Cht c da cam v t l ung th ca ngi Vit Nam

30 nm sau chin tranh

Qu Ton

Tm tt
Trong cuc chin tranh Vit Nam, hn 70 triu lt cht dit c qun s c ri xung vng
chin s. Nghin cu ny s dng s liu v tnh trng ung th do ngi tr li t khai, hoc do
ngi khc cung cp, thu c t cuc iu tra y t quc gia Vit Nam (s mu l 158.019
ngi), kt hp vi s liu v tnh trng phi nhim cht dit c qun s c tnh ton chi tit t
cc thng tin v hot ng qun s ca qun i M v ng minh trong thi gian din ra cuc
chin. Nu ch so snh mt cch gin n, nghin cu khng pht hin thy s khc bit ng k v
t l ung th gia cc x b nhim cht dit c qun s vi cc x khng b nhim. Nhng khi tp
trung vo nhng x c nhim c v s dng mt bin lin tc o lng mc phi nhim, nghin
cu tm thy bng chng cho thy c mi lin h gia liu lng v phn ng; trong s cc x b
phi nhim, nhng x cng c mc phi nhim cao cng c tng quan vi t l ung th c
bo co trong hai nm 2001-2002. Nghin cu khng tm thy bng chng r rng v mc nh
hng khc nhau gia nhm nhng ngi sinh ra trc v sau khi chin dch ri cht c din ra.

M phn loi JEL: N42, N45

T kha: Cht c mu da cam/cht c da cam/cht da cam, cht dit c, ung th, dch t
hc, Vit Nam, chin tranh.

inh V Trang Ngn, L ng Trung v Hong Hoa gip chuyn ng sang ting Vit, dch t bn gc, Agent Orange
and the Prevalence of Cancer in the Vietnamese Population 30 Years after the End of the Vietnam War, World Bank Policy
Research Working Paper #5041, Washington DC: September 2009.
Trn trng cm n s gip v gi ca Jeanne v Steven Stellman trong vic tnh ton cc kt qu o c qu trnh phi
nhim ha cht dit c. L ng Trung v Phng c Tng tr gip chng ti xy dng b s liu cui cng. Nhng trao
i vi William Clark, Jack Colford, Jishnu Das, Quc Anh, Jed Friedman, Lakshmi Iyer, Peter Lanjouw, Carl Mason, Axel
Pustan, Biju Rao, Jeanne Stellman, Steven Stellman, Carrie Turk, Adam Wagstaff v Damien de Walque cng gip ch rt
nhiu cho nghin cu ny.
Nhng pht hin, gii thch v kt lun th hin trong ti liu ny khng nht thit phn nh quan im ca Ngn hng Th
gii, cc Gim c iu hnh cng nh cc quc gia m h i din.

Nhm Nghin cu Kinh t Pht trin. Ngn hng Th gii. MSN MC3-306; 1818 H Street, NW. Washington DC 20433. T:
+1 202 473 9452; Fax: +1 202 522 1153; Email: qdo@worldbank.org; Web: http://econ.worldbank.org/staff/qdo

1. Gii thiu
Trong cuc chin tranh Vit Nam (1959-1975), 72 triu lt cht c dit c c ri xung
t nm 1961 n nm 1971 nhm lm rng l rng v ph hy ma mng. C nhiu loi cht dit
c c s dng, vi tn gi t theo mu sn ca thng cha. c bit n nhiu nht l cht
c mu da cam, chim khong 65% tng lng cht c c s dng (theo nghin cu ca
Stellman v cc ng tc gi, 2003). Trong s , mt s ha cht (Da cam, Tm, Hng v Xanh l
cy) c nng cht 2,4,5-trichlorophenoxyacetic acid cao, c gia tng c t bng 2,3,7,8tetrachlorodibenzo-p-dioxin (sau y gi tt l dioxin). Theo c tnh, c tng cng 366 kg dioxin
nguyn cht c ri xung, trong khi theo T chc Y t Th gii, mc dung np dioxin hng
ngy i vi c th ngi ch l 1-4 pg (1 pg = 10-15kg) cho mi kg th trng. Hn na, s tn d
lu di c ghi nhn v nng dioxin cao trong thc n, t v m c th ngi Vit Nam,
c ngha l c tnh ca cc cht ni trn c th vn tn ti rt lu sau chin tranh. 1
Tuy nhin, chng minh vic ri cht c dit c c tc ng n sc khe ca ngi dn l
hon ton khng d dng. Trong phin to m nguyn n l Hi Nn nhn Cht c Da
cam/Dioxin Vit Nam kin cc cng ty cung cp ha cht dit c cho qun i M ti Vit Nam,
thm phn cp cao Jack Weinstein nhn mnh, "vic c mt s ngi ang phi hng chu bnh
tt sau qu trnh ri ha cht khng phi l bng chng y chng minh c mi quan h
nhn qu ni chung hay c th [gia vic ri cht c v tnh trng bnh tt]" (trch dn trong
nghin cu ca Stone, 2007). Vin Y khoa Hoa K c hai nm mt ln u xut bn mt ti liu v
kin thc khoa hc lin quan ti tc ng ca vic nhim cht c dit c s dng trong chin tranh
Vit Nam (Vin Y khoa, 2007). y l tp hp mt s lng ng k cc ti liu nghin cu tp
trung vo i tng cu binh M. Rt ng tic l Vit Nam, vi mc thu nhp bnh qun u
ngi tnh theo ngang bng sc mua ch khong 2,000 USD nm 2007, khng c mt ti liu vi
mc y v tin cy nh cc nghin cu M, ni m thu nhp bnh qun u ngi l 45.800
USD (theo CIA, 2008).
Nghin cu ny t cu hi rng, nu khng c h s bnh n chi tit, v ch s dng s liu
t mt cuc iu tra a mc tiu trn 36,000 h gia nh ngi Vit Nam, trong c c s liu do
ngi tr li t khai v do ngi th ba khai v tnh trng sc khe c nhn, liu c th lm r tc
ng ca vic ri cht dit c qun s trong chin tranh ti sc khe dn thng 30 nm sau chin
tranh hay khng. Nghin cu ny kt hp nhng thng tin chi tit v cc chin dch qun s ca

Bng chng v mc cao cht dioxin tn d lu di trong thc phm c a ra trong nghin cu ca Schecter v cc
ng tc gi (2003, 2004) v nghin cu ca Schecter, Malish v Ryan (2003); v bng chng v tn d lu di dioxin trong
t, xem nghin cu ca Schecter, Elitzer v Hiters (1989) v nghin cu ca Tuan v cc ng tc gi (2007). Cui cng,
cc nghin cu ca Schecter v cc ng tc gi (1987, 1994, 1995, 1996, 2001, 2002, 2003, 2004, v 2006), CDC (1988),
Kahn v cc ng tc gi (1988), Quynh, Dai v Thom (1989) v Phuong v cc ng tc gi (1996) chng minh s hin din
ca dioxin trong m c th ngi.

qun i M v ng minh vi b s liu v h gia nh, phn tch mi quan h gia mc phi
nhim cht c dit c trong chin tranh vi t l ung th c bo co ngi Vit Nam trong
khong 30 nm sau khi chin tranh kt thc. 2
Khi so snh cc x b nhim c vi cc x khng b nhim c, nghin cu khng tm thy s
khc bit ng k v t l ung th c bo co trong iu tra h gia nh. Pht hin ny c th
phn nh trung thc mt sai lch thng k, v s ngi t vong do ung th c th lm gim t l
nhng ngi b ung th m ta quan st c, trong khi vn nht qun vi mt t l mi nhim ung
th ln hn. Nghin cu cng tm thy mt s tng quan gia liu lng nhim c v mc
phn ng, hay gi l mi tng quan p ng liu (dose-response). Mi tng quan p ng liu
o lng mc phn ng khi liu lng tng thm, trong cc trng hp liu lng ln hn
khng. C th, nghin cu pht hin rng trong cc x tng b nhim c trc y, x no phi
nhim nhiu hn c t l ung th (t khai) cao hn trong thi gian 2001-2002. Mc d c th nhng
pht hin ny th hin mi quan h nhn qu gia vic nhim cht c mu da cam v bnh ung
th, chng ta vn phi ht sc thn trng khi din gii kt qu ny, bi v s liu v phng php
lun c s dng trong nghin cu ny cn nhiu hn ch. Th nht, thng tin v t l mc ung
th c ly t mt cuc iu tra v do c th b sai lch do khai bo; ngoi ra cng khng c
cch no kim nh li nhng khai bo ny, v khng c thng tin c th l ngi tr li b loi bnh
ung th no. Th hai, d liu sn c ch c th cho php ta tnh t l ung th hin mc ch khng
phi l t l mi mc phi, do c th dn ti nhng sai lch thng k, mc d trong trng hp
ny, chng ta c l do tin rng h s sai lch l hng v pha khng. Th ba, s ri cht dit
c qun s chc chn khng th l ngu nhin, m ph thuc vo cc iu kin c th ti a
phng m rt c th ng thi cng lin quan n cc yu t nguy c gy ung th. Mc d c th
theo di v kim sot kh nhiu cc yu t gy nhiu, nhng nghin cu ny vn khng th loi b
hon ton yu t bt ng nht tim tng ca cc yu t .
Nghin cu ny l mt trong s cc cng trnh nghin cu khoa hc v di chng chin tranh
(xem bi tng kt ca Blattman v Miguel, 2009). Khi khng th qu nhn mnh n hu qu trc
tip ca chin tranh, o bng t l thng vong v hu qu trn s tn hi thn th, cc nh nghin
cu cng quan tm phn tch v qu trnh hi phc kinh t v s pht trin di hn sau chin
tranh. Organski and Kugler (1977) v gn y l Chen, Loayza v Reynal-Querol (2008) tm thy
bng chng cho thy cc quc gia c th quay tr li mc pht trin kinh t trc chin tranh sau
khi ha bnh lp li. Nhiu nghin cu cp quc gia cng tm thy bng chng v s hi t di hn.
Davis v Weinstein (2002), Brakman, Garretsen v Schramm (2004) v Miguel v Roland (2006) ln
2

