Webber Eliza J, Tran Tan, June Ronald, Healy Emily, Andrews Tara M, Younkin Roubie, MacDonald Justin, Adams Erik S
Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA.
Department of Mathematical Sciences, Statistical Consulting and Research Services, Montana State University, Bozeman, MT, USA.
BMC Musculoskelet Disord. 2021 Feb 13;22(1):181. doi: 10.1186/s12891-021-04041-x.
Arthritis and joint pain are highly prevalent in agricultural (ag) workers. Many ag operations are sustained by a small number of workers, and the disability of even one worker thus contributes to economic hardship. This study investigated associations between joint health in Montana ag workers and economic well-being and work capacity.
This observational mixed-methods study utilized quantitative survey data and qualitative focus group data. 299 ranchers and farmers in 9 Montana counties completed either an online or paper survey that included participant demographics, joint symptoms, history of arthritis and arthritis type, financial status, work capacity, and the need to rely on others to complete one's work. The Western Ontario and McMaster Universities arthritis index (WOMAC) survey was completed by those with hip or knee pain. Data were entered into REDCap v8.9.2 for analysis with SAS 9.4, using logistic and linear regression models to detect associations between covariables and to calculate odds ratios and confidence intervals. Focus groups were held with ranchers in two Montana counties, discussing similar topics, and the themes expressed were identified.
87.6% of survey respondents reported joint pain, 47.8% a diagnosis of arthritis, and 22.4% osteoarthritis (OA). A 10-point increase in WOMAC was significantly associated with lower work capacity (OR 2.00; 95% CI [1.58, 2.55], p < 0.01), worse financial condition (OR 1.23; 95% CI [1.01,1.48], p = 0.04), and increased reliance on others (OR 1.82; 95% CI [1.32, 2.55], p < 0.01). An arthritis diagnosis was associated with worsening work capacity (OR 4.66; 95% CI [2.71, 8.01], p < 0.01) and increased odds of relying on others (OR 3.23; 95% CI [1.56, 6.66], p < 0.01). A diagnosis of OA was significantly associated with decreased work capacity (OR 3.47; 95% CI [1.97, 6.11], p < 0.01). Unadjusted for age and BMI, we found a significant association between years spent working in agriculture and joint health, which became non-significant after adjusting for age and BMI. Focus group themes included decreased productivity with increased joint symptoms and a tendency for ranchers to avoid interaction with the health care system.
Poor joint health is associated with economic risk on Montana ranches and farms.
关节炎和关节疼痛在农业工人中极为普遍。许多农业生产活动由少数工人维持，因此哪怕一名工人残疾都会导致经济困难。本研究调查了蒙大拿州农业工人的关节健康与经济福祉及工作能力之间的关联。
这项观察性混合方法研究利用了定量调查数据和定性焦点小组数据。蒙大拿州9个县的299名牧场主和农民完成了在线或纸质调查，内容包括参与者的人口统计学信息、关节症状、关节炎病史和关节炎类型、财务状况、工作能力以及依靠他人完成工作的需求。有髋部或膝盖疼痛的人完成了西安大略和麦克马斯特大学关节炎指数（WOMAC）调查。数据录入REDCap v8.9.2，使用SAS 9.4进行分析，采用逻辑回归和线性回归模型来检测协变量之间的关联，并计算比值比和置信区间。在蒙大拿州的两个县与牧场主进行了焦点小组讨论，讨论类似主题，并确定了表达的主题。
87.6%的调查受访者报告有关节疼痛，47.8%被诊断患有关节炎，22.4%患有骨关节炎（OA）。WOMAC增加10分与工作能力降低显著相关（比值比2.00；95%置信区间[1.58, 2.55]，p < 0.01）、财务状况变差（比值比1.23；95%置信区间[1.01, 1.48]，p = 0.04）以及对他人的依赖增加（比值比1.82；95%置信区间[1.32, 2.55]，p < 0.01）。关节炎诊断与工作能力恶化（比值比4.66；95%置信区间[2.71, 8.01]，p < 0.01）和依赖他人的几率增加（比值比3.23；95%置信区间[1.56, 6.66]，p < 0.01）相关。OA诊断与工作能力下降显著相关（比值比3.47；95%置信区间[1.97, 6.11]，p < 0.01）。在未对年龄和体重指数进行调整时，我们发现从事农业工作的年限与关节健康之间存在显著关联，但在对年龄和体重指数进行调整后，这种关联变得不显著。焦点小组的主题包括随着关节症状增加生产力下降，以及牧场主倾向于避免与医疗保健系统互动。
关节健康不佳与蒙大拿州牧场和农场的经济风险相关。
