PREDICTORS OF LOW BACK INJURY AND DISABILITY IN THE ARMY

腰背部疾病是劳动力中发病率、时间损失和身体残疾的主要来源，是社会的主要成本。提高对可预防风险因素的认识的局限性包括确保足够的样本量的成本、研究人群的限制、薪酬制度的混淆以及需要详细的工作任务数据。此外，很少有研究有长期随访信息来确定长期残疾发展的风险因素。通过连接现有的陆军数据库，这项具有成本效益的研究将检查和量化职业、个人和行为特征与腰部疾病发病率和随后的残疾发展的关系。这项研究的具体目的是：1)确定腰部住院率最高的职业；2)确定伤残率最高的职业；3)确定腰部住院和长期残疾的危险因素；4)根据可改变的危险因素提出潜在的干预措施。这项回溯性队列研究将跟踪1989至1997年间的所有陆军人员，通过加扰的社会安全号码将人员、住院、残疾和健康风险评估数据库联系起来。这些数据提供了广泛的信息，包括工作分类、身体工作需求、医疗、吸烟和锻炼等个人因素、工作压力和工作满意度等工作因素、社会因素和残疾委员会评估。还将审查详细的工作任务，以确定职业特征，使人们有较高的腰背疾病风险。Kaplan-Meier将对从入伍到最初住院和出院的腰部疾病的生存功能进行评估。多变量COX比例风险模型将被用来确定腰背部疾病的重要预测因素。研究结果将用于制定针对初级预防和预防长期残疾发展的干预措施。这项研究产生的好处包括预防受伤和残疾以及可能节省的大量费用，并将适用于民事和军事环境。

Low back disorders are a major source of morbidity, lost time, and physical disability in the workforce and represent major costs to society. Limitations to improving knowledge of preventable risk factors include costs of ensuring adequate sample sizes, restricted study populations, confounding by compensation systems and the need for detailed job task data. In addition, few studies have long-term follow-up information to determine risk factors for development of long-term disability. Through linkage of available Army databases, this cost effective study will examine and quantify the relationships of occupational, individual, and behavioral characteristics to the incidence of both low back disorders and the subsequent development of disability. The specific aims of this study are to: 1) identify occupations with the highest rates of low back hospitalization; 2) identify occupations with the highest rates of disability; 3) identify risk factors for low back hospitalization and for long-term disability; and 4) propose potential interventions based on identification of modifiable risk factors. This retrospective cohort study will follow all Army personnel between 1989 and 1997 by linking personnel, hospitalization, disability, and health risk appraisal databases by scrambled social security number. These data provide extensive information including job classification, physical job demands, medical treatment, personal factors such as smoking and exercise, job factors such as work stress and job satisfaction, social factors, and disability board evaluations. Detailed job tasks will also be examined to identify occupational characteristics placing persons at elevated risk for low back disorders. Kaplan-Meier estimates of survival function from Army entry to initial hospitalization and medical discharge for a low back disorder will be performed. Multivariate Cox proportional hazards models will be employed to determine important predictors for low back disorders. Study findings will be used to develop interventions directed at both primary prevention and at preventing development of long term disability. Benefits resulting from this study include prevention of injury and disability and large potential cost savings and will be applicable in both civilian and military settings.