Liss G M, Armstrong C, Kusiak R A, Gailitis M M
Health and Safety Studies Service, Ontario Ministry of Labour, Toronto, Canada.
Am J Ind Med. 1992;22(3):395-409. doi: 10.1002/ajim.4700220312.
Following a work refusal at a plant manufacturing ice cream novelties in Ontario, we were asked to document cases of cumulative trauma disorders (CTDs) and carpal tunnel syndrome (CTS) in this workplace. There were 17 employees with possible hand and wrist problems identified from Workers Compensation Board (WCB) Forms, and from a list prepared at the time of the refusal. After obtaining consents, confirmations of the diagnoses of CTDs, CTS, and of surgical procedures for CTS were obtained from the physicians involved. The relative risk for these disorders among plant employees was estimated in two ways: 1) the rate of CTS operations between 1979 and 1990 was compared to that in the general population using Ontario Health Insurance Plan (OHIP) data on physicians' billings for these operations; and 2) the frequency of WCB first payment claims for tendinitis and CTS during 1987 to 1989 at the plant was compared to that among the entire labor force of Ontario. CTDs had been diagnosed in all 17 workers: 9 had had operations for CTS, but one had had this operation prior to working at the plant. Compared to the remaining 8 workers who had CTS operations, an estimated 0.08 CTS operations would be expected among the 150 employees on the plant's seniority lists between 1979 and 1990, if the estimated rates in the general population were present at the plant, giving a Standardized Morbidity Ratio of 10.0 (95% confidence interval [CI] 4.3-19.7; one-sided p = 2.1 x 10(-6)). There were 6 WCB claims for tendinitis and CTS among plant employees during 1987 through 1989. This frequency was about 68 times that in the entire Ontario labor force (95% CI 24.7-150). This investigation has shown that CTDs, and particularly CTS, documented by medical records, have occurred at least 10 times more frequently than expected at this plant. Use of health insurance billing data to estimate CTS operation rates represents a simple method for estimating the burden of illness at the individual plant level due to CTS (at least for that portion proceeding to surgery), using an objective outcome that can be confirmed from medical records.
在安大略省一家生产新奇冰淇淋的工厂发生工作拒绝事件后，我们被要求记录该工作场所累积性创伤疾病（CTD）和腕管综合征（CTS）的病例。从工人赔偿委员会（WCB）表格以及拒绝发生时所编制的一份名单中，识别出17名可能存在手部和腕部问题的员工。在获得同意后，从相关医生处获取了CTD、CTS的诊断确认以及CTS手术程序的确认。通过两种方式估计了工厂员工中这些疾病的相对风险：1）利用安大略省医疗保险计划（OHIP）关于这些手术的医生账单数据，将1979年至1990年期间CTS手术率与普通人群的手术率进行比较；2）将1987年至1989年期间该工厂WCB首次支付的肌腱炎和CTS索赔频率与安大略省全体劳动力的索赔频率进行比较。所有17名工人都被诊断出患有CTD：9人接受了CTS手术，但其中1人在进入该工厂工作之前就已经做过该手术。与其余8名接受CTS手术的工人相比，如果该工厂的资历名单上的150名员工中存在普通人群的估计发病率，那么在1979年至1990年期间预计会有0.08例CTS手术，标准化发病比为10.0（95%置信区间[CI] 4.3 - 19.7；单侧p = 2.1×10⁻⁶）。1987年至1989年期间，该工厂员工中有6例WCB肌腱炎和CTS索赔。这个频率约为安大略省全体劳动力索赔频率的68倍（95% CI 24.7 - 150）。这项调查表明，根据医疗记录记录的CTD，尤其是CTS，在该工厂发生的频率至少比预期高10倍。利用医疗保险账单数据来估计CTS手术率，代表了一种使用可从医疗记录中确认的客观结果，在单个工厂层面估计CTS所致疾病负担的简单方法（至少对于进行手术的那部分病例而言）。
