Jackson Jennie A, Liv Per, Sayed-Noor Arkan S, Punnett Laura, Wahlström Jens
Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden; Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.
Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.
Spine J. 2023 Jan;23(1):136-145. doi: 10.1016/j.spinee.2022.08.009. Epub 2022 Aug 24.
Degenerative changes due to cervical spondylosis (CS) can detrimentally affect work ability and quality of life yet understanding of how physical exposure affects disease progression is limited.
To assess the associations between occupational physical exposures and occurrence of surgically treated cervical spondylosis (ST-CS) and early exit from the labor market via disability pension.
STUDY DESIGN/SETTING: Prospective register study with 20 years follow-up period.
Swedish construction workers participating in a national health surveillance project conducted between 1971 and 1993.
Surgically treated cervical spondylosis (ST-CS) and early labor market exit at a minimum rate of 25% time on disability pension.
Associations between occupational physical exposures (job exposure matrix) and subsequent ST-CS (National Hospital in-patient register) and early labor market exit via disability pension (Swedish Social Insurance Agency register) were assessed in a cohort of male construction workers (n=237,699).
A total of 1381 ST-CS cases were present and a 20 years incidence rate of 35.1 cases per 100,000 person years (95% confidence interval (CI) 33.2-36.9). Increased relative risk (RR) for ST-CS was found for workers exposed to non-neutral (RR 1.40, 95% CI 1.15-1.69), and awkward neck postures (1.52, 1.19-1.95), working with the hands above shoulder height (1.30, 1.06-1.60), and high upper extremity loading (1.35, 1.15-1.59). Increased risk was also present for workers who reported frequent neck (3.06, 2.18-4.30) and upper back (3.84, 2.57-5.73) pain in the 12 months prior to survey. Among workers with elevated arm exposure, higher risk was seen in those who also had more frequent neck pain. ST-CS cases took early retirement more often (41.3%) and at a younger age (53 years) than the total study cohort (14.8% and 56 years of age, respectively).
Occupational exposure to non-neutral neck postures, work with hands above shoulders and high loads born through the upper extremities increased the risk for ST-CS and early retirement due to disability. Decreasing postural and load exposure is salient for primary, secondary, and tertiary prevention of CS. Neck pain was shown to be a prognostic factor for ST-CS, which stresses the importance of acting early and taking preventative action to reduce workplace exposure, and the need for systematic medical check-ups within primary or occupational care to mitigate disease progression and early labour market exit due to disability.
颈椎病（CS）导致的退行性变会对工作能力和生活质量产生不利影响，但对于身体暴露如何影响疾病进展的了解有限。
评估职业身体暴露与接受手术治疗的颈椎病（ST-CS）的发生以及通过残疾抚恤金提前退出劳动力市场之间的关联。
研究设计/设置：一项为期20年随访期的前瞻性登记研究。
参与1971年至1993年期间开展的一项全国健康监测项目的瑞典建筑工人。
接受手术治疗的颈椎病（ST-CS）以及以至少25%的时间领取残疾抚恤金为标准的提前退出劳动力市场。
在一组男性建筑工人（n = 237,699）中评估职业身体暴露（工作暴露矩阵）与随后的ST-CS（国家医院住院登记）以及通过残疾抚恤金提前退出劳动力市场（瑞典社会保险局登记）之间的关联。
共出现1381例ST-CS病例，20年发病率为每10万人年35.1例（95%置信区间（CI）33.2 - 36.9）。发现暴露于非中立姿势（相对风险（RR）1.40，95% CI 1.15 - 1.69）、颈部姿势笨拙（1.52，1.19 - 1.95）、双手举过肩部高度工作（1.30，1.06 - 1.60）以及上肢负荷过高（1.35，1.15 - 1.59）的工人患ST-CS的相对风险增加。在调查前12个月报告频繁颈部（3.06，2.18 - 4.30）和上背部（3.84，2.57 - 5.73）疼痛的工人中也存在风险增加的情况。在手臂暴露水平较高的工人中，颈部疼痛更频繁的工人风险更高。ST-CS病例比整个研究队列更常提前退休（41.3%）且退休年龄更小（53岁），而整个研究队列的提前退休率分别为14.8%，退休年龄为56岁。
职业暴露于非中立颈部姿势、双手举过肩部工作以及上肢承受高负荷会增加患ST-CS和因残疾提前退休的风险。减少姿势和负荷暴露对于颈椎病的一级、二级和三级预防至关重要。颈部疼痛被证明是ST-CS的一个预后因素，这强调了早期行动和采取预防措施以减少工作场所暴露的重要性，以及在初级或职业保健中进行系统医学检查以减轻疾病进展和因残疾提前退出劳动力市场的必要性。
