Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France.
Santé publique France, the French national public health agency, Direction of Occupational Health, EpiprevTMS team associated to the University of Angers, F-49000, Angers, France.
BMC Public Health. 2020 Apr 6;20(1):456. doi: 10.1186/s12889-020-08548-1.
Upper extremity musculoskeletal disorders (UEMSD) are one of the most common and costly occupational health problems. We aimed to assess the population-attributable fraction (PAF) of personal and occupational risk factors associated with incident UEMSD in a working population.
From 2002 to 2005, a random sample of 3710 workers from the Pays de la Loire region in France, aged 20-59 were included by occupational physicians (OPs). Between 2007 and 2010, 1611 workers were re-examined by their OPs. Subjects free from UEMSD at baseline were included in this study (1275 workers, mean age: 38.2 years). Cox regression models with equal follow-up time and robust variance estimates were used to estimate age-adjusted and multivariable-adjusted relative risks (RRs) and their 95% confidence intervals (CIs). Based on multivariable models, PAF associated with each factor included in the models was estimated.
During the follow-up period, 143 (11%) cases of UEMSD were diagnosed. PAFs for factors associated with the incident UEMSD risk were 30% (7 to 51) for high physical exertion (RPE Borg scale ≥12), 12% (- 0.2 to 24) for low social support, 7% (- 3 to 17) for working with arms above shoulder level (≥2 h/day), 20% (12 to 28) for age group ≥45, 13% (3 to 22) for the age group 35-44, and 12% (0.3 to 24) for female gender.
Our study suggests that an important fraction of UEMSD can be attributed to occupational exposures after the contributions of personal and other work-related factors are considered. In terms of public health, our findings are in agreement with the ergonomic literature postulating that a high proportion of UEMSD are preventable through modifying workplace risk factors. Such information is useful to help public health practitioners and policy makers implement programs of prevention of UEMSD in the working population.
上肢肌肉骨骼疾病（UEMSD）是最常见和代价最高的职业健康问题之一。我们旨在评估与工作人群中 UEMSD 发病相关的个人和职业危险因素的人群归因分数（PAF）。
2002 年至 2005 年，法国卢瓦尔河地区的职业医生（OPs）对随机抽取的 3710 名 20-59 岁的工人进行了研究。2007 年至 2010 年，1611 名工人接受了他们的 OPs 复查。本研究纳入了基线时无 UEMSD 的受试者（1275 名工人，平均年龄：38.2 岁）。使用具有相等随访时间和稳健方差估计的 Cox 回归模型来估计年龄调整和多变量调整后的相对风险（RR）及其 95%置信区间（CI）。基于多变量模型，估计了纳入模型的每个因素与 UEMSD 发病风险相关的 PAF。
在随访期间，诊断出 143 例（11%）UEMSD 病例。与 UEMSD 发病风险相关的因素的 PAF 分别为：体力劳动强度高（RPE 博尔格量表≥12）30%（7 至 51）、社会支持低 12%（-0.2 至 24）、手臂高于肩部水平工作（≥2 小时/天）7%（-3 至 17）、年龄≥45 岁 20%（12 至 28）、年龄 35-44 岁 13%（3 至 22）和女性 12%（0.3 至 24）。
我们的研究表明，在考虑个人和其他工作相关因素的贡献后，UEMSD 的很大一部分可以归因于职业暴露。从公共卫生的角度来看，我们的研究结果与提出通过改变工作场所危险因素，很大一部分 UEMSD 是可以预防的人体工程学文献相一致。这些信息对于帮助公共卫生从业者和政策制定者在工作人群中实施 UEMSD 预防计划非常有用。
