Mäkelä M, Heliövaara M, Sievers K, Knekt P, Maatela J, Aromaa A
Social Insurance Institution, Helsinki, Finland.
J Clin Epidemiol. 1993 Jun;46(6):549-59. doi: 10.1016/0895-4356(93)90128-n.
The relationship between disability and various musculoskeletal disorders was investigated in 7217 men and women representative of the Finnish population aged 30 years or more. They participated in the Mini-Finland Health Survey and were first screened by interview and questionnaire about limitations in daily activities. The outcome variables were reduced working capacity, an occasional need for assistance in daily activities, and a regular need for assistance in daily activities. In a two-phase medical examination, all cases fulfilling predetermined diagnostic criteria of musculoskeletal, cardiovascular, respiratory and mental disorders and diabetes were recorded independently. In multivariate logistic regression analyses, inflammatory arthritis was the strongest determinant of all forms of disability. Osteoarthritis, especially in the hip, was a strong determinant of both occasional and regular need for assistance, and chronic low back pain was a strong determinant of reduced working capacity and occasional need for assistance among those aged 30-64 years. Other musculoskeletal disorders also determined the prevalence disability, but these relationships were reduced by taking comorbidity into account. A low level of education and a low (less than 20 kg/m2) or very high (at least 35 kg/m2) body mass index represented independent determinants of all forms of disability, and a history of physically strenuous work an independent determinant of reduced working capacity, when disabling illness was adjusted for. The proportion of all forms of disability attributable to musculoskeletal disorders, in models including, age, sex, other disabling illness and significant non-medical determinants of disability, was close to 20%. The disorders with the highest community impact were chronic low back pain among those aged 30-64, osteoarthritis of the hips and knees and inflammatory arthritis.
对7217名年龄在30岁及以上的芬兰代表性男女进行了残疾与各种肌肉骨骼疾病之间关系的调查。他们参与了芬兰小型健康调查，首先通过访谈和问卷对日常活动受限情况进行筛查。结果变量包括工作能力下降、偶尔需要日常活动协助以及经常需要日常活动协助。在两阶段医学检查中，所有符合肌肉骨骼、心血管、呼吸和精神疾病以及糖尿病预定诊断标准的病例均被独立记录。在多变量逻辑回归分析中，炎症性关节炎是所有形式残疾的最强决定因素。骨关节炎，尤其是髋部骨关节炎，是偶尔和经常需要协助的强烈决定因素，慢性腰痛是30 - 64岁人群工作能力下降和偶尔需要协助的强烈决定因素。其他肌肉骨骼疾病也决定了残疾患病率，但考虑到合并症后，这些关系有所减弱。低教育水平以及低（低于20kg/m²）或非常高（至少35kg/m²）的体重指数是所有形式残疾的独立决定因素，在调整致残疾病后，体力劳动强度大的工作史是工作能力下降的独立决定因素。在包括年龄、性别、其他致残疾病和残疾的重要非医学决定因素的模型中，所有形式残疾归因于肌肉骨骼疾病的比例接近20%。对社区影响最大的疾病是30 - 64岁人群中的慢性腰痛、髋部和膝部骨关节炎以及炎症性关节炎。