Thng qua C quan Vn th Lu tr Quc gia Hoa K (the National Archives and Records Administration), qun i M
xy dng c c s d liu thng tin chi tit v nhng hot ng qun s trong thi chin. Kalyvas v Kocher (2009) xem
xt nhng yu t quyt nh vic s dng bo lc bng cch s dng H thng nh gi Thn p, mt c s d liu v bo
lc chng li dn thng ti cc thn p Vit Nam. Gn gi hn vi nghin cu ny v mt phng php lun v ngun s
liu, nghin cu ca Miguel v Roland (2006) li s dng thng tin v hot ng nm bom tm hiu nhng tc ng di
hn ca n ti pht trin kinh t.

lt tm thy bng chng v s bt kp tng trng nhng khu vc b nh hng nng n bi

nh bom Nht Bn, c v Vit Nam. V cc vn lin quan n hu qu v mt sc kho ca
chin tranh, hu ht cc n lc nghin cu tp trung vo i tng nghin cu l cu chin binh
(hu ht cc nghin cu y khoa c cc chuyn gia trong ngnh nh gi cho v tc ng ca
cht c da cam ln sc khe u c thc hin trn i tng l cu chin binh), trong khi c rt
t s ch dnh cho dn thng; mt phn c th l v khng c s liu ph hp. Tuy nhin, vn c
nhng ngoi l nh: cng trnh phn tch xuyn quc gia ca Ghobarah, Huth v Russett (2003)
cung cp nhng bng chng chng minh nhng hu qu gin tip v ko di ca chin tranh lm
tng thm gnh nng v t vong v tn tt. cp vi m, nghin cu ca Alderman, Hoddinot v
Kinsey (2004) v nghin cu ca Akresh, Verwimp v Bundervoet (2009) tm hiu hu qu ca cc
cuc xung t ln mc suy dinh dng tr em v tnh trng sc khe lu di, cn Do v Iyer
(2009) tng kt cc cng trnh nghin cu mi m v hu qu ca chin tranh ln sc khe tm
thn, v lit k khi qut nhng thch thc v mt phng php lun trong vic nh gi cc tc
ng ca nhng cuc xung t bo lc ln sc khe tm thn. Nghin cu ny cng n lc gii
quyt mt s vn v nhn dng (identification) c nu ln trong nghin cu ca Do v Iyer
(2009).
Nghin cu c b cc nh sau: phn 2 cung cp nhng thng tin c bn v cuc chin tranh
Vit Nam c lin quan n nghin cu ny. Phn 3 miu t d liu c s dng trong phn tch v
din gii phng php phn tch nh lng. Phn 4 trnh by v tho lun v cc kt qu, v phn
5 tng kt li ton b nghin cu.

2. Cuc chin tranh Vit Nam v nhng tranh ci v cht c da cam

Chin tranh Vit Nam hay Chin tranh ng Dng ln th hai khi ngun t cuc Chin tranh
ng Dng ln th nht (1946-1954), t du chm ht cho 70 nm thng tr ng Dng ca
thc dn Php v chia Vit Nam thnh hai min Bc Nam sau Hi ngh Geneva ngy 21 thng By
nm 1954.3 Mt min Bc Vit Nam theo ch cng sn v mt min Nam Vit Nam thn phng
Ty c hnh thnh hai bn v tuyn 17.
Ngy chin tranh bng n thng c tnh t cuc tn cng u tin ca qun du kch min
Bc Vit Nam i vi qun min Nam nm 1959. H Ch Minh, v lnh t ca min Bc Vit Nam, t
mc tiu l thng nht t nc di ch cng sn. Thng 12 nm 1960, chnh quyn H Ni
thnh lp Mt trn Dn tc Gii phng (NLF) min Nam Vit Nam. Ban u, s tham d ca M ch

Phn ny khi qut mt s thng tin chung c bit n v Chin tranh Vit Nam, v khng c nh gii thch v bt k
kha cnh no ca cuc xung t. Xem (VD) Guilmartin (1991) bit thm thng tin v cc cuc chin tranh Vit Nam k
t khi c s tham d ca Php.

hn ch vic cung cp tr gip k thut v ti chnh cho chnh quyn Min Nam nhm gip
Qun i Vit Nam Cng ha (ARVN) chin u chng li du kch. Sau s kin Vnh Bc b thng 8
nm 1964 khi tu chin M b tn cng ngoi khi b bin Vit Nam, M tng cng s hin din
v mt qun s; nhng binh lnh M u tin c mt Vit Nam vo nm 1965. Sau nhiu giao
tranh khc lit, min Bc Vit Nam v Mt trn Dn tc Gii phng thc hin cuc Tng tn cng
Tt Mu thn nm 1968 ng lot trn nhiu thnh ph min Nam Vit Nam. Mc d phe cng
sn phi gnh chu nhiu thng vong nng n, chin dch ny gy ting vang ln v mt chnh
tr v tm l; Tng thng Lyndon Johnson khng th ti c c v Richard Nixon nhm chc vi k
hoch chm dt s tham d ca M v xy dng Qun i Vit Nam Cng ha ln mnh. Ngy 27
thng Mt nm 1974, Hip nh Ha bnh Paris c k kt chm dt xung t; ton b qun M
sau rt khi Vit Nam. Khng lu sau, min Bc Vit Nam tip tc tn cng v nhanh chng nh
bi Qun i Vit Nam Cng ha. Cc lc lng cng sn tin vo Si Gn, th min Nam Vit
Nam vo ngy 30 thng T nm 1975. Chin tranh Vit Nam kt thc v mc tiu t nc thng
nht di ch cng sn c thc hin.
Mt c im gy tranh ci trong k nguyn chin tranh qun s Vit Nam l vic s dng rng
ri cht dit c qun s. Trong giai on 1961-1971, c tnh c khong 72 triu lt cht c
c qun i M v ng minh ri xung Vit Nam, vi mc tiu ph hy ni tr n v ngun
lng thc ca i phng.4 Mt s cht c dit c c gia tng c tnh bng dioxin, c tnh
tng cng 366 kg dioxin nguyn cht c ri xung trong chin tranh (theo nghin cu ca
Stellman v cc ng tc gi, 2003). Bng 1 c trch t ti liu nghin cu ca Stellman v cc
ng tc gi (2003), cung cp s liu v tng loi ha cht dit c s dng trong cuc chin tranh.
Cht c da cam l loi c s dng nhiu nht, chim 65% lng ha cht dit c s dng.
[BNG 1]
T nm 1977, nhiu bo co v cc triu chng nh hng ti sc khe ca cc cu binh chin
tranh Vit Nam thc y chnh ph M phi yu cu thc hin nhng nghin cu nh gi v kh
nng m s phi nhim cht dit c li hu qu v sc khe cho cc cu binh. Quc hi M
thng qua Lut Cht c Da cam nm 1991, trong yu cu Vin Hn Lm Khoa hc Quc gia
(Hoa K) nh gi nhng hu qu v sc khe do nhim cht dit c qun s trong thi gian chin
tranh. C hai nm mt ln, Vin Y khoa li cung cp nhng cp nht v cc bng chng khoa hc
lin quan n ch ny.
Nhng tranh ci ny cn dn n mt cuc chin php l. Cc cu binh v ngi dn Vit Nam
np n kin cc cng ty ha cht sn xut cht dit c. n kin b bc vo ngy 10 thng 3
4

Hu ht (nhng khng phi tt c) nhng chin dch ri cht c dit c l mt phn trong Chin dch Ranch Hand, mt
danh ca hot ng ri cht c dit c ca Khng qun M t 1962-1971.

nm 2005 v c khng n ln Ta Ti cao. Sau , ngy 2 thng Ba nm 2009, ta n ti cao

quyt nh gi nguyn phn quyt bc n.

