詹長權臺灣大學：職業醫學與工業衛生研究所楊惠如Yang, Hui-JuHui-JuYang2007-11-282018-06-292007-11-282018-06-292007http://ntur.lib.ntu.edu.tw//handle/246246/59864目的：透過收集飲用水品質及空氣品質等環境品質資料，與社區整合式篩檢之民眾個人資料，進行環境品質與高血壓相關性之研究。 材料與方法：研究族群為台灣81個社區81,949位20歲以上參與社區整合式篩檢之民眾（2001年至2005年）。高血壓依據美國國家高血壓預防、診斷、評估以及治療聯合委員會第七次報告建議之分類，收縮壓高於或等於140 毫米汞柱，或舒張壓高於或等於90 毫米汞柱者定義為高血壓個案。空氣品質資料為環保署空氣品質監測網之空氣品質測站資料，項目包括空氣中懸浮微粒（粒徑小於10微米）、二氧化氮、二氧化硫、一氧化碳、臭氧，資料收集期間為1993年至2005年。飲用水品質資料來源為台灣自來水公司之檢測資料，以及環保署毒管處之抽驗資料，項目包括硬度、酸鹼值、亞硝酸鹽、硝酸鹽、硫酸鹽，資料收集期間為1979年至2005年。統計模式採用具有隨機校應的廣義線性混合型模式，控制相關危險因子，包括性別、年齡、身體質量指數、抽菸、飲酒、運動習慣、家族病史、教育程度，探討環境品質與高血壓之關係。 結果：共計選取12個社區共18867為民眾為空氣品質研究社區，而飲用水品質則有81個社區共81949個民眾。12個空氣品質研究社區中，高血壓年齡標準化盛行率為23 %，而81個飲用水品質研究社區中之高血年齡標準盛行率為24 %。在個人危險因子方面，性別、年齡、身體質料指數、飲酒、低教育程度、家族病史、飯前血糖，在本研究中發現與高血壓有正相關。而抽菸、運動、高密度脂蛋白，在本研究中發現與高血壓有負相關。空氣品質中，二氧化硫(OR: 1.21, 1.12-1.29)，懸浮微粒(PM10) (OR: 1.10, 1.06-1.15), 以及二氧化氮 (OR: 1.16, 1.08-1.25)與罹患高血壓有顯著正相關。而在飲水品質中，硝酸鹽 (OR: 0.91, 0.85-0.97)，硫酸鹽(OR: 0.98, 0.98-0.99)以及總硬度(OR: 0.97, 0.96-0.98)則與罹患高血壓呈現顯著負相關。 結論：空氣品質中之二氧化硫、懸浮微粒以及二氧化氮與高血壓呈現正相關，而飲用水品質中的硝酸鹽、硫酸鹽、總硬度，則呈現負相關。確切的劑量反應和生物機轉需要後續的研究以釐清。Purpose: The purpose of this study is to investigate the association between hypertension and air and drinking water quality. Material and methods: Our study population includes 81,949 residents over 20 years old of 81 communities who have participated in a community-based integrated screen programs for multiple diseases from 2001 to 2005 in Taiwan. The classification of participant’s hypertensive status is based on the JNC7 criteria. The air quality data in each community including particulate matter, nitrogen oxide, sulfur dioxide, carbon oxide, and ozone from 1993 to 2005 were obtained from the TEPA air pollutant monitor network. The quality of drinking water in each community including hardness (calcium carbonate), pH, nitrite, nitrate, and sulfate during 1979-2005 obtained from a routine monitoring program operated by the Taiwan Water Cooperation (TWC) and Taiwan Environmental Protection Agency (TEPA). We used Generalized Linear Mixed-effect models to investigate the association between hypertension and environmental quality items adjusted for gender, age, body mass index, smoking, drinking, exercise, education level and family history. Results: We collected 18867 subjects in 12 communities to study the association of air quality and hypertension, and 81949 subjects in 81 communities to study the association of drinking water quality and hypertension. The age adjusted prevalence rate averaged at 23 % among the 12 communities, and the age adjusted prevalence rate of hypertension averaged at 24 % among the 81 communities. In our study, we found the effects of these risk factors of hypertension as follows: gender, age, BMI, drinking, low educational level, hypertension family history, and glucose value showed the positive effects of hypertension; cigarette smoking, exercise behavior, and HDLC value showed negative effects. We found the positive effects of sulfur dioxide (OR: 1.21, 1.12-1.29), PM10 (OR: 1.10, 1.06-1.15), and nitrogen dioxide (OR: 1.16, 1.08-1.25) in air quality and the negative effects of nitrite (OR: 0.91, 0.85-0.97), sulfate (OR: 0.98, 0.98-0.99), and hardness (OR: 0.97, 0.96-0.98) in drinking water quality. Further multiple pollutants and gender difference analysis also showed similar results. Conclusion: Sulfur dioxide, particulate matter, and nitrogen dioxide in air quality are positively associated with hypertension, whereas nitrite, sulfate, and hardness are negatively associated with hypertension. Further studies can be performed to explore the dose response and biomechanism.I Introduction 1 1.1 The Studies of Hypertension 1 1.2 The Health Effects of Environmental Quality 5 1.2.1 Air Quality 5 Particulate Matter 5 Carbon Monoxide 10 Ozone 10 Sulfur Dioxide 11 Nitrogen Dioxide 12 1.2.2 Drinking Water Quality 13 Hardness 14 II Material and Method 15 2.1 Study Framework 15 2.2 Study Population 16 2.2.1 Definition and Measurements of Blood pressure 24 2.2.2 Individual Risk Factors 25 2.3 Air Quality 26 2.4 Drinking Water Quality 27 2.5 Data Analysis 28 III. Results 32 3.1 Air Quality 32 3.1.1 The air pollutants’ concentration in the 12 air quality communities 32 3.1.2 The distribution of individual risk factors in the 12 air quality communities 35 3.1.3 The prevalence of hypertension in the 12 air quality sample communities 39 3.1.4 The model of hypertension and air quality 41 3.2 Drinking Water Quality 48 3.2.1 The drinking water pollutants concentration in the 81 water quality communities 48 3.2.2 The distribution of individual risk factors in the 81 water quality communities 53 3.2.3 The prevalence of hypertension in the 81 drinking water quality communities 67 3.2.4 The model of hypertension and drinking water quality 71 3.3 Multiple pollutants of air quality and drinking water quality 77 IV. Discussion 85 4.1 Air quality, drinking water quality and hypertension 85 4.2 Study limitations 94 4.3 Conclusion 96 V. Reference 97 VI. Appendixes 103711547 bytesapplication/pdfen-US空氣品質飲用水品質高血壓廣義線性混合型模式Air qualitydrinking water qualityhypertensionGeneralized Linear Mixed Modelthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59864/1/ntu-96-R94841005-1.pdf