Associations of Duration of Exposure and Years of Service with Trans-Trans Muconic Acid Level among Printing Industry Workers in Medan, North Sumatera

Background: Trans, trans-Muconic acid is a metabolite of benzene in humans. The determination of its concentration in urine is used as a biomarker of occupational or environmental exposure to benzene. Benzene, also known as benzol, is a colorless liquid with a sweet odor. Benzene evaporates into air very quickly and dissolves slightly in water. Benzene is used in various industries incuding printing industry to make other chemicals. Benzene in the eyes may cause general irritation and damage to cornea. People who breathe benzene for long periods may experience harmful effects in the tissues that form blood cells, especially the bone marrow. This study aimed to analyze the associations of duration of exposure and years of service with trans-trans muconic acid level among printing industry workers in Medan, North Sumatera. Subjects and Method: This was a cross sectional study carried out at printing industry in Medan, North Sumatera. A sample of 16 printing workers were selected for this study. The dependent variable was trans-trans muconic acid level. The independent variables were age, sex, duration of exposure, and years of service. The data were collected by questionnaire and analyzed by a multiple linear regression. Results: The associations of age and sex with trans-trans muconic acid was stastically non-significant. The associations of duration of exposure and years of service with trans-trans muconic acid were stastically significant. The longer duration of exposure and the longer years of service, the higher trans-trans muconic acid level indicating the higher benzene level. Conclusion: Trans-trans muconic acid level is associated with duration of exposure and years of service. Keywords: age, sex, duration of exposure, years of service, trans-trans muconic aci

Geographical variations and district-level factors associated with COVID-19 mortality in Indonesia: a nationwide ecological study

Abstract Background Ensuring health equity, especially for vulnerable populations in less developed settings with poor health system is essential for the current and future global health threats. This study examined geographical variations of COVID-19 mortality and its association with population health characteristics, health care capacity in responding pandemic, and socio-economic characteristics across 514 districts in Indonesia. Methods This nationwide ecological study included aggregated data of COVID-19 cases and deaths from all 514 districts in Indonesia, recorded in the National COVID-19 Task Force database, during the first two years of the epidemic, from 1 March 2020 to 27 February 2022. The dependent variable was district-level COVID-19 mortality rate per 100,000 populations. The independent variables include district-level COVID-19 incidence rate, population health, health care capacity, and socio-demographics data from government official sources. We used multivariable ordinal logistic regression to examine factors associated with higher mortality rate. Results Of total 5,539,333 reported COVID-19 cases, 148,034 (2.7%) died, and 5,391,299 (97.4%) were recovered. The district-level mortality rate ranged from 0 to 284 deaths per 100,000 populations. The top five districts with the highest mortality rate were Balikpapan (284 deaths per 100,000 populations), Semarang (263), Madiun (254), Magelang (250), and Yogyakarta (247). A higher COVID-19 incidence (coefficient 1.64, 95% CI 1.22 to 1.75), a higher proportion of ≥ 60 years old population (coefficient 0.26, 95% CI 0.06 to 0.46), a higher prevalence of diabetes mellitus (coefficient 0.60, 95% CI 0.37 to 0.84), a lower prevalence of obesity (coefficient -0.32, 95% CI -0.56 to -0.08), a lower number of nurses per population (coefficient -0.27, 95% CI -0.50 to -0.04), a higher number of midwives per population (coefficient 0.32, 95% CI 0.13 to 0.50), and a higher expenditure (coefficient 0.34, 95% CI 0.10 to 0.57) was associated with a higher COVID-19 mortality rate. Conclusion COVID-19 mortality rate in Indonesia was highly heterogeneous and associated with higher COVID-19 incidence, different prevalence of pre-existing comorbidity, healthcare capacity in responding the pandemic, and socio-economic characteristics. This study revealed the need of controlling both COVID-19 and those known comorbidities, health capacity strengthening, and better resource allocation to ensure optimal health outcomes for vulnerable population