3. S liu v phng php lun

3.1. S liu
nghin cu tc ng ca vic ri cht c dit c n tnh trng ung th ca ngi dn Vit
Nam, tc gi kt hp hai b s liu quan trng.

3.1.1. iu tra Y t Quc gia Vit Nam 2001-2002

Tnh trng ung th (t khai v khai qua ngi th ba) c thu thp t cuc iu tra Y t
Quc gia Vit Nam (VNHS). VNHS l cuc iu tra cp quc gia do B Y t phi hp vi Tng cc
Thng k thc hin. 1.200 x/phng c chn phn tng ngu nhin (t tng cng 8.926
x/phng) v 36.000 h gia nh c phng vn t thng 11/2001 n thng 11/2002. VNHS thu
thp thng tin v bnh tt bng hnh thc t khai v khai qua ngi th ba. Ni chnh xc hn, iu
tra vin phng vn mt ngi i din gia nh (thng l ch h hoc v/chng ca ch h) v
tnh trng sc khe ca tt c cc thnh vin trong gia nh. C th, thng tin v ung th c hi
v ghi li nh sau: "Xin hi c ai trong gia nh ta tng c bc s hoc nhn vin y t chn
on mc mt trong nhng bnh sau? 1) Huyt p?, 2) Ung th?, 3) ng kinh?". Cu tr li "C"
c nh du bng mt du X trong ct tng ng vi tng loi bnh, v dng tng ng vi c
nhn b bnh . Bin s kt qu m chng ti quan tm trong nghin cu ny c ly t cu tr
li cho cu hi c b ung th hay khng.
Tnh trng kinh t - x hi c nh gi da trn thng tin v vic s dng cc ti sn c bn,
hc vn v mc tiu dng lng thc, thc phm. Ngoi ra, cuc iu tra cn c ring mt m-un
iu tra khc thu thp thng tin v tin s chm sc sc khe ca mi c nhn. Cui cng, cc x
ni cc h gia nh c tr c i chiu vi danh sch chnh thc cc x ti Vit Nam ca Tng cc
Thng k, danh sch ny cng cung cp ta a l ca trung tm hnh chnh x.

3.1.2. H thng Bo co Cht c dit c

Ngoi VNHS, nghin cu ny xy dng s liu v s phi nhim cht dit c qun s bng cch
s dng file d liu H thng Bo co Cht c dit c ca C quan Qun l D liu S Ch huy Vin
tr Qun s M (US Military Assistance Command Data Management Agencys Herbicide Report
System - HERBS). D liu ny bao gm nhng thng tin v cc hot ng qun s trong Chin dch
Ranch Hand, gm c thng tin v cc chin dch khng qun (my bay cnh c nh, trc thng) v
lc qun (xe ti, hnh qun). Nghin cu cng s dng H thng Thng tin a l (geographic

information system - GIS) gip cho vic tnh ton thng tin phi nhim t HERBS c d dng
hn (nghin cu ca Stellman v cc ng tc gi, 2003; nghin cu ca Stellman v Stellman,
1986, 2003, 2005). H thng thng tin a l GIS ban u c thit k iu tra tc ng ca
cht c da cam v cc cht dit c khc cc cu binh M. V tr ca a s cc n v thuc qun
i M u c th xc nh vi chnh xc kh cao. Phn ln cc n v ny rt t hoc khng di
chuyn, v d cc n v n tr; vi nhiu n v c ng, v tr m n di chuyn cng c xc
nh. Tuy nhin s liu v c dn Vit Nam th khc hn. Rt kh xc nh chnh xc v tr hin ti
ni h gia nh sinh sng, cha k ti v tr h sinh sng thi im ri cht dit c. Do , ch s
xc xut b phi nhim do Stellman v cc ng tc gi (2003) v Stellman v Stellman (1986, 2003,
2005) tnh ton khng th s dng c trong bi cnh ca nghin cu ny.
Tuy nhin, h thng thng tin a l GIS cng cho php ta tnh ton s ln mt cuc ri cht
dit c c th ri xung trong phm vi 0.5, 1, 2 v 5 km so vi im tham chiu, v cng cho php
chng ta ch gii hn loi cht c c t dioxin m thi. Tuy nhin, theo thit k th ngi s dng
GIS khng th xc nh gii hn vng m mt cch ch quan. Do mt x Vit Nam thng c
bn knh khong 5 km, cc phng php o m ny gp phi vn : a s cc h sng ranh
gii ca cc vng m bn knh 5 km , m cht dit c thng c ri xung cc cnh ng la
v cc khu rng, cch xa cc trung tm hnh chnh x. khc phc hn ch ny, tc gi m rng
phm vi vng m bng cch tnh tng cng s cuc ri cht dit c trn phm vi 7 hnh trn bn
knh 5 km tip xc nhau. Hnh trn u tin (chic gia) t trung tm x. Su hnh trn ngoi
vi cn li, vi tm l 6 im cch nhau mt khong cch 10 km, to nn mt hnh lc gic ng
knh 20 km nh c minh ha trong Hnh 1. m bo s nht qun, 6 im ngoi vi c chn
sao cho hnh lc gic c mt trc Bc-Nam song song vi ng kinh tuyn. Tng cng s ln m
ri vo 7 hnh trn ny cho ta mt con s c tnh v s ln b ri cht dit c xy ra trong phm vi
15 km so vi v tr tham chiu. Cch m s ln ri cht c dit c ny l phng php c lng
bng bin thay th ch yu c s dng trong nghin cu ny. Ngoi ra, s m ln ri dioxin ch
tnh n nhng ln ri cht dit c c cha dioxin (Cht c Da cam, Tm, Hng v Xanh l cy)
[HNH 1]

3.1.3. H s v hot ng chin s v thng tin v cng nm bom

kim sot cc yu t c kh nng quyt nh mc khc lit ca cuc chin, nghin cu
ny cn s dng d liu b sung v hot ng nm bom do Chng trnh Qun l Thng tin v Hot
ng Bom mn (Information Management and Mine Action Programs - iMMAP). D liu ny kt hp
thng tin t H s Hot ng Chin s (Combat Activities, CACTA), C s D liu ng Nam
(South-East Asia Database, SEADAB) v H s Ho lc Hi qun Chin u (Combat Naval Gunfire
File, CONGA), bao qut nhng hot ng chin s ca qun ng minh trong giai on t thng 10
7

nm 1965 n thng 6 nm 1975 ngoi tr mt vi thng thiu ht s liu. B s liu ny bao gm

nhng bin sau: loi my bay, loi bom, s lng, ti trng, ngy th bom v v tr th bom. V tr
ghi trong s liu l v tr th bom thc t, c th khc vi v tr b nh hng. V d, trong trng
hp B52 ri thm, v tr th bom vi mc ch thng thng l gc trn phi ca hnh vung vi
cnh 1,5 km, y c coi l im chnh xc nht c ghi nhn ca hnh vung (chi tit xem thm
nghin cu ca Miguel v Roland, 2006)
thng nht vi bng ch s phi nhim cht c dit c, nghin cu ny xy dng mt bin
s o cng nm bom bng cch tnh tng cng s lng tt c cc loi bom trong mt vng
m 15 km xung quanh trung tm x. Mt bin nh phn th hin liu mt x c b th bom trong
vng 15 km tnh t trung tm hay khng, v mt bin o lng cng nm bom tnh bng
logarit ca tng s lng bom c th trong phm vi ny.

3.1.4. Cc ngun d liu khc

Thng tin b sung v vic s dng cht dit c nng nghip, lng tiu th thuc l v cn, s
tiu dng than v ci c ly t iu tra Mc sng H gia nh Vit Nam 2004 (VHLSS) xem
xt cc yu t nh hng cp h gia nh. Tng cc Thng k thc hin cuc iu tra cp
quc gia mang tn iu tra Mc sng H gia nh Vit Nam (VHLSS) trong nm 2004. Mt m-un
iu tra chi tit v lng tiu th lng thc v phi lng thc c thc hin trn tng s 9.000
h ti 3.300 x. B s liu ny cho php tnh ton lng tiu th cht dit c v thuc tr su ti
mi khu vc t nng nghip, v tnh bnh qun trn s x iu tra. Tng t nh vy, mc tiu th
than v ci, thuc l v cn trn u ngi ca h gia nh cng c tnh bnh qun cho cc x.
Mc phi nhim cht dit c qun s c tnh ton cho tng x trong iu tra VHLSS xem
xt liu c s lin quan ni bt no gia s phi nhim cht c dit c trong qu kh vi mc tiu
th cht dit c/thuc tr su nng nghip, than , ci, thuc l v cn trong hin ti. ng tic
l, mc trng khp cc x trong iu tra VHLSS v iu tra VNHS khng ln kt hp hai
b s liu ny vi nhau, cng nh khng kim sot hon ton nhng bin s ny trong tnh
ton hi quy.
kim sot nhng yu t gy nhiu do mi trng, b s liu ny c kt hp
thm vi s liu v thi gian c nh nng hng ngy trong giai on 1975-1999. S liu v nh
nng do Trung tm T liu Kh tng (MDC), c quan thuc B Ti nguyn v Mi trng Vit Nam
cung cp. S liu c thu thp hng ngy trong giai on 1975-2006 t 108 trm kh tng trong
c nc. Mi x trong iu tra VNHS c gn vi mt trm kh tng gn nht v s gi c nh
nng trong ngy c tnh trung bnh trong giai on t 1975-1999.

