly associated with occupational accident (aOR2=4.90, 95% CI: 1.28- 18.81). Conclusion: This study identified that dust exposure, noise exposure, insufficient sleep (less than six hours), and high personal burnout are associated with an increased risk of occupational accidents among construction workers. Future efforts should prioritize educational training, health promotion programs, regular health examinations, and enhanced occupational health conditions within the construction industry to reduce the incidence of occupational accidents.