職場社會心理危害對受僱者肌肉骨骼及心腦血管疾病之疾病負荷研究

Abstract

背景：肌肉骨骼疾病為臺灣職災保險現金給付中首要的職業病類型，心腦血管疾病則為職災死亡給付中最大宗的職業病類型，然而，目前仍少有研究透過完整的職場危害來推估職場社會心理危害對於這些疾病負荷規模的影響。本研究利用「族群可歸因分率（Population Attributable Fraction，以下簡稱PAF）」進行「比較性風險評估（Comparative Risk Assessment，簡稱CRA）」，此方法不但可獲得特定危險因子造成疾病負荷的程度，還可比較不同危險因子造成的疾病負荷規模，以提供政策推行時排列職場危險因子介入順序的考量依據。 目的：瞭解臺灣職場社會心理危害對受僱者造成職業相關疾病的疾病負荷程度。 方法：針對與職業相關的肌肉骨骼疾病，一併考慮職場人因性危害及社會心理危害進行疾病負荷推估：各職場危害的PAF由2016年「勞動環境安全衛生狀況認知調查」資料估算，分析對象為20-65歲受僱於政府或私人企業的工作者，職場危害以量表或題項測量，包括工作心理負荷、工作控制、工作回饋、職場正義、工作時間、輪班方式及與全身或手部有關的各種人因性危害；肌肉骨骼疾病則使用挪威肌肉骨骼傷害問卷測量；利用以對數為連結函數的二項式模型（Log-linked binomial model）計算各職場危害的盛行率比（prevalence ratio，以下簡稱PR）後，套入各職場危害之暴露盛行率計算PAF；疾病負荷程度以失能損失年（Years Lived with Disability，以下簡稱YLD）呈現，各疾病的嚴重度分布及失能權重套用全球疾病負荷的數值，盛行個案的人數則由2000-2016年全民健保資料庫的處方及治療明細檔（含門急診及住院）計算，計算的疾病包括頸部痛、肩膀痛、下背或腰部的肌肉骨骼疾病三種，每種疾病在2016年盛行個案數和全球疾病負荷的失能權重相乘後得到各疾病於2016年整體的YLD，再乘上各職場危害的PAF後，即獲得各疾病可歸因於不同危險因子的YLD，最後，除以臺灣2016年20-65歲的年中人口數，獲得每十萬人口因與職業相關的肌肉骨骼疾病造成之YLD。針對與職業相關的心腦血管疾病，使用文獻回顧的方式獲得職場社會心理危害及職場噪音危害對冠心病及中風的相對危險性（relative risk，簡稱RR），各職場社會心理及噪音危害的暴露盛行率亦由2016年「勞動環境安全衛生狀況認知調查」的資料計算，2016年冠心病及中風盛行個案的人數則由2000-2016年全民健保資料庫的處方及治療明細檔（含門急診及住院）計算，最後，使用與推估肌肉骨骼疾病負荷的相同步驟，估算2016年每十萬人口因與職業相關的心腦血管疾病造成之YLD。 結果：職場人因性危害對男性受僱者頸部、肩部、下背或腰部肌肉骨骼疾病的PAF分別為8.5%、12.4%、17.5%，2016年20-65歲男性因此損失10、11、309 YLD/10萬人，而職場人因性危害對女性受僱者各部位的肌肉骨骼疾病之PAF分別為11.1%、10.7%、17.8%，分別造成20-65歲女性損失19、12、340 YLD/10萬人；職場社會心理危害造成男性受僱者頸部、肩部、下背或腰部肌肉骨骼疾病的PAF分別為32.5%、21.3%、29.3%，對20-65歲男性分別造成39、24、518 YLD/10萬人，在女性部分PAF分別為24.0%、19.5%、21.5%，可造成40、23、411 YLD/10萬人。在與職業相關的心腦血管疾病方面，冠心病的部分有31.6%可歸因於職場社會心理危害、缺血性中風有9.5%，另有3.1%的心腦血管疾病可歸因於職場噪音危害，2016年20-65歲民眾因職場社會心理危害造成的冠心病或缺血性中風損失21.7及4.1 YLD/10萬人，因職場噪音危害造成心腦血管疾病的損失為3.6 YLD/10萬人。 結論：職場社會心理危害造成與職業相關的疾病負荷規模不容小覷，未來在減少傳統危險因子的職場健康促進之外，宜多加考慮減輕職場社會心理危害之介入方式，以期獲得更好的職業健康預防成效。