3.2. Phng php nh lng

tm hiu cc yu t tc ng n t l ung th c bo co, chng ti c lng m hnh
hi quy logistic a bin nh sau:

= + + +
1

trong pijk l xc xut mt c nhn i trong h gia nh j sng x k ang b mt loi ung th no
trong giai on 2001-2002; Herbk l i lng ch mc phi nhim cht dit c qun s ca x
k, v Xijk l mt vec-t ch nhng c im nhn khu hc v kinh t-x hi ca mi c nhn nh
tui (v tui bnh phng) v hc vn, tnh trng kinh t-x hi cp h gia nh (theo mc chi
tiu u ngi), v khu vc sinh sng (thnh th hay nng thn), thi gian c nh nng mt tri (s
gi nng trung bnh ca x trong thi gian 1975-1999) v cng b nm bom (lng bom) trong
thi gian chin tranh; ijk l sai s c gi nh l c phng sai khng ng nht
(heteroskedasticity) v t tng quan v khng gian (spatial auto-correlation). Sai s chun vng
(robust standard error) c tnh ton, tp hp theo cp tnh gii thch kh nng t tng quan
v mt khng gian.5 Hn na, cc gi tr c lng c tnh gia quyn bng cch s dng trng s
l quy m dn s c cung cp sn trong c s d liu tnh n cc c trng ca thit k chn
mu.
Tc ng ca s phi nhim i vi nhng ngi sinh trc v sau khi kt thc chin dch ri
cht c dit c c c tnh bng cch b sung thm cc bin tng tc (ch s phi nhim tng
tc vi bin s nh phn th hin thi im sinh ca c nhn l trc hay sau nm 1971) trong cng
thc sau:

= + + 1 >1971 + +
1

H s th hin nh hng ca phi nhim cht c dit c ti nhng ngi sinh ra sau khi
kt thc chin dch ri cht c c khc so vi nhng ngi sinh trc v nguy c c th b trc
tip nhim c hay khng.

4. Kt qu nghin cu v tho lun

Phn ny lm r mi tng quan gia t l ung th (t khai) trong mt x Vit Nam, v mc
x b ri cht dit c trong qu kh. Bng 2 miu t cc bin s s dng trong phn tch ny

Thi im 1999, Vit Nam c chia thnh 8926 x, phng v 61 tnh, thnh.

v s phn b cc hot ng ri cht c dit c. Gn mt na (593 trn 1.200) s x trong iu

tra b ri cht c t nht mt ln trong phm vi 15 km tnh t trung tm x; con s ny gim cht t
xung 568 nu s ln ri cht c dit c ch tnh cht c c cha dioxin. Lu rng t l ung th
tng th l 0,08%.
[BNG 2]
4.1. Mc phi nhim cht c dit c v t l ung th
Bng 3 th hin kt qu hi quy logistic a bin xc nh cc nhn t tc ng ti ung th.
Do thiu thng tin trong iu tra, s lng mu quan st gim t 158.019 (ct 1, 4 v 7) xung cn
148.022 khi yu t gio dc v tiu dng bnh qun u ngi c a vo m hnh (ct 2, 5 v
8). Trong cc ct 3, 6 v 9, mt bin s cho bit mi c nhn c i iu tr ni tr hoc ngoi tr
trong vng 12 thng qua hay khng c b sung thm vo m hnh hi quy.
Ct 1 n 3 th hin cc yu t kinh t-x hi nh hng n ung th. Ta thy t l ung th
cao hn ph n, v s chnh lch ny tng ln nhng tng vi tc gim dn theo tui. T
l ung th cao hn nu ni sinh sng l khu vc thnh th. Cng nm bom thi chin, v s gi
nng khng c bt k mi tng quan no vi t l ung th. Mt khc, c mi tng quan cht ch
gia t l ung th c bo co vi vic s dng cc bin php chm sc sc khe.
Cc ct t 4 ti 9 th hin s tng quan (hoc khng tng quan) gia t l ung th vi hai
gi tr o lng s phi nhim cht c dit c. Hai gi tr ny l nhng bin nh phn c gi tr
bng 1 nu c nhn sng trong mt x tng chu (i) t nht mt ln ri cht dit c (ct 4 ti 6),
hoc (ii) t nht 39 ln ri cht dit c (ct 7 ti 9) v bng 0 nu cha tng phi nhim. 6 Cc kt
qu khng cho thy bt k s khc bit no v t l ung th gia nhng x tng phi nhim vi
cht dit c qun s vi cc x cha phi nhim bao gi, trong s phi nhim c tnh bng
mt trong hai gi tr o lng ni trn.
[BNG 3]
Bng 4 l kt qu ca phn tch liu lng- phn ng. Thay v so snh cc x tng v
cha tng b phi nhim, phn tch ny ch tp trung vo nhng x tng b ri cht c t nht 1 ln
trc khi chin tranh kt thc, v so snh v t l ung th gia cc x ny nhng nhng tn sut
khc nhau. Trong trng hp ny, chng ti o lng s phi nhim bng mt bin lin tc - mc
phi nhim c tnh bng logarit s ln b ri cht c. Trong cc ct t 1 n 6, cc gi tr
phi nhim lin tc c thm vo cng thc s dng cho Bng 3. Mt mt, cc x ch b ri cht
6

Mt x hng chu t nht 39 ln ri cht c s nm trong 25% s x b ri nhiu nht.

10

c mt ln (c ngha l logarit bng 0) bo co t l ung th thp hn cc x cha b ri cht c

ln no. Mt khc, kt qu cng cho thy mt mi tng quan gia liu lng - phn ng. Trong
nhng x tng b phi nhim, c thm 10% gi tr phi nhim cht c dit c s dn n tng
thm 2% kh nng mc ung th. C ngha l mt c nhn nm trong x phn v 75 trong phn
phi mc phi nhim (tng ng vi vic hng chu 91 ln ri cht c) c tnh c nguy c
mc ung th cao gp i mt c nhn tng t sng ti x phn v 25 (tng ng vi 18 ln ri
cht c).7
Khi cho thm mt i lng tng tc bng mt bin nh phn th hin c nhn c sinh ra
trc hay sau nm 1971 (thi im kt thc chin dch ri cht c), kt qu cc ct t 4 n 6
cho thy nhng ngi sinh sau nm 1971 th mi tng quan liu lng- phn ng tr nn yu
hn v khng c ngha v mt thng k mc tin cy quy chun. Thay v xem xt ton b s
mu, php hi quy trnh by trong cc ct t 7 n 12 loi b s i tng nhng x cha tng
phi nhim. Kt qu mu c iu kin ny vn kh nht qun vi mu y ; mc phi nhim
c tng quan thun vi nguy c mc ung th. Tuy nhin, trong trng hp ny, khng c s khc
bit c ngha thng k gia nhng ngi sinh trc v sau 1971, v tc ng ca s phi nhim
ln nhng ngi sinh sau 1971 c pht hin ch mc tin cy l 10%, tr trng hp c tnh
n yu t s dng dch v chm sc sc khe (ct 12).
[BNG 4]
Bng A1 v A2 phn ph lc cng cho nhng kt qu phn tch nh trong bng 3 v 4, tuy
nhin ch tnh n nhng ln ri c dioxin xy dng s liu v phi nhim. Mc d trng c v
tng t nhau, nhng cc kt qu ny khng c ngha thng k mc tin cy thng c s
dng.
4.2. Bn lun
Phn sau y bn lun v kt qu ca nghin cu rng c s tn ti mt mi tng quan
thun gia mc phi nhim cht dit c trong qu kh vi t l ung th hin ti, trong iu kin
s liu c nhng sai lch thng k c k trn. Phn bn lun ny nhm mc nh gi nhng
hn ch ca phng php lun c s dng, v bin minh cho mi quan h nhn qu ca cc h
s tng quan c lng c. C ba vn cn c gii quyt: (i) vic s dng tnh trng
ung th t khai xy dng bin o lng t l ung th, (ii) cch o lng mc phi nhim cht
c dit c, v (iii) sai lch tim tng do nhiu bin khng quan st c (omitted variables).

Vi phn tch liu lng- phn ng, s phn loi phi nhim ch tnh n nhng x b ri cht c t nht 1 ln tnh n
trc thi im chin tranh kt thc

11

4.2.1. Tnh trng ung th t khai

Rt nhiu cc nghin cu tm hiu mi lin h tim tng gia dioxin v ung th c tin
hnh trn cc cu chin binh khng phi ngi Vit Nam, h l nhng ngi c sn h s bnh n
hoc c lm cc xt nghim sng lc bng sinh thit v X-quang (ch mt s t ngoi l da
trn s liu t khai, v d nghin cu ca Kang v cc ng tc gi, 2006). Vit Nam khng c sn
nhng thng tin c tnh h thng nh vy, v h s quc gia v ung th c th c tng quan
thun vi vic ri cht c dit c, bi v chnh ph c th khuyn khch tin hnh xt nghim
sng lc ung th nhng vng b ri nhiu cht c, v vy s c sai lch trong vic nh gi mi
tng quan gia t l ung th thu c t h s theo di ung th quc gia vi cng ri cht
c chin tranh.
Mt phng n khc l s dng nhng iu tra trn quy m ln v s phi s dng thng tin
v sc khe t khai hoc khai qua ngi th ba. Trong nghin cu ny, thng tin tr li ca mi
thnh vin trong h gia nh do ngi i din gia nh bo co (thng l ch h hoc v/chng
ch h). Thng tin ny khng chu bt c s kim nh no. Ngoi ra, nghin cu khng cho php
nh gi chnh xc loi ung th m mt c nhn ang mc phi. Mc d c mt nghin cu M do
Dominguez v cc ng tc gi (2007) thc hin, v h kt lun rng thng tin v tin s ung th
t khai c nhy l 85,7% (dao ng t 92,1% i vi ung th v n 42,9% i vi cc loi ung
th mu), nhng cc nc ang pht trin th khng c nghin cu tng ng no. Mc d
cch tip cn ca nghin cu ny cn tn ti mt s hn ch, c th tin rng nghin cu mang li
nhng ng gp mi khi khng c nhiu s la chn cho cc cch tip cn thay th (Phng v cc
ng tc gi, 1996; Kamarova v cc ng tc gi, 1998).8 gii quyt nhng kh khn trong iu
kin hn ch v ngun d liu hin nay, mt s bin c thit k xc nh s bt ng nht
(heterogeneity) trong tnh chnh xc ca thng tin t khai: trnh hc vn v mc chi tiu c nhn,
mt bin nh phn thnh th/nng thn v mt bin nh phn khc xc nh c nhn c c iu
tr ni tr hoc ngoi tr hay khng trong vng 12 thng qua. Nhng bin s ny gip chng ta nm
bt mt phn nhn thc ca c nhn v tnh hnh sc khe hoc kh nng tip cn vi cc
phng tin sng lc xt nghim ung th, v cc nguy c khc (v d nh nhim khu vc thnh
th), ri ro ngh nghip (tng quan vi thu nhp hoc hc vn) hay quan h nhn qu ngc
(nhng ngi b ung th thng c nhiu kh nng s dng dch v chm sc sc kho hn). Tuy
nhin, vic kim sot nhng bin s ny hu nh khng nh hng n mi quan h gia mc
phi nhim cht dit c v t l ung th m chng ta quan st c.
Tuy vy, c th xy ra trng hp nhng ngi bit rng nhng x hi h sinh sng b ri
nhiu cht c trong qu kh s c xu hng khai rng h cng ang b ung th dn n sai lch
8

