Vad Marie Vestergaard, Frost Poul, Rosenberg Jacob, Andersen Johan Hviid, Svendsen Susanne Wulff
Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.
Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark.
Occup Environ Med. 2017 Nov;74(11):769-775. doi: 10.1136/oemed-2016-104160. Epub 2017 May 25.
To evaluate exposure-response relationships between occupational mechanical exposures and first-time lateral and medial inguinal hernia repair and effects of lifestyle factors. To estimate if occupational mechanical exposures advance the repairs.
This longitudinal study was based on a cohort of men aged 18-65 years with questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. We estimated occupational mechanical exposures using a job exposure matrix. First-time inguinal hernia repairs from 1998 to 2014 were identified in the Danish Hernia Database. We used Cox regression analyses and calculated excess fractions among the exposed and rate advancement periods (RAPs).
Among 17 967 men, we identified 382 lateral and 314 medial repairs. The risk of lateral repairs increased with time spent standing/walking with an HR of 1.45 (95% CI 1.12 to 1.88) for ≥6 hours/day versus <4 hours/day, corresponding to an excess fraction of cases of 31% in the group with ≥6 hours/day. This group had a RAP of 6.7 (95% CI 2.6 to 10.8) years. Medial repairs were not associated with occupational mechanical exposures. A body mass index ≥30 kg/m showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes.
Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would be preventable if the time spent standing/walking could be reduced from ≥6 to <4 hours/day. The repairs might even be postponed by 6-7 years.
评估职业性机械暴露与首次腹股沟外侧和内侧疝修补之间的暴露-反应关系以及生活方式因素的影响。估计职业性机械暴露是否会促使疝修补提前。
这项纵向研究基于丹麦拉马齐尼中心肌肉骨骼研究数据库中18至65岁男性队列的问卷调查数据。我们使用工作暴露矩阵估计职业性机械暴露。在丹麦疝数据库中识别出1998年至2014年的首次腹股沟疝修补病例。我们使用Cox回归分析，并计算暴露组中的超额分数和率推进期（RAPs）。
在17967名男性中，我们识别出382例腹股沟外侧修补和314例腹股沟内侧修补。腹股沟外侧修补的风险随着站立/行走时间的增加而增加，每天站立/行走≥6小时与每天站立/行走<4小时相比，风险比（HR）为1.45（95%置信区间1.12至1.88），这对应于每天站立/行走≥6小时组中31%的超额病例。该组的RAP为6.7年（95%置信区间2.6至10.8）。腹股沟内侧修补与职业性机械暴露无关。体重指数≥30kg/m²在两种修补类型中均显示出较低的HRs。休闲时间的体育活动和吸烟状况与任何结局均无关。
假设存在因果关系，结果表明，如果每天站立/行走时间能从≥6小时减少至<4小时，最高暴露类别中约30%的首次腹股沟外侧疝修补是可以预防的。疝修补甚至可能推迟6至7年。
