张磊, 黄春萍. 工作相关肌肉骨骼疾患的机构聚集性:基于杭州市16家机构的多水平统计模型分析[J]. 环境与职业医学, 2019, 36(12): 1119-1124. DOI: 10.13213/j.cnki.jeom.2019.19384
引用本文: 张磊, 黄春萍. 工作相关肌肉骨骼疾患的机构聚集性:基于杭州市16家机构的多水平统计模型分析[J]. 环境与职业医学, 2019, 36(12): 1119-1124. DOI: 10.13213/j.cnki.jeom.2019.19384
ZHANG Lei, HUANG Chun-ping. Institutional clustering of work-related musculoskeletal disorders: Multilevel statistical model analysis of 16 institutions in Hangzhou[J]. Journal of Environmental and Occupational Medicine, 2019, 36(12): 1119-1124. DOI: 10.13213/j.cnki.jeom.2019.19384
Citation: ZHANG Lei, HUANG Chun-ping. Institutional clustering of work-related musculoskeletal disorders: Multilevel statistical model analysis of 16 institutions in Hangzhou[J]. Journal of Environmental and Occupational Medicine, 2019, 36(12): 1119-1124. DOI: 10.13213/j.cnki.jeom.2019.19384

工作相关肌肉骨骼疾患的机构聚集性:基于杭州市16家机构的多水平统计模型分析

Institutional clustering of work-related musculoskeletal disorders: Multilevel statistical model analysis of 16 institutions in Hangzhou

  • 摘要: 背景 工作相关肌肉骨骼疾患(WMSDs)严重影响劳动者健康。国内研究多围绕职工个体特征因素展开分析,而作为工作相关疾病,WMSDs可能存在工作机构的聚集性。

    目的 从个体和机构两个层面分析WMSDs的发生情况,从而为防控职工WMSDs提供依据。

    方法 采用分层整群抽样的方法,2014年从杭州市参加职业体检的单位中选择代表行政管理、教育、机械制造、电力、化工、商业、卫生等行业的16家机构所有在职体检职工进行北欧肌肉骨骼量表调查,病例定义为研究对象曾经发生颈、肩、上背、肘、下背、腕/手、臀/腿、膝、踝/足9个部位中的任何部位出现持续疼痛、剧痛或不适的症状超过24 h者。采用自填式问卷。不同性别、婚姻状况和劳动类型的WMSDs发生率比较采用χ2检验。WMSDs发生率随年龄、工龄、文化程度、经济水平的变化趋势采用Cochran-Armitage趋势检验。利用MLwiN 2.0软件,以机构为水平2单位,职工为水平1单位,以是否发生WMSDs为应变量,建立肌肉骨骼疾患的两水平logistic模型。

    结果 1 686名在职职工WMSDs发生率为50.1%(95% CI:47.7%~52.5%),不同机构WMSDs发生率不同(χ2=68.85,P < 0.01)。男性职工WMSDs发生风险是女性的2.35倍(χ2=51.63,P < 0.01),工龄≥20年的职工发生风险是工龄 < 20年职工的1.32倍(χ2=5.00,P=0.03),家庭人均月收入≥1 500元/月的职工发生风险是 < 1 500元/月的职工的1.38倍(χ2=7.69,P < 0.01),未婚职工的发生风险是已婚职工的0.68倍(χ2=7.21,P < 0.01),脑力劳动者发生风险是脑体混合劳动者的1.35倍(χ2=4.49,P=0.03)。水平2单位随机效应在零模型中有统计学意义(χ2=4.21,P=0.04),而在纳入个体特征的两水平logistic模型中没有统计学意义(χ2=2.29,P=0.13)。

    结论 职工WMSDs发生率较高。两水平logistic模型分析显示,男性、已婚、≥ 20年工龄、高收入、脑力劳动类型等个体特征是WMSDs的危险因素,提示有这些属性的人群应是WMSDs防控重点关注的对象。基于现有样本研究,职工WMSDs表现在机构水平的聚集现象可能是因为某些个体特征在机构间的聚集性所致。

     

    Abstract: Background Work-related musculoskeletal disorders (WMSDs) seriously affect the health of workers. Many domestic studies focus on individual characteristics of employees, but as a workrelated disease, WMSDs are possibly clustered in some specific institutions.

    Objective This study aims to analyze the morbidity of WMSDs at individual and institutional levels, and provide reference to prevent and control WMSDs.

    Methods By stratified cluster sampling method, 16 institutions including administrative management, education, machinery manufacture, electricity, chemical industry, business, and medical service were selected from the institutions that ordered occupational physical examination services in Hangzhou in 2014, and the employees were asked to complete Nordic musculoskeletal questionnaire. Those reporting ache, pain, or discomfort symptoms in neck, shoulders, upper back, elbows, low back, wrists/hands, hips/thighs, knees, ankles/feet that lasted for more than 24 h were defined as WMSDs cases. The morbidity rates of WMSDs among the employees with different sex, marital status, and work types were compared by chi-square test. The variational tendencies of WMSDs with age, working years, education, and income level were tested by Cochran-Armitage tendency test. A two-level logistic model of WMSDs with institutions as level 2 units and employees as level 1 units was established by software MLwiN 2.0.

    Results The morbidity rate of WMSDs in 1 686 workers was 50.1% (95% CI:47.7%-52.5%), and the rates were significantly different among the institutions (χ2=68.85, P < 0.01). The risk of WMSDs was 2.35 times higher for males versus females (χ2=51.63, P < 0.01), 1.32 times higher for those with ≥ 20 working years versus those with < 20 working years (χ2=5.00, P=0.03), 1.38 times higher for the ≥ 1500 yuan per capita monthly income group versus the < 1 500 yuan monthly income group (χ2=7.69, P < 0.01), 0.68 times for the single employees versus married ones (χ2=7.21, P < 0.01), and 1.35 times higher for mental labors versus mixed mental and manual labors (χ2=4.49, P=0.03). The random effect of level 2 unit was significant in zero model (χ2=4.21, P=0.04), but the two-level logistic model including individual characteristics was not significant (χ2=2.29, P=0.13).

    Conclusion The morbidity rate of WMSDs is high among the selected employees. According to the two-level logistic model, those who are male, married, with ≥ 20 working years, earning high income, mental labors are target population for WMSDs prevention and control. The findings indicate that the congregation of WMSDs at institutional level is resulted from the clustering of individual characteristics among institutions.

     

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