Occupational exposures and health-related quality of life in the Manaus Metropolitan Region, Amazonas State, Brazil: a cross-sectional study

Abstract: We aimed to investigate the association between occupational exposures and health-related quality of life among both informal and formal workers in the Brazilian Amazon. We conducted a cross-sectional study with working adults in the Manaus Metropolitan Region, Amazonas State, in 2015. Participants were selected through a three-step probabilistic sampling. The primary outcome was the health-related quality of life indicator, measured by the Brazilian validated version of the European Quality of Life 5-Dimensions 3-Levels (EQ-5D-3L) tool. Adjusted multivariate analysis was performed by Tobit regression and considered the complex sampling design. Results were converted to odds ratio (OR). Out of the 1,910 working individuals from the sample, 60.2% were formal workers. Informal workers were significantly more exposed to occupational risks than formal workers (p ≤ 0.05). Mean utility score for informal and formal workers was 0.886 (95%CI: 0.881; 0.890). Quality of life of informal workers was negatively impacted by exposure to noise (OR = 1.28; 95%CI: 1.13; 1.52), occupational stress (OR = 1.95; 95%CI: 1.65; 2.21), and industrial dust (OR = 1.46; 95%CI: 1.28; 1.72), while formal workers were negatively associated with exposure to chemical substances (OR = 1.58; 95%CI: 1.28; 1.87), noise (OR = 1.40; 95%CI: 1.23; 1.65), sun (OR = 1.65; 95%CI: 1.09; 1.40), occupational stress (OR = 1.65; 95%CI: 1.46; 1.87), biological material (OR = 2.61; 95%CI: 1.72; 3.97), and industrial dust (OR = 1.46; 95%CI: 1.28; 1.65). Exposure to occupational risks among workers from the Manaus Metropolitan Region was high, affecting both informal and formal workers. Brazilian policies need to be enforced to reduce the impacts on quality of life among workers in this region.

摘要：本研究旨在探究巴西亚马逊地区非正式与正式劳动者的职业暴露与健康相关生活质量之间的关联。我们于2015年在亚马孙州马瑙斯大都会区开展了针对在职成年人的横断面研究。研究对象通过三步概率抽样法选取。本研究的主要结局指标为健康相关生活质量，采用经巴西验证的欧洲五维健康量表3水平版（European Quality of Life 5-Dimensions 3-Levels, EQ-5D-3L）进行测量。校正后的多变量分析采用托比特回归（Tobit regression）进行，并考虑了复杂抽样设计。结果以比值比（odds ratio, OR）形式呈现。在本次研究纳入的1910名在职个体中，60.2%为正式劳动者。非正式劳动者的职业暴露风险显著高于正式劳动者（p ≤ 0.05）。非正式劳动者与正式劳动者的平均效用得分分别为0.886（95%CI：0.881；0.890）。暴露于噪声（OR = 1.28；95%CI：1.13；1.52）、职业性应激（OR = 1.95；95%CI：1.65；2.21）与工业粉尘（OR = 1.46；95%CI：1.28；1.72）会对非正式劳动者的生活质量产生负面影响；而正式劳动者的生活质量则与接触化学物质（OR = 1.58；95%CI：1.28；1.87）、噪声（OR = 1.40；95%CI：1.23；1.65）、日晒（OR = 1.65；95%CI：1.09；1.40）、职业性应激（OR = 1.65；95%CI：1.46；1.87）、生物材料（OR = 2.61；95%CI：1.72；3.97）及工业粉尘（OR = 1.46；95%CI：1.28；1.65）呈负相关。马瑙斯大都会区劳动者的职业暴露风险处于较高水平，对非正式与正式劳动者的生活质量均造成影响。巴西需强化相关政策执行，以降低该地区劳动者生活质量所受的负面影响。