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题名	基于伤残调整寿命年（DALYs）的饮用水健康风险评价
作者	潘申龄
学位类别	硕士
答辩日期	2014-05
授予单位	中国科学院研究生院
授予地点	北京
导师	杨敏
关键词	健康风险评价 饮用水 伤残调整寿命年 消毒副产物 氟化物 砷 health risk assessment drinking water disability adjusted life years (DALYs) disinfection byproducts (DBPs) fluoride arsenic
其他题名	Health Risk Assessment of Drinking Water Based on Disability-adjusted Life Years (DALYs)
学位专业	环境工程
中文摘要	近年来，我国的水污染形势并未得到有效遏制。为保证供水安全，有必要从健康风险评价的角度对饮用水进行安全管理。一般，污染物的健康风险表示为特定的疾病终点（如癌症，腹泻）。由于疾病终点的差异性，不同污染物的风险不可直接进行比较。为此，WHO 推荐采用标准指标— 伤残调整寿命年（disability-adjusted life years，DALYs）表达污染物造成的疾病负担。目前，多类污染物的DALYs 计算方法尚不成熟。本研究选取我国两次大规模水质调查中不同类别的检出率较高的污染物：三卤甲烷（THMs）、卤乙酸（HAAs）、二甲 基亚硝胺（NDMA）、溴酸盐，氟化物以及砷，对其基于DALYs 的健康风险评价方法进行研究，并根据全国水质调查数据，计算各污染物引起的疾病负担和经济负担，对其进行初步的风险排序和成本-效益分析。该工作完善了饮用水健康风险评价方法体系，并为饮用水中不同污染物质的风险比较及优先污染物筛选提供了方法学支持。主要研究成果归纳如下：      1) 改进了各类污染物基于 DALYs 的健康风险评价方法。对于DBPs，将EPA建立的风险评价模型结合WHO 建立的癌症疾病模型，使传统的终身癌症发病率估算值转化为DALYs 损失值。对于氟化物，首次以FP 优化的Meta 回归分析方法建立全国尺度上的饮水氟含量和氟斑牙患病率的剂量-效应关系，在DALYs基本计算公式的基础上，估算不同严重程度氟斑牙的疾病负担。对于砷，以已有的计算方法为基础，将美国环保局和国家研究委员会建立的饮水砷与癌症的剂量-效应曲线结合WHO 的疾病模型，精细化了DALYs 的计算结果。       2) 在所建方法的基础上，根据我国水质调查数据，分别计算了六种污染物造成的健康风险，分别以DALYs 损失和癌症发病率（除氟化物）表示。按DALYs损失（单位：10-6 DALYs per person-year），其风险排序从大到小分别为：氟化物（16.27），砷（2.19），NDMA（0.61），THMs（0.59），HAAs（0.35），溴酸盐（0.011）。其中，氟化物和砷的风险超过WHO 制订的参考水平（单位：10-6 DALYs per person-year）。由于影响人口众多，疾病持续时间长，氟化物造成的疾病负担不容忽视。按癌症发病率（单位：10-5），风险排序为：砷（5.87），THMs（2.35），HAAs（1.42）， NDMA（0.45），溴酸盐（0.038）。DALYs和癌症发病率表示的癌症风险排序不一致，因为DALYs 指标综合了癌症的发病率、严重程度和人群影响程度三个尺度。       3) 根据各污染物的 DALYs 损失，采用人力资本法（HCA）计算其造成的经济负担（单位：百万元），从大到小分别为：氟化物（327.94），砷（86.94），NDMA（17.47），THMs（17.38），HAAs（10.48），溴酸盐（0.47），与DALYs的排序结果一致。氟化物造成的经济负担最大，提高氟斑牙患者的就诊率可以减 少DALYs 损失，但会进一步增加经济负担。
英文摘要	In recent years, China's water pollution has not been effectively curbed. To ensure the safety of water supply, safety management must be carried out in drinking water based on the health risk assessment. The risks of pollutants are usually expressed in specific disease endpoints (such as cancer, diarrhea). Due to the differences of disease endpoints, the risks of different pollutants cannot be compared directly. Therefore, WHO recommended the standard metric: disability-adjusted life years (DALYs) expressing the burden of disease caused by pollutants. Currently, DALYs calculation methods of many kinds of pollutants are immature. This research selected specific pollutants that had higher detection rate in China's two large-scale water quality investigation: trihalomethanes (THMs), haloacetic acids (HAAs), N-Nitrosodimethylamine (NDMA), bromate, fluoride and arsenic, and investigated their methods of health risk assessment based on DALYs. Then according to the data of the national water quality survey, the disease burden and economic burden of the selected pollutants were calculated and ranked. Finally, preliminary cost-benefit analyses were conducted. This work will improve the method system of health risk assessment on drinking water, and provide methodology support or the comparison and prioritization of health risks of different pollutants in drinking water. The main results are summarized as follows:       1) The health risk assessment methods based on DALYs of various pollutants were improved. For DBPs, the traditional risk assessment models established by EPA were combined with the disease model established by the World Health Organization (WHO) to convert the lifetime cancer incidence estimates into DALYs lost. For fluoride, this paper attempted for the first time to establish the dose-response relationship of the fluoride content in drinking water and prevalence rate of dental fluorosis on a national scale by meta-regression optimized by fractional polynomial. Then based on the basic calculation formulas of DALYs, the disease burden of moderate and severe dental fluorosis were calculated. For arsenic, the existing calculation method of disease burden was further improved. The dose-response curves of arsenic in drinking water and various cancers established by the United States Environmental Protection Agency (EPA) and the National Research Council (NRC) were combined with disease model established by WHO to refine the results of DALYs.       2) Based on the established methods and the water quality survey data, the health risks of the six pollutants were calculated, and expressed in DALYs lost and cancer incidence rates (except for fluoride) respectively. According to DALYs (unit: 10-6 DALYs per person-year), the descending order of the risks was fluoride (16.27), arsenic (2.19), NDMA (0.61), THMs (0.59), HAAs (0.35) and bromate (0.011). The risks of fluoride and arsenic exceeded the risk reference level of WHO (110-6 DALYs per person-year). The disease burden of fluoride ranked the first due to a large number of its affected people and its long disease duration. According to cancer incidence rates (unit: 10-5), the descending order of the risks was arsenic (5.87), THMs (2.35), HAAs (1.42), NDMA (0.45) and bromate (0.038). The rankings of the risks expressed in DALYs and incidence rates were different, since DALYs incorporated three dimensions-cancer incidences, cancer severity and the extent of population influence.       3) Based on the estimated DALYs of six pollutants, human capital approach (HCA) was adopted to calculate their economic burdens (unit: million yuan),and the descending order was: fluoride (327.94), arsenic (86.94), NDMA (17.47),THMs (17.38), HAAs (10.48), and bromate (0.47), consistent with that of DALYs.Fluoride caused the biggest economic burden. The improvement of the treatment rate of dental fluorosis patients can reduce the loss of DALYs, but will further increase the economic burden.
公开日期	2015-07-08
内容类型	学位论文
源URL	[http://ir.rcees.ac.cn/handle/311016/15641]
专题	生态环境研究中心_环境水质学国家重点实验室
推荐引用方式 GB/T 7714	潘申龄. 基于伤残调整寿命年（DALYs）的饮用水健康风险评价[D]. 北京. 中国科学院研究生院. 2014.

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