职业性煤尘和噪声联合暴露与工人高频听力损失之间的关联：一项横断面研究

文献信息

中文摘要

背景： 职业环境中含有多种有害因素，噪声常与其他物理、化学因素共存，导致联合暴露，可能增加工人听力损伤的风险。本研究旨在探讨职业性噪声和煤尘联合暴露与工人噪声性听力损失之间的关联，为职业人群中职业性噪声性听力损失的预防和控制提供依据。
方法： 我们对1,187名职业暴露工人进行了横断面研究。选取2023年在白银市某职业健康检查机构接受职业健康检查的工人作为研究对象，分为单纯噪声组（276人）和噪声-煤尘联合暴露组（911人）。采用纯音气导听阈测试评估听力损失，并应用χ²检验和多因素logistic回归分析识别高频听力损失（HFHL）的危险因素。
结果： 噪声组和噪声-煤尘联合暴露组HFHL的患病率分别为35.5%和46.8%，差异有统计学意义（p < 0.001）；语频听力损失的患病率相对较低。听力异常主要集中在高频范围，在4,000 Hz附近有明显下降。多因素logistic回归分析表明，年龄、性别和职业危害因素暴露是HFHL的独立危险因素。经多变量调整后，与单纯噪声暴露相比，职业性噪声和煤尘联合暴露与更高的HFHL风险相关（OR = 1.620，95% CI：1.198-2.190，p = 0.002）。
结论： 职业性噪声性听力损失以HFHL为主，被归类为职业性噪声和煤尘联合暴露的工人发生HFHL的调整后风险高于被归类为单纯职业性噪声暴露的工人。应加强对联合暴露于多种危害因素的工人的综合防护和职业健康监护。

英文摘要

BACKGROUND: Occupational environments contain a wide variety of harmful factors, with noise often coexisting with other physical, chemical factors, leading to combined exposure that may increase the risk of hearing impairment among workers. This study aims to investigate the association of occupational noise and coal dust combined exposure on noise-induced hearing loss in workers, providing evidence for the prevention and control of occupational noise-induced hearing loss in occupational populations.
METHODS: We conducted a cross-sectional study of 1,187 occupationally exposed workers. These workers who underwent occupational health examinations at a certain occupational health examination institution in Baiyin City in 2023 were selected as study subjects and divided into a noise only group (276 participants) and a combined noise-coal dust exposure group (911 participants). Pure-tone air-conduction audiometry was used to assess hearing loss, and the χ 2 test and multivariate logistic regression analysis were applied to identify risk factors for high-frequency hearing loss (HFHL).
RESULTS: The prevalence rates of HFHL were 35.5 and 46.8% in the noise group and the combined noise-coal dust exposure group, respectively, with a statistically significant difference (p < 0.001); the prevalence of speech-frequency hearing loss was relatively low. Hearing abnormalities were primarily concentrated in the high-frequency range, with a marked decline around 4,000 Hz. Multivariate logistic regression analysis indicated that age, gender, and exposure to occupational hazards were independent risk factors for HFHL. After multivariable adjustment, combined exposure to occupational noise and coal dust was associated with higher odds of HFHL compared with noise exposure alone (OR = 1.620, 95% CI: 1.198-2.190, p = 0.002).
CONCLUSION: Occupational noise-induced hearing loss is predominantly HFHL, and Workers classified as jointly exposed to occupational noise and coal dust had higher adjusted odds of HFHL than workers classified as exposed to occupational noise alone. Comprehensive protection and occupational health surveillance for workers exposed to combined hazards should be strengthened.