Prakash K C, Neupane Subas, Leino-Arjas Päivi, von Bonsdorff Mikaela B, Rantanen Taina, von Bonsdorff Monika E, Seitsamo Jorma, Ilmarinen Juhani, Nygård Clas-Håkan
School of Health Sciences, University of Tampere, FI-33014, Tampere, Finland.
Scand J Work Environ Health. 2017 Sep 1;43(5):405-414. doi: 10.5271/sjweh.3656. Epub 2017 Jun 26.
Objectives We investigated whether the extent of biomechanical exposures and job strain in midlife separately and jointly predict disability in old age. Methods Participants of the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 (aged 44-58 years) responded to disability questionnaires in 2009 (1850 women and 1082 men). Difficulties in performing five activities of daily living (ADL) and seven instrumental ADL (IADL) were used to assess severity of disability (score range: 0-12, 0=no disability). Information on biomechanical exposures and job strain was collected by questionnaire at baseline. Adjusted prevalence proportion ratios (PR) and 95% confidence intervals (95% CI) were modelled using mixed negative binomial regression with robust variance. The joint effect of two exposures was quantified using the concept of relative excessive risk due to interaction (RERI). Results The overall prevalence of disability (score: 1-12) was 46.7% (women: 41%; men: 57%). Compared to low-level exposures in an adjusted model, the PR of high baseline biomechanical exposures for each one unit increase in the disability score was 1.31 (95% CI 1.10-1.55) and PR of high job strain was 1.71 (95% CI 1.26-2.32). Associations were rather similar in gender-stratified analyses. Furthermore, the joint effect (high strain/high biomechanical) was multiplicative (women: PR 1.32, 95% CI 1.21-1.45; men: PR 1.27, 95% CI 1.13-1.44), but no additive effect was observed when fully adjusted. Conclusion High biomechanical exposure and job strain in midlife were strongly associated with the severity of disability in later life. The workplace could serve as arena for preventive interventions regarding disability in old age.
目的 我们研究了中年时期生物力学暴露程度和工作压力单独及共同作用是否能预测老年时的残疾情况。方法 1981年芬兰市政雇员老龄化纵向研究（FLAME）的参与者（年龄44 - 58岁）在2009年回答了残疾调查问卷（1850名女性和1082名男性）。通过执行五项日常生活活动（ADL）和七项工具性日常生活活动（IADL）时的困难程度来评估残疾严重程度（评分范围：0 - 12，0 = 无残疾）。在基线时通过问卷调查收集生物力学暴露和工作压力的信息。使用具有稳健方差的混合负二项回归模型调整患病率比例比（PR）和95%置信区间（95%CI）。使用交互作用相对超额风险（RERI）概念量化两种暴露的联合效应。结果 残疾（评分：1 - 12）的总体患病率为46.7%（女性：41%；男性：57%）。在调整模型中，与低水平暴露相比，基线生物力学暴露每增加一个单位，残疾评分的PR为1.31（95%CI 1.10 - 1.55），高工作压力的PR为1.71（95%CI 1.26 - 2.32）。在按性别分层分析中关联相当相似。此外，联合效应（高压力/高生物力学暴露）是相乘的（女性：PR 1.32，95%CI 1.21 - 1.45；男性：PR 1.27，95%CI 1.13 - 1.44），但在完全调整后未观察到相加效应。结论 中年时期高生物力学暴露和工作压力与晚年残疾严重程度密切相关。工作场所可作为老年残疾预防干预的场所。
