Esquirol Yolande, Niezborala Michel, Visentin Monique, Leguevel Anne, Gonzalez Ignacio, Marquié Jean-Claude
UMR 1027 Paul Sabatier University, CHU, Toulouse, France.
Faculté de médecine, 37 allées jules Guesde 31000 Toulouse, France.
Occup Environ Med. 2017 Mar;74(4):243-251. doi: 10.1136/oemed-2015-103443. Epub 2016 Sep 26.
Among the aetiological factors of chronic low back pain (CLBP), occupational factors are often suspected, but their contribution remains to be ascertained. This study aimed to determine the impact of a wide range of occupational factors on the incidence and persistence of CLBP.
From the VISAT (VIeillissement SAnté Travail) study, 1560 workers were examined at baseline and 5 years later. CLBP was defined as having low back pain or specific treatment for at least 6 months. Participants newly affected with CLBP and those with persistent CLBP at follow-up were distinguished. In addition to individual factors, a broad panel of occupational factors were analysed, covering employment, physical, organisational and psychosocial factors. Multivariate analyses were used to determine predictive factors of incidence and persistence of CLBP. Receiver operating characteristic (ROC) curves were performed to analyse the contribution of occupational factors.
22.6% of participants without any CLBP initially presented with CLBP 5 years later, while 53.7% of participants with CLBP at baseline had CLBP at the second collection. Carrying heavy loads, the lack of recognition of completed work and productivity-related income predicted a higher risk of incidence of CLBP. However, no significant association between occupational factors and the risk for persistence of CLBP was observed, while the risk was multiplied by two for history of depression and rheumatological events. ROC curves confirmed the significant contribution of occupational factors to incidence of CLBP.
Occupational factors played a pivotal role in the incidence of CLBP, while individual factors were the main determinants of persistence of CLBP.
在慢性下腰痛（CLBP）的病因中，职业因素常被怀疑，但它们的作用仍有待确定。本研究旨在确定多种职业因素对CLBP发病率和持续性的影响。
从VISAT（职业健康老龄化）研究中，1560名工人在基线时接受检查，并在5年后再次检查。CLBP定义为下腰痛或接受特定治疗至少6个月。区分随访中新发CLBP的参与者和持续性CLBP的参与者。除了个体因素外，还分析了一系列广泛的职业因素，包括就业、身体、组织和社会心理因素。采用多变量分析来确定CLBP发病率和持续性的预测因素。绘制受试者工作特征（ROC）曲线以分析职业因素的作用。
最初无CLBP的参与者中有22.6%在5年后出现CLBP，而基线时有CLBP的参与者中有53.7%在第二次检查时仍有CLBP。搬运重物、工作完成未获认可以及与生产率相关的收入预测CLBP发病率较高。然而，未观察到职业因素与CLBP持续性风险之间存在显著关联，而抑郁症和风湿病事件史会使风险增加一倍。ROC曲线证实职业因素对CLBP发病率有显著作用。
职业因素在CLBP发病率中起关键作用，而个体因素是CLBP持续性的主要决定因素。
