Xu Q, Jia N, Sun X, Zhang M B, Guo X W, Zhang H D, Ling R J, Liu Y M, Wang Z, Li G, Yin Y, Shao H, Li J, Zhang H D, Qiu B, Wang D Y, Zeng Q, Wang R G, Ye Y, Xiao B, Zou H, Chen J C, Li D X, Liu Y Q, Shi Q H, Liu J X, Jiang E F, Qi J, Mei L Y, Zhao X F, Yang M M, Wang Z X
Laboratory of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2024 Dec 20;42(12):937-945. doi: 10.3760/cma.j.cn121094-20240422-00177.
To establish a structural equation model of lower back pain and its risk factors in occupational population in China based on a large-sample occupational epidemiological survey and structural equation analysis, so as to lay the foundation for the prevention of this disease. A total of 73497 occupational epidemiological cases were selected from June 2018 to December 2023 using the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire. The results were analyzed using ergonomic hazard factors and their risk source classification criteria. Confirmatory factor analysis was then applied to extract individual factors, work organization, working postures, work types, muscle fatigue, and lower back pain. These factors were subsequently classified into six categories and structural equation model was established. The main structural reliability and validity indexes of the structural equation model of lower back pain and its adverse ergonomic factors after adjustment were basically up to standard[goodness of fit index (GFI) was 0.956, the adjusted goodness of fit index (AGFI) was 0.944, the root mean square error of approximation (RMSEA) was 0.043, the normed fit index (NFI) was 0.922, the comparative fit index (CFI) was 0.923, and the Tucker-Lewis index (TLI) was 0.908], and the model fit was good. There were correlations among four exogenous latent variables: individual factors, work organization, working postures and work types. Among them, individual factors had a weak negative correlation with the three exogenous potential variables of work organization, working postures and work types (=-0.30, -0.11, -0.18), and work organization had a moderate positive correlation with working postures and work types (=0.49, 0.55). There was a strong positive correlation between work types and working postures (=0.72). The direct path coefficients of individual factors, working postures and muscle fatigue were 0.07, 0.11 and 0.40, respectively. The direct path coefficients of work types were -0.07. There was an indirect path mediated by muscle fatigue between work types, working postures and work organization and lower back pain, and the indirect path coefficients were: work types-muscle fatigue-lower back pain (0.15), working postures-muscle fatigue-lower back pain (-0.04) and work organization-muscle fatigue-lower back pain (0.27) . When carrying out the prevention and control of lower back pain, the pathogenesis of lower back pain induced by workers' muscle fatigue caused by work organization, working postures, and work types factors should be comprehensively considered, so as to provide a theoretical reference for improving the prevention and control level of lower back pain.
基于大样本职业流行病学调查和结构方程分析，建立中国职业人群下背痛及其危险因素的结构方程模型，为该病的预防奠定基础。2018年6月至2023年12月，使用中文版肌肉骨骼疾病电子问卷选取了73497例职业流行病学病例。采用人体工程学危险因素及其风险源分类标准对结果进行分析。然后应用验证性因素分析提取个体因素、工作组织、工作姿势、工作类型、肌肉疲劳和下背痛等因素。随后将这些因素分为六类并建立结构方程模型。调整后下背痛及其不良人体工程学因素的结构方程模型的主要结构可靠性和有效性指标基本达标[拟合优度指数（GFI）为0.956，调整后拟合优度指数（AGFI）为0.944，近似均方根误差（RMSEA）为0.043，规范拟合指数（NFI）为0.922，比较拟合指数（CFI）为0.923，塔克-刘易斯指数（TLI）为0.908]，模型拟合良好。四个外生潜在变量之间存在相关性：个体因素、工作组织、工作姿势和工作类型。其中，个体因素与工作组织、工作姿势和工作类型这三个外生潜在变量呈弱负相关（分别为=-0.30、-0.11、-0.18），工作组织与工作姿势和工作类型呈中度正相关（分别为=0.49、0.55）。工作类型与工作姿势之间呈强正相关（=0.72）。个体因素、工作姿势和肌肉疲劳的直接路径系数分别为0.07、0.11和0.40。工作类型的直接路径系数为-0.07。工作类型、工作姿势和工作组织与下背痛之间存在由肌肉疲劳介导的间接路径，间接路径系数分别为：工作类型-肌肉疲劳-下背痛（0.15），工作姿势-肌肉疲劳-下背痛（-0.04），工作组织-肌肉疲劳-下背痛（0.27）。在进行下背痛的防治时，应综合考虑工作组织、工作姿势和工作类型等因素导致工人肌肉疲劳诱发下背痛的发病机制，为提高下背痛的防治水平提供理论参考。
