Study On Disability Weights Of Health Outcomes In Lead Contaminated Sites

Objective: In recent years,as heavily polluting enterprises have been shut down or relocated from the city,a large number of contaminated sites,mainly heavy metal pollution,have been generated in cities and surrounding areas.As one of the most toxic heavy metal elements in the environment,lead(Pb)will cause health damage to a variety of organ systems once it enters the human body.In order to quantify health damage,the economic burden of disease can be used for evaluation,but there is currently a lack of disability weight(DW)for health damage caused by lead pollution.This study uses a combination of professional and general descriptions of health states,drawing on the research methods of the Global Burden of Disease(GBD),to clarify the disability weights of different degrees of health damage caused by lead pollution in sites,providing important parameters for the economic burden of diseases caused by lead pollution.Methods: According to Chinese National Occupational Health Standard GBZ 37-2015 "Diagnosis of Occupational Chronic Lead Poisoning",the professional description of chronic mild,moderate and severe lead poisoning was determined.The Euro Qol five-dimension Health Scale was used to convert the professional description into general description,and experts from occupational hospitals and general hospitals were invited to comprehensively demonstrate the accuracy of professional description and general description.Referring to the construction principle of the severity spectrum of health states in Europe,12 different health states were selected from the published DW from light to heavy,and "deafness" with cross-cultural stability was included.A total of 13 health states constituted the health impairment severity spectrum in this study,and their professional and general descriptions were determined.Experts from general hospitals were invited to comprehensively demonstrate the accuracy of the descriptions.Then,the Delphi method was used to comprehensively demonstrate the matching degree between GBD 2019 and the health states of this study.The Mean >4.0 and the variance between expert opinions(CV)<0.25 were considered as the health states matching.By referring to the Paired Comparison(PC)method in GBD,this study carried out a network questionnaire survey among medical professionals and general population by two-stage sampling and multi-stage stratified random sampling respectively on July 1,2022,to collect demographic information of respondents and responses to paired comparison questions.A total of 1202 questionnaires(542 from medical professionals and 660 from the general population)were collected.After screening,455 valid questionnaires from medical professionals and 558 valid questionnaires from the general population were collected,with effective response rates of 83.95% and 84.56%.The data were analyzed using R software(version 4.1.1).The probability regression coefficient is obtained by using Probit Regression analysis on the result of the paired comparison problem,and the LOESS function model is established.Finally,the DW of chronic lead poisoning in different degrees is obtained,and the 95% uncertainty interval of the DW of the health states were estimated using a Monte Carlo model.In addition,Pearson correlation analysis was used to evaluate the change of the probability regression coefficient divided by the basic characteristics of the interviewees and the relationship among the medical professionals,the general population,and GBD 2019 DW.Spearman correlation analysis was used to evaluate the relationship between DW in this study and DW in China.Results: A total of 15 expert consultation questionnaires were sent out and 15 were collected,with effective recovery of 100%,indicating a high expert positive coefficient.The authority coefficient of experts is 0.89,indicating that the credibility and authority of experts are great.Except for diabetes mellitus and HIV/AIDS(seropositive and asymptomatic),the mean of the remaining health states ranged from 4.40 to 4.80,and the coefficient of variation ranged from 0.09 to 0.14,which could be considered to match the health states of GBD 2019.Among medical professionals,the DW for chronic mild lead intoxication was 0.136(95%UI: 0.083-0.215),chronic moderate lead intoxication was0.345(95%UI: 0.208-0.512),and chronic severe lead intoxication was 0.497(95%UI:0.282-0.713).In the general population,the DW for chronic mild lead intoxication was0.127(95%UI: 0.071-0.215),chronic moderate lead intoxication was 0.337(95%UI:0.189-0.528),and chronic severe lead intoxication was 0.574(95%UI: 0.282-0.823).The results showed that the disability weight was positively correlated with the severity of disease for specific health states.Pearson correlation analysis showed that probability regression coefficients of different gender,age,education level and income level were highly correlated(P<0.01).There was a high correlation between the DW of medical professionals and the general population(P<0.01).There was a moderate correlation between DW in medical professionals and DW in GBD 2019(P<0.05),and a moderate correlation between DW in general population and DW in GBD 2019(P<0.05).Spearman correlation analysis showed that DW of different populations in this study was moderately correlated with DW in China(P<0.05).Conclusion : In this study,a combination of professional description and general description was used to describe health states,and the paired comparison of GBD was used to obtain DW of different degrees of chronic lead intoxication for the first time.There was a high correlation between the DW of medical professionals and the general population,indicating that their views were consistent.Gender,age,education level and income level had no significant effect on health states assessment.