Lötters Freek, Burdorf Alex, Kuiper Judith, Miedema Harald
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Scand J Work Environ Health. 2003 Dec;29(6):431-40. doi: 10.5271/sjweh.749.
This study aimed at developing a model for determining the work-relatedness of low-back pain for a worker with low-back pain using both a personal exposure profile for well-established risk factors and the probability of low-back pain if the worker were unexposed to these factors.
After a systematic review of the literature, the pooled prevalence of low-back pain in an unexposed population and the pooled odds ratio (OR) for each risk factor was calculated in a meta-analysis using a random effect model. An unbiased risk estimate for each risk factor was obtained by correcting the pooled OR for confounding by other risk factors. The probability of low-back pain was calculated with a logistic regression model. The input was (i) the age-dependent prevalence when not exposed and (ii) the unbiased risk estimates per risk factor of low and high exposure. The etiologic fraction was calculated to determine the level of work-relatedness.
The pooled prevalence for low-back pain among unexposed subjects was 22%, 30%, and 34% for the <35-year, 35-to-45-year, and >45-year age categories, respectively. The pooled OR was 1.51 [95% confidence interval (95% CI) 1.31-1.74] for manual materials handling, 1.68 (95% CI 1.41-2.01) for frequent bending or twisting, 1.39 (95% CI 1.24-1.55) for whole-body vibration, and 1.30 (1.17-1.45) for job dissatisfaction. For high exposure to manual materials handling, frequent bending or twisting, and whole-body vibration, the pooled OR was 1.92, 1.93, and 1.63, respectively.
The model is the first that estimates the probability of work-relatedness for low-back pain for a given worker with low-back pain seen by a general practitioner or an occupational health physician.
本研究旨在开发一种模型，该模型利用既定风险因素的个人暴露概况以及工人未暴露于这些因素时的腰痛概率，来确定患有腰痛的工人的腰痛与工作的相关性。
在对文献进行系统综述之后，使用随机效应模型在荟萃分析中计算未暴露人群中腰痛的合并患病率以及每个风险因素的合并比值比（OR）。通过校正合并OR以消除其他风险因素的混杂作用，获得每个风险因素的无偏风险估计值。使用逻辑回归模型计算腰痛的概率。输入数据为：（i）未暴露时按年龄划分的患病率，以及（ii）每个风险因素低暴露和高暴露时的无偏风险估计值。计算病因分数以确定工作相关性水平。
<35岁、35至45岁和>45岁年龄组未暴露受试者中腰痛的合并患病率分别为22%、30%和34%。人工搬运物料的合并OR为1.51[95%置信区间（95%CI）1.31 - 1.74]，频繁弯腰或扭转的合并OR为1.68（95%CI 1.41 - 2.01），全身振动的合并OR为1.39（95%CI 1.24 - 1.55），工作不满意的合并OR为1.30（1.17 - 1.45）。对于人工搬运物料、频繁弯腰或扭转以及全身振动的高暴露情况，合并OR分别为1.92、1.93和1.63。
该模型是首个用于估计全科医生或职业健康医生所诊治的患有腰痛的特定工人的腰痛与工作相关性概率的模型。
