Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures
Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures
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DOI：
10.1136/oemed-2017-104744
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发表时间：
2018-07-01
影响因子：
4.9
通讯作者：
Evanoff, Bradley A.
中科院分区：
文献类型：
--
作者：
Dale, Ann Marie;Ekenga, Christine C.;Evanoff, Bradley A.
背景：在与工作相关的肌肉骨骼疾病研究中，越来越多地使用工作暴露矩阵（JEM）来提供暴露估计；很少有研究检验这种估计的有效性，也没有比较JEM与其他暴露获得的关联。目的：本研究使用来自公开数据集（Occupational Network, O*NET）的JEM估计上肢暴露，并将偶发腕管综合征（CTS）的暴露-疾病关联与在一项大型前瞻性研究中使用观察到的物理暴露测量获得的暴露-疾病关联进行比较。方法对2393名不同行业的工人进行随访，随访时间长达2.8年（5.5人年）。标准职业分类（SOC）代码在入学时分配给该工作。从O*NET中提取与手部用力和重复性活动的物理暴露相关的SOC代码。我们使用多变量Cox比例风险回归模型来描述单独观察到的物理暴露和来自O*NET的JEM暴露的CTS事件的暴露-疾病关联。结果两种暴露方法均发现CTS事件与力和重复暴露之间存在关联，并有剂量反应证据。两种方法观察到的关联相似，使用JEM方法计算hr的ci稍宽。结论：与使用个体观察金标准法获得的相关性相比，使用JEM估计的暴露与CTS的暴露-疾病相关性相似。虽然JEMs有许多局限性，但在一些研究中，它们可以在没有观察到个人水平暴露的情况下提供有用的暴露估计。
Background There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures.Objective This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study.Methods 2393 workers from several industries were followed for up to 2.8years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET.Results Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose-response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method.Conclusion Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the gold standard' method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.