Nu tnh trng ung th (t khai) hon ton khng xc nh c, khng c mi lin h no c pht hin. Kt qu trong
bng 4 li a ra gi khc. Cc sai s o ngu nhin ca cc bin s ph thuc tng vt so vi cc sai s tiu chun, khng
k sai lch nhng h s hi quy.

12

thng k do k c/nh kin ca ngi c hi. 9 Tuy nhin, nhng bng chng trnh by trong
bng 3 khng cho thy s khc bit no gia mt x cha tng b ri cht c vi mt x tng b
ri (cc ct t 4 n 6). Nhng x trn v di mc phn v 75 (cc ct t 7 n 9) cng khng cho
thy s khc bit no. Nu nh k khai sai lm nh hng ti mi tng quan gia t l ung th v
s phi nhim cht dit c, th ta c th s pht hin ra mi lin h nht nh khi s dng gi tr o
lng nh phn ca phi nhim (bng 3) hn l gi tr lin tc (bng 4), bi mi ngi thng thng
s nh n vic h c b phi nhim hay khng trc khi nh n mc phi nhim (nng hay
nh) ca h. Ngoi ra, nhng tnh ton th hin trong bng 4 (cc ct t 1 n 6) ng ra phi cho
kt qu ngc li, mt x cha tng phi nhim bo co t trng hp ung th hn mt x mt
ln b ri cht dit c.

4.2.2. Gi tr o lng phi nhim cht c dit c

Khc vi cc nghin cu trc y, trong nghin cu ny chng ta khng bit mc dioxin
mi c nhn thc s b nhim. Thay vo , chng ti s dng thng tin v v tr a l ca cc t
ri cht c dit c xy dng bin s o lng mc phi nhim. Vic s dng cc h s qun
s hay thng tin nh gi phi nhim t khai lm thc o mc phi nhim vi cc cu binh
cng l mt vn tranh ci (nghin cu ca Young, 2004; Young, Cecil v Guilmartin, 2004).10
Hn na, mt s nghin cu da trn cc h s qun s rt ra kt lun v s phi nhim li khng
mang yu t ngh nghip (nghin cu ca Michalek v Pavuk, 2008; nghin cu ca Pavuk,
Michalek v Ketchum, 2006; nghin cu ca OBrien, Decoufle v Boyle, 1991). Trong nghin cu
ny,chng ti s dng mc phi nhim trong qu kh ca mt x thi im hin ti lm gi tr
o lng mc phi nhim cht c dit c. Verger v cc ng tc gi (1994) tm thy bng
chng v mt mi tng quan thun nht nh gia mc phi nhim ghi trong cc h s qun s
v lng dioxin thc t c trong m m ca dn c min Nam Vit Nam. y c th l bng chng
v s phi nhim trc tip trong thi gian chin tranh, hoc s phi nhim gin tip qua lng thc,
t hay trm tch sng ngi b nhim c dioxin.
Vn ng lu u tin l d liu trong h s qun s c th khng phn nh ng mc
phi nhim trn thc a. Cc trm tch sng ngi v tm, c b nhim dioxin c th li nm nhiu
h lu dng chy so vi ni ri cht c, v iu kin a l cng nh s vn ng ca t ai cng
gy nh hng ti s phn b mc nhim dioxin theo khng gian (Phuong v cc ng tc gi,
1996). Ngoi ra, khong 8% nhng v th cht c khng ch r l s dng loi cht c dit c
no, mc d cht c da cam thng l loi c s dng nhiu nht (Stellman v Stellman, 2005).
9

Lu rng nu h s bnh n sn c, nhng sai lch tng t vn ph bin: nhng ngi tin rng h phi chu ng vic
ri cht c s c xu hng xt nghim sng lc ung th nhiu hn.
10
Michalek v Pavuk (2008), Pavuk, Michalek v Ketchum (2006), Pavuk v cc ng tc gi (2005), Bullman, Watanabe v
Kang (1994), Mahan v cc ng tc gi (1997), Dalager v cc ng tc gi (1991, 1995), Kang v cc ng tc gi (1986,
1987) v Anderson (1990) s dng cc h s qun s xy dng gi tr phi nhim c hi gin tip; Giri v cc ng tc
gi (2004) v Zafar v Terris (2001) li da vo s t nh gi phi nhim ca tng c nhn.

13

Chnh nhng sai s v o c nh vy l nguyn nhn dn n s thiu chc chn ca nhng kt

qu s dng mc phi nhim cht c dit c c dioxin (bng ph lc A1 v A2). Cui cng,
cch xy dng bin s v mc phi nhim cng l mt nguyn nhn dn n sai s. S ln ri
cht c khng c thng tin v thnh phn ha cht hay lng cht c tht s c ri xung.
Hn na, mi c hi b phi nhim c o bng cch tnh tng cng s ln ri trong mt phm vi,
m khng tnh n s phn hy cht c theo khng gian v thi gian. Tuy nhin, chng ti tin
rng cc sai s o c y khng tng quan vi t l ung th, vi mc thin lch gn bng
khng, v vy nh gi s c thin hng thn trng hn l mi lin quan thc. V d, kh c kh
nng l mt x khng c thng tin y trong h s qun s li l nhng khu vc c t l ung th
thp; s vn ng ca t, mc d c nh hng ti phi nhim, khng c xem l c nh
hng ti t l ung th. Do , nhng li o lng c in v bin gii thch ni trn rt c th s
lm tng sai lch thng k; dn ti kt qu l khng tm ra c mi lin h gia phi nhim v
t l ung th.
Th hai, d liu v c nhn c ly t mt iu tra a vng min thc hin 26 nm sau khi
chin tranh Vit Nam kt thc, m khng c nhng thng tin v qu kh. Do , hai vn na c
th pht sinh: th nht l s thay i ni c tr ca mi c nhn gia thi im ri cht c v thi
im tin hnh iu tra (v d nhng ngi lnh chin u nhng vng b ri cht c sau chin
tranh tr v qu nh ni khc, hoc h gia nh mi chuyn n sinh sng ti x trong vng iu
tra), v hai l iu tra v h gia nh ch ly thng tin v ung th nhng ngi cn sng ti thi
im thng k. S dch chuyn dn s hoc suy gim dn s t nhin vi cc l do t vong khng
lin quan n nhim dioxin lm tng thm sai s v o lng cc bin s v t l ung th, gy
nh hng bt li n s chnh xc ca kt qu nh gi tuy khng lm sai lch kt qu . 11 Cui
cng, nu mc phi nhim cao lm tng t l t vong, th cc khu vc b ri cht c nhiu s c
t l ung th thp; h s m ca bin phi nhim nh phn trong bng 4, cc ct t 1 n 6, cho
thy c kh nng tn ti s sai lch thng k .

4.2.3. Bin khng quan st c (omitted variables) v gii thch v mi quan h nhn
qu ca kt qu nghin cu
C nhng nguy c gy ung th khc c th gy nhiu i vi mi tng quan gia s phi
nhim cht c v ung th trnh by trong bng 4.
Cc chin dch ri cht c dit c khng phi l mt qu trnh mang tnh ngu nhin, m c
th ph thuc vo mt s tnh cht ca a phng, m nhng tnh cht ny c th cn tn ti n
ngy nay v c th nh hng ti t l ung th. Cung tng t nh vy, vic nm bom v ri cht

11

Tc ng ca nhng ngi lnh tr v nh t nhng vng b ri nhiu cht c c xu hng li lm sai lch kt qu dn ti
vic khng thy mi lin h no gia phi nhim v t l ung th. Hn na, cc chnh sch hn ch di c ca nh nc cng
lm gim ng k cc c hi di c. VNHS khng c thng tin v di c nn chng ti khng th tm hiu c th v vn ny.

