Virtanen Marianna, Vahtera Jussi, Head Jenny, Dray-Spira Rosemary, Okuloff Annaleena, Tabak Adam G, Goldberg Marcel, Ervasti Jenni, Jokela Markus, Singh-Manoux Archana, Pentti Jaana, Zins Marie, Kivimäki Mika
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
PLoS One. 2015 Nov 16;10(11):e0143184. doi: 10.1371/journal.pone.0143184. eCollection 2015.
Studies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability.
Participants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis.
Separate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the 'high-risk' group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38-1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21-1.46). These associations were similar in men and women, younger and older participants, and across occupational groups.
Diabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.
糖尿病工作残疾研究将糖尿病视为一种同质疾病。我们试图根据工作残疾的潜在风险因素，在糖尿病患者中识别亚组。
研究对象为来自三个前瞻性队列（芬兰公共部门研究、GAZEL研究和白厅II研究）的2445名糖尿病员工。通过在4年随访期间与病假登记册和残疾抚恤金登记册的关联来确定工作残疾情况。采用特定研究的潜在类别分析，根据常见的合并疾病和健康风险行为识别亚组。使用固定效应荟萃分析汇总各研究中随访时与工作残疾的关联。
每个队列中针对男性和女性的单独潜在类别分析支持分为两类的解决方案，其中一个亚组（共1086人，占44.4%）慢性躯体疾病、心理症状、肥胖、身体活动不足和戒酒的患病率较高，另一个亚组（共1359人，占55.6%）这些因素的患病率较低。在调整后的荟萃分析中，“高风险”组的参与者有更多的工作残疾天数（合并率比=1.66，95%置信区间1.38-1.99）和更多的工作残疾发作次数（合并率比=1.33，95%置信区间1.21-1.46）。这些关联在男性和女性、年轻和年长参与者以及不同职业群体中相似。
就工作残疾风险而言，糖尿病并非同质疾病。约一半的糖尿病患者被归入一个以合并健康状况聚集、肥胖、身体活动不足、戒酒以及相关的高工作残疾风险为特征的亚组；另一半则归入一个风险特征更有利的亚组。
