Anatomy of the healthy worker effect: a critical review.
Anatomy of the healthy worker effect: a critical review.
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健康工人效应的剖析：批判性评论。
DOI：
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发表时间：
1983
期刊：
影响因子：
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通讯作者：
Roy L. Gibson
中科院分区：
文献类型：
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作者：
C. Wen;Shan P. Tsai;Roy L. Gibson
健康劳动者效应是以下因素综合作用的结果：(1)劳动力的选择；(2)伴随就业而改变的生活方式；(3)标准化死亡率(SMR)的方法学特征。虽然选择一般人口作为比较人口是造成这一效果的根本原因，但目前还没有更可行、更广泛接受或更好的替代办法。目前对健康工作者效应的理解大多局限于对劳动力选择的考察。本报告的目的是用一项大型队列研究中的例子来说明除选择之外的许多因素的重要性。它们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、跟踪调查的时间以及SMR方法的某些特点。结果表明，某些健康工作者效应是SMR方法的特征，并且健康工作者效应的强度取决于队列中活跃工作者的比例。此外，健康工作者效应的消失可能是由于队列的老龄化等因素，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，它的消失可能是SMR方法论的产物。
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.