14

c c th gy ra mt s c tnh ca a phng v tr thnh nguy c gy ung th. Chng ti

a vo phng trnh hi quy mt s bin o lng mc nm bom nm bt nhng yu t
nh hng chung v a l ca c vic nm bom v vic ri cht c ( tng quan gia nm bom
v ri cht c l 0,32 vi p<0,01). xc nh nhng yu t gy nhiu tim n khc, chng ti
kim sot c s gi nng bng mt bin gi tr trung bnh ca thi gian c nng trong ngy trong
giai on 1975-1999. Tnh trng kinh t - x hi, nh gi bng trnh hc vn v mc tiu dng
trn u ngi, v mt bin nh phn thnh th/nng thn cng c thm vo kim sot cc
bin s trong m hnh hi quy.
Ngoi ra, rt c th nhng vng b ri cht c vi cng cao trong qu kh tng l
nhng khu rng rm, hoc nhng vng kh hu nng nghip i hi phi s dng lng cht dit c
v tr su nhiu hn duy tr nng sut nng nghip mc cao. V th, s liu v tnh trng ung
th c th b nh hng bi cht dit c v tr su nng nghip. Tuy nhin, cc bin o lng
thuc dit c v tr su nng nghip c tng quan nghch (tng quan = -0,1082, p<0,01) vi
cng ri cht c trong chin tranh (Hnh 2, bng trn bn tri). Cui cng, vic ri cht c
dit c c th c lin quan n cc yu t nguy c gy ung th khc: ht thuc, ung ru v ri ro
ngh nghip nh vic s dng than v ci cho nhu cu tiu th nng lng. Hnh 2 th hin
nhng tng quan gia mc phi nhim cht c dit c v mc tiu th bnh qun u ngi
ca cc h x v than , ci (bng trn bn phi), thuc l (bng di tri) v ru (bng di
phi). Cc yu t ny nu c tng quan vi mc phi nhim th l tng quan nghch.
[HNH 2]

5. Kt lun
Nghin cu ny nh gi bng phng php nh lng mi lin h gia s phi nhim cht
c dit c v t l ung th trong cng ng ngi Vit Nam 30 nm sau khi kt thc chin tranh
Vit Nam. Do Vit Nam khng th lp li nhng phng php c tnh h thng nh tng lm
vi cc cu binh M, chng ti p dng mt cch tip cn khc. Chng ti s dng nhng s liu t
khai v khai qua ngi th ba v t l ung th, v tm thy mt mi lin h thun gia tnh trng
phi nhim cht dit c qun s trong qu kh v t l ung th hin ti. Cn phi tha nhn rng
phng php c p dng b hn ch v khng c thng tin vi tin cy cao v tnh trng ung
th t khai v khai qua ngi th ba, v phi s dng t l ung th c pht hin thay cho t l
ung th mi mc phi, v v thiu thng tin v loi ung th. Tuy nhin, nu i cho ti khi nhng
nghin cu su hn c tin hnh, chng ta c mt nguy c l bng chng s mt dn v nhm
ngi ln tui tng chu nh hng phi nhim nhiu nht s khng cn na.

15

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4.

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17

Hnh 1: M rng vng m xung quanh cc trung tm hnh chnh x o gi tr phi nhim cht c dit c

-10

6
4
2

corr = -0.1082
P-value = 0.0003

2
4
6
Log all-herbicide hit count

2
4
6
Log all-herbicide hit count

Fitted values

2
4
6
Log all-herbicide hit count
Log '000 VND/cap

Fitted values

4
8

corr = -0.0074
P-value = 0.7936

corr = -0.0063
P-value = 0.8229

Alcohol

Log '000 VND/cap

Cigarettes

Fitted values

Log '000 VND/sqm

corr = -0.0479
P-value = 0.1104

-5

Coal-firewood

Hnh 3: S tng quan gia mc phi nhim cht c dit c qun s v cc gi tr tiu dng hin ti khc nhau

2
4
6
Log all-herbicide hit count
Log '000 VND/cap

Fitted values

Bng 1: Thnh phn v s lng cc ha cht dit c c ri trong giai on 1961-1971

Tn
Cht c Hng

Thnh phn ha hc
60%-40% n-Butyl: isobutyl ester of 2,4,5-T

S lng c tnh (lt)

50 312 ri - 413 852 theo s sch thu mua

Cht c Xanh l cy

n-Butyl ester 2,4,5-T

31 026 theo s sch thu mua

Cht c Tm

50% n-Butyl ester 2,4,-D; 30% n-Butyl ester 2,4,5-T; 20% isobutyl ester 2,4,5-T

1 892 773

Cht c Da cam

50% n-Butyl ester 2,4,-D; 50% n-Butyl ester 2,4,5-T

45 677 937 (bao gm cht c Da cam II)

Cht c Da cam II

50% n-Butyl ester 2,4,-D; 50% isooctyl ester 2,4,5-T

t nht 3 591 000 c vn chuyn

Cht c Trng

Acid weight basis: 21.2%; tri-isopropanolamine salts of 2,4-D; 5.7% picloram

20 556 525

Cht c Xanh da tri (bt)

Cacodylic acid v sodium cacodylate

25 650

Cht c Xanh da tri (nc) Cacodylic acid v sodium cacodylate

Ngun: Stellman v cc ng tc gi (2003)

501 381

Bng 2: Tm tt thng k

Kt qu v tnh trng sc khe ca i tng nghin cu (VNHS)

i tng nghin cu b ung th (1:c, 0:khng)
Cc c im kinh t - x hi ca i tng nghin cu (VNHS)
Gii tnh (1:nam, 0:n)
Tui (tnh theo nm)
Trnh hc vn (lp hc)
S ngi trong h gia nh
Chi tiu u ngi (ngn ng)
Sng thnh th (1:c, 0:khng)
Trung bnh s gi nng trong giai on 1975-1999 (gi)
tng iu tr ni tr hoc ngoi tr trong vng 12 thng trc thi gian iu tra (1:c, 0:khng)
c im cp x (HERBS, iMMAP, v MDC)
X tng b ri cht c trong vng 15 km
Tng s ln b ri cht c (tt c cc loi) trong vng 15 km
X tng b ri dioxin trong vng 15 km
Tng s ln b ri dioxin trong vng 15 km
X tng b nm bom trong vng 15 km
Tng lng bom th trong vng 15 km (triu pounds)
Trung bnh s gi nng trong giai on 1975-1999 (gi)
S liu th cp: c im cp x nm 2004 (VHLSS)
Lng tiu th cht dit c v tr su nng nghip bnh qun/m2 t nng nghip (ngn ng)
Lng tiu th than , ci, mn ca, tru ca h gia nh tnh theo bnh qun u ngi (ngn ng)
Lng tiu th bia v ru ca h tnh theo bnh qun u ngi (ngn ng)
Lng tiu th thuc l ca h tnh theo bnh qun u ngi (ngn ng)
Ghi ch: Cc quan st trong d liu VNHS c tnh gia quyn vi trng s chn mu

S quan st

S x

Gi tr trung
bnh

lch chun

158,019

1,200

0.08%

2.81%

158,019
158,019
148,279
158,019
157,744
158,019
158,019
158,019

1,200
1,200
1,128
1,200
1,196
1,200
1,200
1,200

48.51%
26.634
1.068
5.160
3,910
22.80%
5.633
20.87%

49.98%
19.381
1.044
1.958
4,757
41.95%
1.320
40.64%

1,200
1,200
1,200
1,200
1,200
1,200
1,200

49.42%
42.458
47.42%
19.388
77.58%
38.146
5.610

50.02%
92.469
49.95%
42.260
41.72%
120.577
1.325

1,133

0.085

0.466

1,114
1,246
1,268

98.269
58.572
120.125

62.429
92.486
119.403

Bng 3: Hi quy logistic v cc yu t tc ng ti ung th - nh hng ca s phi nhim i vi tt c cc loi cht dit c
Bin ph thuc: Nhng c nhn khai bo b ung th (1:c, 0:khng)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Cc bin c lp:
0.815
0.792
0.813
tng b ri t nht mt trong cc loi ha cht (1:c, 0:khng)
(0.369)
(0.364)
(0.378)
1.228
1.166
S ln b ri cht c trong vng 15 km trn phn v 75 (1:c, 0:khng)
(0.284)
(0.279)
4.120
3.087
3.171
3.504
2.582
2.671
5.324
3.734
tng b nm bom t nht mt ln (1:c, 0:khng)
(4.687)
(3.862)
(3.923)
(4.093)
(3.264)
(3.339)
(6.369)
(4.786)
0.964
0.983
0.981
0.974
0.995
0.992
0.948
0.972
Logarit ca tng lng bom
(0.064)
(0.071)
(0.071)
(0.066)
(0.072)
(0.071)
(0.067)
(0.073)
0.984
1.011
0.999
1.048
1.086
1.064
0.956
0.989
S gi nng bnh qun hng ngy t 1975-1999 (gi)
(0.090)
(0.095)
(0.092)
(0.176)
(0.199)
(0.195)
(0.088)
(0.095)
0.602** 0.550*** 0.651**
0.602** 0.552*** 0.652**
0.603** 0.550***
Gii tnh ca i tng (1:nam, 0:n)
(0.130)
(0.110)
(0.127)
(0.129)
(0.110)
(0.127)
(0.130)
(0.110)
1.160*** 1.149*** 1.149*** 1.160*** 1.149*** 1.149*** 1.160*** 1.149***
Tui ca i tng (nm)
(0.039)
(0.044)
(0.044)
(0.039)
(0.044)
(0.044)
(0.039)
(0.044)
0.999*** 0.999*** 0.999*** 0.999*** 0.999*** 0.999*** 0.999*** 0.999***
Tui bnh phng
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
1.635*** 1.655** 1.748*** 1.660*** 1.684** 1.776*** 1.624**
1.650**
Sng khu vc thnh th (1:c, 0:khng)
(0.328)
(0.391)
(0.406)
(0.343)
(0.405)
(0.419)
(0.332)
(0.393)
0.998
1.001
1.021
1.000
1.003
1.022
0.998
1.001
Quy m h gia nh
(0.042)
(0.043)
(0.044)
(0.043)
(0.043)
(0.044)
(0.043)
(0.043)
1.102
1.064
1.095
1.059
1.104
Trnh hc vn (lp hon thnh)
(0.142)
(0.137)
(0.141)
(0.136)
(0.143)
0.884
0.890
0.890
0.895
0.877
Logarit mc tiu dng ca h tnh theo u ngi
(0.131)
(0.137)
(0.131)
(0.137)
(0.129)
tng iu tr ni hoc ngoi tr trong vng 12 thng (1:c, 0:khng)
5.246***
5.240***
(0.963)
(0.962)
0.000*** 0.000*** 0.000*** 0.000*** 0.000*** 0.000*** 0.000*** 0.000***
Hng s
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)
(0.000)

