Gulati Sahil, Lygre Stein Håkon Låstad, Grønning Marit, Haga Jon Magnus
Norwegian Centre for Maritime And Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMJ Open. 2025 Sep 2;15(9):e103837. doi: 10.1136/bmjopen-2025-103837.
To investigate whether seafarers in Norway who were declared unfit for service at sea or received a time-limited health certificate had a higher risk of acute somatic hospital admissions compared with those who received a full health certificate.
Registry-based cohort study.
Seafarers in Norway who presented to a seafarer's doctor to obtain a health certificate between 2018 and 2019, as required for work aboard Norwegian vessels. The study was conducted within Norway's publicly funded healthcare system.
Norwegian seafarers aged 18-70 years who underwent medical examinations (n=43 758), including n=5452 females (12.5%).
Acute somatic hospital admission within 2 years of medical examination. HRs were estimated using Cox regression models in two separate time periods (0-3 months and 3-24 months), with adjustment for possible confounding from age, gender, level of education and centrality of residence (proximity to healthcare services).
The crude risk of acute somatic hospital admissions was higher for individuals who received a declaration of unfitness, as compared with those who received a full health certificate, in both follow-up periods: 0-3 months (HR=5.13, 95% CI: 3.27 to 8.04) and 3-24 months (HR=2.63, 95% CI: 2.07 to 3.34). Similarly, those with time-limited health certificates had a higher risk in both periods: 0-3 months (HR=2.02, 95% CI: 1.39 to 2.93) and 3-24 months (HR=2.45, 95% CI: 2.15 to 2.79). Adjustment of the analyses for socio-demographic factors did not change the effect estimates substantially.
These findings highlight the importance of comprehensive and continuous health assessments to help prevent adverse health outcomes and ensure safety at sea, particularly among vulnerable subgroups of seafarers.
调查与获得完整健康证明的挪威海员相比，被宣布不适宜海上服役或获得限时健康证明的挪威海员急性躯体疾病住院风险是否更高。
基于登记处的队列研究。
2018年至2019年期间，根据挪威船只工作要求，向海员医生出示以获取健康证明的挪威海员。该研究在挪威公共资助的医疗保健系统内进行。
年龄在18 - 70岁之间接受医学检查的挪威海员（n = 43758），其中包括n = 5452名女性（12.5%）。
医学检查后2年内急性躯体疾病住院情况。使用Cox回归模型在两个不同时间段（0 - 3个月和3 - 24个月）估计风险比（HR），并对年龄、性别、教育水平和居住中心性（靠近医疗服务机构）可能存在的混杂因素进行调整。
在两个随访期内，与获得完整健康证明的个体相比，获得不适宜证明的个体急性躯体疾病住院的粗略风险更高：0 - 3个月（HR = 5.13，95%CI：3.27至8.04）和3 - 24个月（HR = 2.63，95%CI：2.07至3.34）。同样，持有限时健康证明的个体在两个时间段内风险也更高：0 - 3个月（HR = 2.02，95%CI：1.39至2.93）和3 - 24个月（HR = 2.45，95%CI：2.15至2.79）。对社会人口学因素进行分析调整后，效应估计值没有实质性变化。
这些发现凸显了全面和持续健康评估对于预防不良健康结局以及确保海上安全的重要性，特别是在海员中的弱势群体中。
