Unverzagt Susanne, Bergmann Annekatrin, Denny Kathleen, Frese Thomas, Hirpa Selamawit, Weyer Johannes
Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany.
Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany.
J Occup Med Toxicol. 2024 May 6;19(1):14. doi: 10.1186/s12995-024-00415-8.
Hip osteoarthritis (HOA) is a leading cause of disability increasing with age and is more prevalent in women and in various physically demanding occupations. This systematic review identifies and summarises occupational exposures for women in physically demanding occupations and discusses sex differences and consequences.
In this systematic review, we searched various electronic databases for reports published between date of database inception and October 2022. We included cohort studies and case-control studies that assessed the association between exposure to physically demanding occupations and the development of HOA. We then assessed the methodological quality of selected studies, extracted relative effects, compared the risk for women and men and meta-analytically reviewed the effects of physically demanding occupations. All steps were based on a study protocol published in PROSPERO (CRD42015016894).
We included six cohort studies and two case-control studies in this systematic review. These studies showed a considerably increased risk of developing HOA in both sexes. Women working in traditionally female-dominated occupations such as cleaning, sales, catering, childcare and hairdressing that are physically demanding, have a higher risk of developing HOA than men in similarly physically demanding occupations. Conversely, in traditionally male-dominated occupations with a high heterogeneity of work activities, such as agriculture, crafts, construction, as well as in low-skilled occupations, the risk was higher for men. One exception are health occupations, which are grouped together with a wide range of other technical occupations, making it difficult to draw conclusions.
Existing studies indicate an association between various occupations with a high physical workload and an increased risk of developing HOA. Occupational prevention and individual health promotion strategies should focus on reducing the effects of heavy physical workloads at work. The aforementioned as well as early detection should be specifically offered to women in female-dominated occupations and to people working in elementary occupations.
髋骨关节炎（HOA）是导致残疾的主要原因，且随着年龄增长而增加，在女性以及各种体力要求较高的职业中更为普遍。本系统评价识别并总结了体力要求较高职业中女性的职业暴露情况，并讨论了性别差异及后果。
在本系统评价中，我们检索了各种电子数据库，以查找在数据库建立之日至2022年10月期间发表的报告。我们纳入了队列研究和病例对照研究，这些研究评估了体力要求较高的职业暴露与髋骨关节炎发生之间的关联。然后，我们评估了所选研究的方法学质量，提取了相对效应，比较了女性和男性的风险，并对体力要求较高的职业的效应进行了荟萃分析。所有步骤均基于在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42015016894）上发表的研究方案。
本系统评价纳入了六项队列研究和两项病例对照研究。这些研究表明，两性患髋骨关节炎的风险均显著增加。在清洁、销售、餐饮、儿童保育和美发等传统上以女性为主导且体力要求较高的职业中工作的女性，比从事同样体力要求较高职业的男性患髋骨关节炎的风险更高。相反，在农业、手工艺、建筑等工作活动异质性较高的传统男性主导职业以及低技能职业中，男性的风险更高。卫生职业是一个例外，它与广泛的其他技术职业归为一类，难以得出结论。
现有研究表明，各种体力负荷较高的职业与患髋骨关节炎风险增加之间存在关联。职业预防和个人健康促进策略应侧重于减少工作中繁重体力负荷的影响。上述措施以及早期检测应特别提供给以女性为主导职业中的女性和从事基础职业的人员。