1.201
(0.290)
3.986
(5.044)
0.967
(0.072)
0.974
(0.092)
0.652**
(0.127)
1.149***
(0.044)
0.999***
(0.000)
1.741***
(0.409)
1.021
(0.044)
1.067
(0.138)
0.884
(0.134)
5.257***
(0.965)
0.000***
(0.000)

S quan st

148,022

158,019

148,022

148,022

158,019

148,022

148,022

158,019

148,022

(9)

Ghi ch: Kt qu hi quy c bo co qua t sut chnh (odds ratios). Sai s chun trong ngoc n (robust standard errors), iu chnh phng sai khng ng nht v cm
thng k cp tnh (clustered at the province-level). Cc k hiu ***, ** v * biu hin gi tr c ngha thng k ln lt mc 1, 5 v 10%. Cc quan st c tnh gia quyn vi
trng s chn mu. Gi tr phn v th 75 tng ng vi 39 ln b ri cht c.

Bng 4: Hi quy logistic v cc yu t tc ng ti ung th - phn ng liu lng i vi s ln th bt k loi cht dit c no
Bin ph thuc: Nhng c nhn khai bo b ung th (1:c, 0:khng)
Ton b mu
Cc bin c lp
Logarit s ln b ri cht c

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

1.198**

1.256**

1.270**

1.228**

1.291***

1.306***

1.238**

1.295**

1.319***

1.241**

1.307**

1.334**

(0.104)

(0.126)

(0.126)

(0.110)

(0.134)

(0.134)

(0.117)

(0.137)

(0.138)

(0.123)

(0.149)

(0.150)

0.779*

0.772*

0.771*

0.966

0.913

0.889

(0.126)

(0.123)

(0.122)

(0.141)

(0.136)

(0.132)

Tc ng thm ca logarit s ln ri cht c trn nhng ngi sinh sau 1971

i tng sinh sau 1971 (1:c, 0:khng)
tng b ri mt trong cc loi cht c (1:c, 0:khng)
tng b nm bom (1:c, 0:khng)
Logarit ca tng lng bom
S gi nng bnh qun hng ngy t 1975-1999 (gi)

Mu chn lc

(1)

1.268

1.371

1.390

1.306

2.117

2.136

(0.704)

(0.765)

(0.750)

(1.178)

(1.763)

(1.794)

0.421*

0.341**

0.337**

0.431*

0.352**

0.346**

(0.255)

(0.202)

(0.202)

(0.257)

(0.204)

(0.204)

6.036

5.023

5.262

6.111

5.068

5.318

(7.479)

(6.639)

(6.876)

(7.597)

(6.724)

(6.987)

0.942

0.955

0.951

0.942

0.955

0.952

0.878

0.868

0.852

0.878

0.868

0.852

(0.069)

(0.073)

(0.073)

(0.069)

(0.073)

(0.073)

(0.104)

(0.102)

(0.100)

(0.104)

(0.103)

(0.100)

1.042

1.079

1.057

1.038

1.074

1.054

1.335

1.216

1.201

1.336

1.218

1.202

(0.168)

(0.190)

(0.186)

(0.167)

(0.188)

(0.185)

(0.341)

(0.314)

(0.314)

(0.341)

(0.316)

(0.315)

0.604**

0.553***

0.654**

0.605**

0.553***

0.654**

0.406***

0.365***

0.435***

0.406***

0.364***

0.435***

(0.130)

(0.110)

(0.127)

(0.130)

(0.110)

(0.127)

(0.111)

(0.105)

(0.123)

(0.112)

(0.105)

(0.123)

Tui ca i tng (nm)

1.160***

1.149***

1.150***

1.146***

1.139***

1.141***

1.230***

1.243***

1.245***

1.240***

1.275***

1.269***

(0.039)

(0.044)

(0.044)

(0.046)

(0.051)

(0.047)

(0.060)

(0.065)

(0.066)

(0.078)

(0.077)

(0.077)

Tui bnh phng

0.999***

0.999***

0.999***

0.999***

0.999**

0.999**

0.999***

0.998***

0.998***

0.998***

0.998***

0.998***

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.001)

(0.001)

(0.001)

(0.001)

Sng khu vc thnh th (1:c, 0:khng)

1.620**

1.666**

1.754***

1.622**

1.662**

1.751***

1.265

1.237

1.316

1.265

1.238

1.316

(0.345)

(0.407)

(0.421)

(0.347)

(0.409)

(0.423)

(0.332)

(0.372)

(0.399)

(0.332)

(0.373)

(0.399)

Gii tnh ca i tng (1:nam, 0:n)

Quy m h gia nh

1.002

1.005

1.025

1.002

1.006

1.026

1.026

1.044

1.063

1.026

1.044

1.063

(0.043)

(0.044)

(0.044)

(0.043)

(0.044)

(0.045)

(0.044)

(0.040)

(0.039)

(0.044)

(0.040)

(0.040)

Trnh hc vn (lp hon thnh)

Logarit mc tiu dng ca h tnh theo u ngi

1.098

1.062

1.104

1.069

0.961

0.933

0.965

0.936

(0.141)

(0.136)

(0.144)

(0.140)

(0.153)

(0.148)

(0.152)

(0.148)

0.852

0.859

0.852

0.859

1.047

1.057

1.042

1.054

(0.125)

(0.130)

(0.126)

(0.132)

(0.154)

(0.154)

(0.153)

(0.154)

tng iu tr ni hoc ngoi tr trong vng 12 thng (1:c, 0:khng)

Hng s

Tng cng tc ng nhng ln b ri cht c trn nhng ngi sinh sau 1971

5.264***

5.269***

4.792***

(0.964)

(0.963)

(0.817)

4.788***
(0.812)

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

0.957

0.996

1.007

1.200*

1.193*

1.185

(0.170)

(0.183)

(0.182)

(0.169)

(0.163)

(0.164)

158,019
148,022
148,022
158,019
148,022
148,022
81,268
75,983
75,983
81,268
75,983
75,983
S quan st
Ghi ch: Kt qu hi quy c bo co qua t sut chnh (odds ratios). Sai s chun trong ngoc n (robust standard errors), iu chnh phng sai khng ng nht v cm thng k cp tnh (clustered at the province-level). Cc k hiu ***, **
v * biu hin gi tr c ngha thng k ln lt mc 1, 5 v 10%. Cc quan st c tnh gia quyn vi trng s ca mu. Mu chn lc ch bao gm cc quan st b ri cht c t nht mt ln trong vng 15 km k t trung tm x. Gi tr "Tng
cng tc ng ca log s ln b ri cht c trn nhng ngi sinh sau 1971" trong cc ct 4, 5, 6, 10, 11 v 12 l thng s gia tc ng chnh ("Logarit ca s ln b ri cht c") v bin tng tc ("Tc ng cng thm ca log s ln ln b ri
cht c ln nhng ngi sinh sau 1971"). Khi tc ng chnh l tc ng ca "logarit s ln b ri cht c" trn nhng ngi sinh trc nm 1971.