Background: Musculoskeletal disorders (MSDs) are the most common type of compensated occupational diseases, and cerebro-cardiovascular diseases (CCVD) are the first leading cause of death in workers’ compensation of Taiwan. However, few studies have been conducted to estimate the contribution of psychosocial work hazards to work-related disease burden with a more comprehensive evaluation of multiple work hazards. In this study, comparative risk assessment (CRA) was used to estimate disease burden by incorporating population attributable fraction (PAF). This method can not only obtain information of the extent of disease burden attributable to a specific risk factor, but also compare the extent of burden of different diseases attributable to different risk factors. Results of estimation can provide evidence for prioritizing workplace risk factors in the design of intervention strategies. Objective: This study aimed to examine work-related MSDs and CCVD burden attributable to psychosocial work hazards in employees of Taiwan. Methods: Ergonomic and psychosocial work hazards were both considered to estimate burden of work-related MSDs. PAFs of each work hazard were calculated using data from a nationwide survey conducted by the Institute of Labor, Occupational Safety and Health of the Taiwan Ministry of Labor in 2016. Study subjects for analysis were 20-65 year-old employees. Work hazards including job psychological demands, job control, job reward, workplace justice, working hours, shift work, and whole-body-related or hand-related ergonomic exposures were assessed with scales or question items. Symptoms of MSDs were measured by the Nordic Musculoskeletal Questionnaire. Prevalence ratio (PR) of each work hazard was calculated by log-linked binomial model, and then PAFs of work hazards were calculated by combining prevalence of exposure of each work hazard. Years lived with disability (YLD) was presented to assess the extent of disease burden with the proportions of severity and their disability weights from the Global Burden of Disease Study. Prevalent cases were calculated from claim data of the National Health Insurance Research Database (NHIRD) and the diseases included were neck pain, shoulder pain, and low back pain. Work-related YLD per 100 thousand 20-65 year-old population was calculated by multiplying number of cases by YLD and PAF then dividing by mid-year 20-65 year-old population in 2016. RRs of psychosocial work hazards and workplace noise for coronary heart disease and stroke were obtained from literature review to calculate PAFs for estimating work-related CCVD burden. Prevalence of exposure to each psychosocial work hazard and workplace noise was calculated with data from the above mentioned nationwide survey and the number of prevalent cases was calculated from claim data of NHIRD. Work-related YLD per 100 thousand 20-65 year-old population was calculated by the same method for the estimation of work-related MSDs burden. Results: PAFs of ergonomic work hazards for neck, shoulder and low back pain were 8.5%, 12.4% and 17.5% in male employees, causing 10, 11 and 309 YLD/100,000 in the 20-65 year-old male population, respectively. PAFs of ergonomic work hazards for neck, shoulder and low back pain were 11.1%, 10.7% and 17.8% in female employees, causing 19, 12 and 340 YLD/100,000 in the 20-65 year-old female population, respectively. PAFs of psychosocial work hazards for neck, shoulder and low back pain were 32.5%, 21.3% and 29.3% in male employees, causing 39, 24 and 518 YLD/100,000 in the 20-65 year-old male population, respectively. PAFs of psychosocial work hazards for neck, shoulder and low back pain were 24.0%, 19.5% and 21.5% in female employees, causing 40, 23 and 411 YLD/100,000 in the 20-65 year-old female population, respectively. 31.6%, 9.5% of coronary heart disease and stroke in employees was attributable to psychosocial work hazards, respectively, and 3.1% of CCVD in employees was attributable to workplace noise. In 2016, psychosocial work hazards were estimated to cause 21.7 and 4.1 YLD/100,000 due to coronary heart disease and stroke, respectively, and workplace noise were estimated to cause 3.6 YLD/100,000 due to CCVD in the 20-65 year-old population. Conclusion: Burden of work-related disease attributable to psychosocial work hazards should not be overlooked. In addition to workplace health promotion through reducing traditional risk factors, strategies of reducing psychosocial work hazards should be implemented for more effective occupational health prevention.