Wen C P, Tsai S P, Gibson R L
J Occup Med. 1983 Apr;25(4):283-9.
The healthy worker effect is the composite result from factors such as (1) selection of the work force, (2) changes in lifestyle accompanying employment, and (3) methodological characteristics of the standardized mortality ratio (SMR). While the choice of the general population as the comparison population is the underlying reason for this effect, no more feasible, widely accepted or "better" alternative is yet available. Much of the current understanding of the healthy worker effect has been limited to an examination of selection of the work force. The purpose of this report is to illustrate, using examples from a large cohort study, the importance of many factors other than selection. They include employment-associated benefits such as economic gain, medical insurance and lifestyle changes, the proportion of active workers, the calculation method, data completeness, length of follow-up and certain characteristics of SMR methodology. It is shown that some of the healthy worker effect is characteristic of SMR methodology and that the strength of the healthy worker effect depends on the proportion of active workers in the cohort. Furthermore, the disappearance of the healthy worker effect may be due to factors such as aging of the cohort and can be totally unrelated to the true increase in the mortality risk. In other words, its disappearance, in many instances, may be an artifact of SMR methodology.
（1）劳动力的选择；（2）就业带来的生活方式变化；（3）标准化死亡比（SMR）的方法学特征。虽然选择一般人群作为对照人群是产生这种效应的根本原因，但目前尚无更可行、被广泛接受或“更好”的替代方法。目前对健康工人效应的理解大多局限于对劳动力选择的研究。本报告的目的是通过一项大型队列研究中的实例，说明除选择因素外其他许多因素的重要性。这些因素包括与就业相关的福利，如经济收益、医疗保险和生活方式的改变、在职工人的比例、计算方法、数据完整性、随访时间以及SMR方法学的某些特征。研究表明，健康工人效应的某些方面是SMR方法学所特有的，且健康工人效应的强度取决于队列中在职工人的比例。此外，健康工人效应的消失可能是由于队列老化等因素，并且可能与死亡风险的真正增加完全无关。换句话说，在许多情况下，其消失可能是SMR方法学的一种假象。