Bng A1: Hi quy logistic ca cc yu t tc ng ti ung th - tc ng ca s phi nhim vi cht dioxin

(1)

Bin ph thuc: Nhng c nhn khai bo b ung th (1:c, 0:khng)

(2)
(3)
(4)
(5)
(6)
(7)
(8)

Cc bin c lp
tng b ri ch ring cht dioxin (1:c, 0:khng)

1.023
(0.412)

1.053
(0.424)

1.057
(0.427)

S ln b ri ch ring cht dioxin trong vng 15 km trn phn v 75 (1:c,

0:khng)
tng b nm bom (1:c, 0:khng)
Logarit ca tng lng bom nm xung
S gi nng bnh qun hng ngy t 1975-1999 (gi)
Gii tnh ca i tng (1:nam, 0:n)
Tui ca i tng (nm)
Tui bnh phng
Sng khu vc thnh th (1:c, 0:khng)
Quy m h gia nh

4.120
(4.687)
0.964
(0.064)
0.984
(0.090)
0.602**
(0.130)
1.160***
(0.039)
0.999***
(0.000)
1.635***
(0.328)
0.998
(0.042)

3.087
(3.862)
0.983
(0.071)
1.011
(0.095)
0.550***
(0.110)
1.149***
(0.044)
0.999***
(0.000)
1.655**
(0.391)
1.001
(0.043)
1.102
(0.142)
0.884
(0.131)

0.000***
(0.000)

0.000***
(0.000)

Trnh hc vn (lp hon thnh)

Logarit mc tiu dng ca h tnh theo u ngi
tng iu tr ni hoc ngoi tr trong vng 12 thng (1:c, 0:khng)
Hng s

3.171
(3.923)
0.981
(0.071)
0.999
(0.092)
0.651**
(0.127)
1.149***
(0.044)
0.999***
(0.000)
1.748***
(0.406)
1.021
(0.044)
1.064
(0.137)
0.890
(0.137)
5.246***
(0.963)
0.000***
(0.000)

4.214
(5.030)
0.962
(0.068)
0.978
(0.142)
0.602**
(0.129)
1.160***
(0.039)
0.999***
(0.000)
1.632**
(0.345)
0.997
(0.043)

3.242
(4.104)
0.980
(0.072)
0.996
(0.159)
0.550***
(0.110)
1.149***
(0.044)
0.999***
(0.000)
1.647**
(0.399)
1.001
(0.043)
1.103
(0.142)
0.882
(0.128)

0.000***
(0.000)

0.000***
(0.000)

(9)

3.348
(4.192)
0.978
(0.071)
0.983
(0.156)
0.651**
(0.127)
1.149***
(0.044)
0.999***
(0.000)
1.740***
(0.413)
1.020
(0.043)
1.065
(0.136)
0.888
(0.134)
5.246***
(0.963)
0.000***
(0.000)

1.421

1.367

1.375

(0.364)
6.466*
(8.249)
0.937
(0.071)
0.936
(0.089)
0.603**
(0.130)
1.160***
(0.039)
0.999***
(0.000)
1.650***
(0.342)
0.998
(0.043)

(0.383)
4.677
(6.491)
0.958
(0.078)
0.966
(0.096)
0.550***
(0.110)
1.149***
(0.044)
0.999***
(0.000)
1.649**
(0.397)
1.002
(0.043)
1.107
(0.143)
0.898
(0.136)

0.000***
(0.000)

0.000***
(0.000)

(0.394)
4.857
(6.696)
0.955
(0.078)
0.955
(0.093)
0.651**
(0.126)
1.149***
(0.044)
0.999***
(0.000)
1.742***
(0.412)
1.021
(0.044)
1.070
(0.137)
0.906
(0.142)
5.249***
(0.963)
0.000***
(0.000)

158,019 148,022 148,022 158,019 148,022 148,022 158,019 148,022 148,022

S quan st
Ghi ch: Kt qu hi quy c bo co qua t sut chnh (odds ratios). Sai s chun trong ngoc n (robust standard errors), iu chnh phng sai khng ng nht v
cm thng k cp tnh (clustered at the province-level). Cc k hiu ***, ** v * biu hin gi tr c ngha thng k ln lt mc 1, 5 v 10%. Cc quan st c tnh gia
quyn vi trng s chn mu. Gi tr phn v th 75 tng ng vi 19 ln b ri ch ring cht dioxin.

Bng A2: Hi quy logistic ca cc yu t tc ng ti ung th - phn ng liu lng i vi s ln th ch ring cht dioxin
Bin ph thuc: Nhng c nhn khai bo b ung th (1:c, 0:khng)
Ton b mu
(1)
Cc bin c lp:
Logarit s ln b ri ch ring cht c dioxin

(2)

(3)

Logarit ca tng lng bom nm xung

S gi nng bnh qun hng ngy t 1975-1999 (gi)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

1.131

1.134

1.145

1.164

1.171

1.184

1.162

1.170

1.196

1.160

1.168

1.198

(0.130)

(0.135)

(0.132)

(0.137)

(0.143)

(0.144)

(0.150)

(0.156)

(0.134)

(0.140)

(0.146)

i tng sinh sau 1971 (1:c, 0:khng)

tng b nm bom (1:c, 0:khng)

Mu chn lc
(5)

(0.127)
Tc ng cng thm ca nhng ln ri dioxin i vi nhng ngi sinh sau 1971

tng b ri ch ring cht dioxin (1:c, 0:khng)

(4)

0.760

0.751

0.750

1.022

1.015

0.979

(0.153)

(0.154)

(0.152)

(0.332)

(0.336)

(0.326)

1.167

1.251

1.271

1.075

1.389

1.416

(0.626)

(0.676)

(0.670)

(1.338)

(1.697)

(1.763)

0.711

0.724

0.708

0.724

0.738

0.720

(0.416)

(0.389)

(0.384)

(0.423)

(0.395)

(0.389)

5.871

4.623

4.933

5.977

4.704

5.029

(7.759)

(6.507)

(6.936)

(7.930)

(6.655)

(7.116)

0.943

0.959

0.955

0.942

0.959

0.954

0.857

0.872

0.857

0.857

0.871

0.857

(0.074)

(0.079)

(0.079)

(0.075)

(0.079)

(0.079)

(0.107)

(0.110)

(0.108)

(0.107)

(0.110)

(0.108)

0.978

0.995

0.983

0.974

0.990

0.979

1.337

1.209

1.193

1.337

1.212

1.194

(0.140)

(0.156)

(0.154)

(0.139)

(0.155)

(0.152)

(0.357)

(0.322)

(0.320)

(0.358)

(0.323)

(0.322)

0.602**

0.550***

0.651**

0.603**

0.550***

0.651**

0.415***

0.372***

0.442***

0.415***

0.372***

0.442***

(0.130)

(0.110)

(0.126)

(0.130)

(0.109)

(0.127)

(0.114)

(0.107)

(0.125)

(0.114)

(0.107)

(0.125)

Tui ca i tng (nm)

1.160***

1.149***

1.149***

1.145***

1.137***

1.139***

1.230***

1.240***

1.241***

1.240***

1.270***

1.264***

(0.039)

(0.044)

(0.044)

(0.046)

(0.051)

(0.047)

(0.061)

(0.064)

(0.066)

(0.079)

(0.076)

(0.076)

Tui bnh phng

0.999***

0.999***

0.999***

0.999***

0.999**

0.999**

0.999***

0.998***

0.998***

0.998***

0.998***

0.998***

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.001)

(0.001)

(0.001)

(0.001)

Sng khu vc thnh th (1:c, 0:khng)

1.674***

1.676**

1.771***

1.677***

1.674**

1.771***

1.258

1.265

1.354

1.258

1.265

1.353

(0.362)

(0.410)

(0.426)

(0.363)

(0.412)

(0.429)

(0.330)

(0.393)

(0.427)

(0.329)

(0.392)

(0.425)

Gii tnh ca i tng (1:nam, 0:n)

Quy m h gia nh

0.999

1.003

1.022

0.999

1.003

1.023

1.010

1.036

1.054

1.010

1.037

1.054

(0.043)

(0.043)

(0.044)

(0.043)

(0.043)

(0.044)

(0.045)

(0.040)

(0.039)

(0.045)

(0.040)

(0.039)

Trnh hc vn (lp hon thnh)

Logarit mc tiu dng ca h tnh theo u ngi

1.104

1.066

1.109

1.073

0.935

0.910

0.938

0.912

(0.142)

(0.137)

(0.145)

(0.140)

(0.144)

(0.138)

(0.142)

(0.137)

0.896

0.905

0.896

0.906

1.133

1.152

1.128

1.148

(0.129)

(0.136)

(0.130)

(0.137)

(0.167)

(0.168)

(0.166)

(0.168)

tng iu tr ni hoc ngoi tr trong vng 12 thng (1:c, 0:khng)

Hng s

Tng cng tc ng nhng ln b ri cht c trn nhng ngi sinh sau 1971

5.257***

5.259***

4.663***

(0.963)

(0.962)

(0.797)

4.655***
(0.794)

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

0.000***

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

(0.000)

0.885

0.879

0.888

1.185

1.186

1.173

(0.207)

(0.205)

(0.207)

(0.433)

(0.437)

(0.436)

158,019
148,022
148,022
158,019
148,022
148,022
77,441
72,499
72,499
77,441
72,499
72,499
S quan st
Ghi ch: Kt qu hi quy c bo co qua t sut chnh (odds ratios). Sai s chun trong ngoc n (robust standard errors), iu chnh phng sai khng ng nht v cm thng k cp tnh (clustered at the province-level). Cc k hiu ***, **
v * biu hin gi tr c ngha thng k ln lt mc 1, 5 v 10%. Cc quan st c tnh gia quyn vi trng s ca mu. Mu chn lc ch bao gm cc quan st b ri ch ring cht c dioxin t nht mt ln trong vng 15 km k t trung tm x.
Gi tr "Tng cng tc ng ca log s ln b ri ch ring cht dioxin trn nhng ngi sinh sau 1971" trong cc ct 4, 5, 6, 10, 11 v 12 l thng s gia tc ng chnh ("Logarit ca s ln b ri ch ring cht dioxin") v bin tng tc ("Tc ng
cng thm ca log s ln ln b ri ch ring cht dioxin ln nhng ngi sinh sau 1971"). Khi tc ng chnh l tc ng ca "logarit s ln b ri ch ring cht dioxin" trn nhng ngi sinh trc nm 1971.