职业伤害主动和被动监测的联合应用分析：基于英国HSE数据
Joint application of active and passive surveillance of occupational injuries: Based on UK HSE data
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摘要:
背景 英国采用主动监测和被动监测两种方式共同收集职业伤害数据，构建了较为完善的职业伤害监测体系，可为我国职业伤害监测体系的构建提供借鉴和参考。
目的 分析英国职业伤害主动监测和被动监测结果，探讨主被动监测方式在职业伤害防控领域的联合应用价值。
方法 应用劳动力调查的非致命性职业伤害主动监测数据评估报告数、报告率、年损失工作日、人均损失工作日、每病例平均损失工作日等指标；应用雇主上报的致命性被动监测数据评估报告死亡数、报告死亡率等指标。采用Join-point回归分析2004—2020年致命性和非致命性职业伤害的报告趋势，计算年度变化百分比（APC）和平均年度变化百分比（AAPC）。
结果 主动监测显示，2004—2020年缺勤≥0 d的报告数由89.7（95%CI：85.2~94.2）万降到44.1（95%CI：39.1~49.2）万，报告率由32100/10万（95%CI：3050/10万~3370/10万）降到1410/10万（95%CI：1250/10万~1570/10万），呈线性下降趋势（APC和AAPC均为−3.88%，
P <0.05）；2019年每病例平均损失工作日为9.1（95%CI：6.8~11.5） d。被动监测显示，2004—2020年报告死亡数由223人降到142人，报告死亡率由0.78/10万降到0.44/10万，报告死亡率呈线性下降趋势（APC和AAPC均为−4.59%，P <0.05）。结论 英国致命性和非致命性职业伤害报告率呈线性下降趋势。基于劳动力调查的主动监测方式在非致命性职业伤害评估方面监测指标更多，基于雇主上报的被动监测方式在致命性职业伤害评估方面更具优势，联合应用两种监测方式并结合AAPC等趋势分析指标，能较全面地掌握职业伤害流行病学特征。
Abstract:Background The United Kingdom (UK) adopts active surveillance and passive surveillance to jointly collect occupational injury data, and builds a relatively complete occupational injury surveillance system, which can provide reference for the construction of China's occupational injury surveillance system.
Objective To compare the results of active surveillance and passive surveillance of occupational injuries in the UK, and to explore the joint application value of active and passive surveillance methods in the field of occupational injury prevention and control.
Methods The non-fatal occupational injury active surveillance data from Labor Force Survey were used to calculate indicators such as number of reported cases, reporting rate, lost workdays per year, lost workdays per capita, and average lost workdays per case. The fatal passive surveillance data reported by the employers were used to calculate number of reported deaths, reported mortality, and other indicators. Join-point regression was used to estimate the reported trends of fatal and non-fatal occupational injuries from 2004 to 2020, and the annual percentage change (APC) and average annual percentage change (AAPC) were calculated.
Results The active surveillance data showed that from 2004 to 2020, the number of reported cases of absenteeism ≥0 d due to occupational injury decreased from 89.7 (95%CI: 85.2, 94.2) per ten thousand to 44.1 (95%CI: 39.1, 49.2) per ten thousand, and the reporting rate of occupational injury decreased from 32100/100000 (95%CI: 3050/100000, 3370/100000) to 1410/100000 (95%CI: 1250/100000, 1570/100000), showing a linear downward trend (both APC and AAPC were −3.88%,
P <0.05); the average lost workdays per case in 2019 was 9.1 (95%CI: 6.8, 11.5) d. The passive surveillance data showed that from 2004 to 2020, the number of reported deaths due to occupational injury decreased from 223 to 142, and the reporting rate of occupational injury decreased from 0.78/100000 to 0.44/100000, showing a linear downward trend (both APC and AAPC were −4.59%,P <0.05).Conclusion The reporting rates of fatal and non-fatal occupational injuries in the UK are showing a linear downward trend. The active surveillance method based on Labor Force Survey provides more surveillance indicators for non-fatal occupational injuries, and the passive surveillance method based on employer report has more advantages in assessment of fatal occupational injuries. Jointly applying the two surveillance modalities and the combination of trend analysis indicators, such as AAPC, provide a more comprehensive picture of the epidemiological characteristics of occupational injuries.
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