Choi B C, Levitsky M, Lloyd R D, Stones I M
Workplace Health and Safety Agency, University of Toronto, Ontario, Canada.
J Occup Environ Med. 1996 Apr;38(4):379-89. doi: 10.1097/00043764-199604000-00016.
This study presents the results of analyses performed to generate hypotheses concerning the general patterns of risk factors for occupational sprains and strains, using Ontario workers' compensation data housed in the Workplace Health and Safety Agency (WHSA) data base. Historically, the largest percentage of lost-time injuries in Ontario, Canada, have been sprains and strains. In 1990, there were 171,047 compensated lost-time injuries with a known nature of injury, of which 50.43% were sprains and strains. From cross-tabulations, a number of statistics such as odds ratios (ORs), 95% confidence intervals, P values, attributable risks and number of injuries attributable, were calculated. Results indicate that occupational sprains and strains are related to the time of the day and, in particular, time into the workshift. They occur more frequently than expected (based on the occurrence of non-sprain and non-strain injuries) in the morning hours and in the first 4 hours of the workshift. They are not found to be related to the starting or ending time or the length of the workshift. They occur more frequently than expected during the early part of a week, especially on Mondays, and the early part of a year (January to May). With respect to age, workers 30 to 59 years old have an increased risk of sprains and strains, whereas workers less than 30 years of age, or 60 or more years of age, have a decreased risk. Workers who are not single, and female workers, have a higher risk of sprains and strains than expected. With respect to occupations, nurses and truckers have a higher-than-expected risk. A number of work environments and activities, such as overexertion, bodily reaction from involuntary motions, running and stretching, and slippery surfaces, are associated with a high risk of occurrence of sprains and strains. These results suggest that significant reduction in the number of occupational sprains and strains could be achieved by targeting prevention programs to reduce excess risks encountered in the first 4 hours of the workshift, on Mondays, and during the first 5 months of the year, and by workers 30 to 59 years of age, female workers, and nurses and truck drivers. It is estimated that, with proper interventions to avoid sprains and strains, a large percentage of sprain and strain injuries could be avoided each year: ie 82.49% of injuries due to bodily reaction from involuntary motions, 89.43% of overexertions in lifting objects, 84.64% of running, stretching, and related injuries, and 76.64% of injuries resulting from loss of balance on slippery surfaces. This study uses an internal comparison, ie comparing the risk of sprains and strains to the risk of all other injuries for various risk categories of interest. As a result, an increased OR may mean an increased risk of sprains and strains, or it may mean a decreased risk of all other injuries for a particular risk category. There are also limitations in the use of workers' compensation data base for epidemiologic studies. Therefore, findings in this study are only suggestive for further investigations and should await confirmations before prevention programs are designed.
本研究呈现了利用工作场所健康与安全局（WHSA）数据库中安大略省工人赔偿数据进行分析的结果，以生成关于职业扭伤和拉伤风险因素总体模式的假设。从历史上看，加拿大安大略省因伤误工时间最长的受伤类型中，扭伤和拉伤占比最大。1990年，有171,047起已知受伤性质的赔偿性因伤误工事件，其中50.43%为扭伤和拉伤。通过交叉列表，计算了一些统计数据，如比值比（OR）、95%置信区间、P值、归因风险以及可归因的受伤数量。结果表明，职业扭伤和拉伤与一天中的时间相关，尤其与上班时段相关。它们在上午以及上班时段的前4小时比预期（基于非扭伤和非拉伤受伤的发生情况）更频繁地发生。未发现它们与上班的开始或结束时间以及工作时长相关。在一周的前期，尤其是周一，以及一年的前期（1月至5月），它们比预期更频繁地发生。就年龄而言，30至59岁的工人扭伤和拉伤风险增加，而30岁以下或60岁及以上的工人风险降低。非单身工人以及女性工人扭伤和拉伤的风险高于预期。就职业而言，护士和卡车司机的风险高于预期。一些工作环境和活动，如过度用力、非自主运动引起的身体反应、奔跑和伸展以及湿滑表面，与扭伤和拉伤的高发生风险相关。这些结果表明，通过针对预防项目来降低上班时段的前4小时、周一以及一年的前5个月中遇到的额外风险，以及30至59岁的工人、女性工人、护士和卡车司机所面临的风险，可以显著减少职业扭伤和拉伤的数量。据估计，通过适当干预以避免扭伤和拉伤，每年可以避免很大比例的扭伤和拉伤伤害：即82.49%因非自主运动引起的身体反应导致的伤害、89.43%提举物体时过度用力导致的伤害、84.64%奔跑、伸展及相关伤害，以及76.64%在湿滑表面失去平衡导致的伤害。本研究采用内部比较，即将扭伤和拉伤的风险与各种感兴趣的风险类别中所有其他伤害的风险进行比较。因此，升高后的OR可能意味着扭伤和拉伤风险增加，也可能意味着特定风险类别中所有其他伤害的风险降低。在流行病学研究中使用工人赔偿数据库也存在局限性。因此，本研究中的发现仅为进一步调查提供了提示，在设计预防项目之前应等待确认。
