Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Occup Environ Med. 2007 Dec;64(12):798-805. doi: 10.1136/oem.2006.030148. Epub 2007 Jun 13.
Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA.
The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly.
Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment.
The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies.
之前关于工作与膝骨关节炎（KOA）的研究主要集中在体力需求上；而对于与工作相关的组织政策与 KOA 风险和结果之间的关系，我们知之甚少。我们在美国的一个社区人群中研究了工作场所政策与 KOA 之间的关系。
在约翰斯顿县骨关节炎项目的基线检查中，对有完整就业史和膝关节 X 线的年龄<65 岁的参与者（n=1639），分析了工作场所提供工作便利（转换为体力要求较低的工作；需要减少工作时间的人可兼职工作）和福利政策（带薪病假；残疾津贴）与 KOA 结果（膝关节症状；有症状的 KOA[sKOA]；无症状的放射学 KOA[rKOA]）之间的关系。采用多因素逻辑回归模型估计与每种工作场所政策相关的 KOA 患病率比值比（OR），并调整社会人口统计学特征、生活方式因素、膝关节损伤、体重指数和其他工作场所特征。我们使用倾向评分模型评估有利政策的就业选择中的差异，并相应地调整这种潜在的偏差。
在提供更好政策的工作场所工作的个体，膝关节症状明显减少。与没有提供工作便利（转换为体力要求较低的工作；需要减少工作时间的人可兼职工作）、带薪病假和残疾津贴的工作场所相比，提供工作便利（转换为体力要求较低的工作；需要减少工作时间的人可兼职工作）、带薪病假和残疾津贴的工作场所的 sKOA 患病率较低（8%比 13%、9%比 16%和 8%比 16%）。在多变量模型中，带薪病假（调整后的 OR 0.58，95%CI 0.37 至 0.91）和残疾津贴政策（调整后的 OR 0.54，95%CI 0.35 至 0.85）的 sKOA 患病率差异具有统计学意义。即使在没有明显膝关节相关症状的人群中，工作场所政策与 rKOA 之间也存在类似的负相关模式，并且在倾向评分调整后仍然稳健。
KOA 与工作场所政策之间的负相关关系引起了人们对可能的就业歧视或工作场所政策有益影响的关注。需要进行纵向研究，以阐明与工作场所政策相关的 KOA 风险和结果的动态复杂性。
