化工企业工人在低水平复合职业暴露下的健康状况变化及管理对策分析OA

[Background]Long-term occupational health surveillance facilitates the identification of chronic health risks arising from occupational hazard exposures.However,under low-level exposure conditions in chemical enterprises,traditional workplace-centered risk assessment models are insufficient to fully explain the observed health effects among workers,highlighting the need for individual-focused health management strategies that focus on the worker. [Objective]To characterize long-term health trends among workers in a chemical enterprise and examine the limitations of workplace hazard monitoring and health surveillance under low-level multiple exposure scenarios,thereby providing a scientific basis for more comprehensive worker health protection measures. [Methods]We analyzed 972 occupational health examination records collected over a 15-year period(2010-2024)from a chemical en-terprise,integrating these with enterprise hazard monitoring reports and workshop air monitoring of volatile organic compounds(VOCs).The annual counts and prevalences of abnormalities in liver function tests,metabolic syndrome-related indicators,and liver imaging were summarized.Temporal trends were evaluated using the Cochran-Armitage trend test.Time-related changes in abnormal health in-dicators among active workers were evaluated by generalized linear mixed-effects models(GLMMs),adjusting for age and sex.Individual longitudinal profiles were described for nine workers with continuous 15-year records.In addition,paired comparisons of health outcomes were conducted for 81 workers with both pre-employment and periodic examinations. [Results]Workplace hazard monitoring indicated that airborne concentrations of major occupational contaminants including VOCs,acids and bases,dust,and physical factors were below national occupational exposure limits.However,62 VOC species—including chloroben-zene,chloromethane,and cyclohexane—were detected in workshop air,suggesting complex mixed organic solvent exposure.From 2010 to 2015,occupational health examination records were primarily based on physicians'qualitative assessment,yielding generally low ab-normality detection rates.During 2016-2024,data collection was complete,and the prevalences of abnormalities in liver function,metabolic syndrome-related indicators,and liver imaging among active workers remained relatively high.Trend analysis indicated that only the abnormality rates of total bilirubin(TBIL)and hypertension showed statistically significant temporal trends;other indicators ex-hibited no significant linear changes despite high prevalences.After adjusting for age and sex,the GLMMs showed that the abnormality rates of aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT),TBIL,and hypertension decreased over time,whereas those of total cholesterol,triglycerides,and fatty liver increased.In a subgroup of 9 workers with continuous 15-year follow-up data,the cumulative number of abnormal health indicators increased in several individuals after 2016.Among the 81 workers with both pre-em-ployment and periodic records,abnormalities in total cholesterol,triglycerides,body mass index,and fatty liver were significantly more prevalent after employment over time,whereas changes in liver function enzymes were not statistically significant. [Conclusion]With increasing age,workers exhibit a gradual deterioration in liver function and metabolic-related health indicators,reaching abnormality rates comparable to those reported in the general population.These findings suggest that both workplace-related and non-occupational factors jointly contribute to the observed health changes.Consequently,occupational health management should shift to-wards an"individual-centered"approach.Enhancing workers'health literacy,strengthening workplace health promotion,and extending occupational health services beyond the workplace are essential to comprehensively protect workers'health.