倒班与肥胖对煤矿工人高尿酸血症患病风险的影响:基于横断面研究的剂量-反应关系与交互作用分析

Impact of shift work and obesity on risk of hyperuricemia in coal miners: A cross-sectional design based dose-response relationships and interaction analysis

  • 摘要:
    背景 中国居民高尿酸血症(HUA)患病率逐年增高,而职业人群因倒班工作或肥胖而导致HUA发病风险较高。
    目的 探讨倒班、肥胖对煤矿工人HUA的影响,为预防煤矿工人发生HUA提供科学数据。
    方法 采用横断面研究,以2023年某煤矿集团25619名职工作为研究对象,进行问卷调查与职业健康检查。排除退养、伤退职工,排除问卷调查回答不足或未完成人体测量或血液检查者,最终选择23173人纳入研究。使用非条件logistic回归模型分析HUA与是否倒班、倒班年限、每日倒班工作时长、体质量指数(BMI)、腰高比(WHtR)、内脏脂肪指数(VAI)的关联程度及肥胖与倒班对HUA的交互作用,使用限制性立方样条函数分析倒班年限、每日倒班工作时长与HUA的剂量-反应关系。
    结果 纳入职工的平均年龄为(42.38±9.82)岁。共检出6735例HUA患者,检出率为29.1%,且男性高于女性(31.8% vs. 13.9%)。调整混杂因素后,限制性立方样条模型显示,倒班年限、每日倒班工作时长与HUA存在非线性剂量-反应关系:①当倒班年限超过3.25年,随着工作年限的增加工人患HUA的风险逐渐升高;当倒班年限达到20年时,风险增加呈现一定的“饱和效应”,即HUA风险不再随倒班年限的增加而增高。②每日倒班工作时长在10 h以下时,HUA的风险随着倒班时长的增加而升高,但在超过10 h后,风险趋于稳定。调整混杂因素后,logistic回归分析结果显示:与从不倒班者相比,倒班、倒班年限10~20年及20年以上、每日倒班工作时长8 h以下及超过8 h人群患HUA风险更高,OR分别为1.14(95%CI:1.06~1.22)、2.42(95%CI:2.20~2.67)、2.23(95%CI:2.00~2.48)、1.41(95%CI:1.29~1.54)与1.90(95%CI:1.75~2.06);与各肥胖指数正常者相比,BMI超重及肥胖组、VAI较高及很高组、WHtR超标组HUA患病风险更大,OR(95%CI)分别为2.01(1.85~2.17)、3.51(3.20~3.84)、1.42(1.32~1.54)、2.10(1.91~2.30)与1.82(1.69~1.97)。交互作用分析显示倒班(P<0.001)与肥胖指数(P<0.001)对HUA均不存在交互作用。
    结论 进行倒班工作、倒班工作年限长与每日倒班工作时长多会增加煤矿工人HUA患病的风险,同时肥胖对HUA发病的作用也不容忽视。

     

    Abstract:
    Background The prevalence of hyperuricemia (HUA) among Chinese residents has been increasing annually, with occupational populations facing a higher risk of HUA due to shift work or obesity.
    Objective To investigate the impact of shift work and obesity on HUA among coal miners, and to provide scientific data for the prevention of HUA in this occupational group.
    Methods A cross-sectional study was conducted with 25619 workers from a coal mining group in 2023 as the study population, using a questionnaire survey and occupational health check-ups. Workers who were retired or on medical leave, as well as those who provided incomplete responses to the questionnaire or did not complete anthropometric measurements or blood tests, were excluded. A total of 23173 participants were included in the study. An unconditional logistic regression model was used to analyze the association between HUA and selected factors such as shift work status, years of shift work, daily shift work hours, body mass index (BMI), waist-to-height ratio (WHtR), and visceral adiposity index (VAI), as well as the interaction between obesity and shift work on HUA. Restricted cubic spline functions were used to analyze the dose-response relationship between years of shift work, daily shift work hours, and HUA.
    Results The average age of the included workers was (42.38 ± 9.82) years. A total of 6735 workers reported positive HUA, with a positive rate of 29.1%, and the prevalence was higher in men compared to women (31.8% vs. 13.9%). After adjusting for confounding factors, the restricted cubic spline model revealed a nonlinear dose-response relationship between years of shift work, daily shift work duration, and HUA: ① When the years of shift work exceeded 3.25 years, the risk of HUA in workers gradually increased with longer work duration. At 20 years of shift work, the risk increase showed a "saturation effect," meaning that the risk of HUA no longer increased with additional years of shift work. ② When daily shift work duration was below 10 h, the risk of HUA increased with the length of shift work, but after exceeding 10 h, the risk stabilized. After adjusting for confounding factors, the logistic regression model showed that, compared to non-shift workers, shift workers, those with 10-20 years and over 20 years of shift work experience, as well as those working less than 8 h and more than 8 h per day, had a higher risk of HUA, with odds ratios (OR) of 1.14 (95%CI: 1.06, 1.22), 2.42 (95%CI: 2.20, 2.67), 2.23 (95%CI: 2.00, 2.48), 1.41 (95%CI: 1.29, 1.54), and 1.90 (95%CI: 1.75, 2.06), respectively. Additionally, compared to individuals with normal obesity indices, those with overweight and obesity based on BMI, high and very high VAI and excessive WHtR had a higher risk of HUA, with ORs of 2.01 (95%CI: 1.85, 2.17), 3.51 (95%CI: 3.20, 3.84), 1.42 (95%CI: 1.32, 1.54), 2.10 (95%CI: 1.91, 2.30), and 1.82 (95%CI: 1.69, 1.97), respectively. The interaction analysis showed no interaction between shift work and obesity index (both Ps < 0.001).
    Conclusion Shift work, longer shift work years, and longer daily shift work hours increase the risk of HUA among coal miners. Additionally, the role of obesity in the development of HUA cannot be ignored.

     

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