工作组织因素对职业性肌肉骨骼损伤患病影响的病例对照研究

A case-control study on the effect of work organization on the prevalence of WMSDs

目的探讨与工作组织有关的因素对职业性肌肉骨骼损伤（WMSDs）患病的影响,为合理工作制度的制定以及WMSDs的干预提供依据。方法选取北京、河南、湖北、广东等地的14个行业共计41个企业（工厂）的工人进行病例对照研究,采用自主研制的肌肉骨骼损伤调查问卷对所选人群进行统一的问卷调查,其中,1 931名自诉患有WMSDs的工人作为观察组,1 991名对照组工人在性别、年龄、身高、体质量、教育程度等方面与之匹配,使用单因素分析和多因素非条件logistic回归进行分析。结果首先使用卡方检验对问卷中涉及到工作组织的18个可疑危险因素进行初步筛选（α=0.1）,然后利用多因素非条件logistic回归,最终筛选出2个与WMSDs相关的因素,包括1个危险因素：人员短缺（OR=1.265,95%CI=1.190~1.346,P〈0.01）,1个保护因素：工间休息充足（OR=0.274,95%CI=1.073~1.433,P〈0.01）。结论工作组织因素对WMSDs的影响是多样的,相关的队列研究可能为其机制提供更多的证据。

Objective To explore the risk factors of work-related musculoskeletal disorders associated with work organization based on a large sample of workers in several typical industries and provide evidence for further research. Methods Workers from a total of 41 work sites belonging to alternative industries in Beijing, Henan, Hubei and Guangdong province were included in this case-control study. We used the questionnaire developed by ourselves in order to investigate the individual and work-related factors that may affect the prevalence of WMSDs. Among all the subjects, 1931 workers who claimed to suffer from WMSDs were selected to be the case group while the control group consisting of 1991 workers was matched with the case group in age, gender, height, weight and degree of education, and all factors were analyzed by chi- square test and multivariate non-conditional logistic regression. Results Firstly we used chi-square test to conduct preliminary screening among 18 suspicious risk factors that were associated with work organization. Then enter selection was used in logistic regression model and finally 4 variables entered into the equation, but only 2 variables were statistically significant（P〈0.05）, including 1 risk factor： shortage of personnel（OR = 1.265,95%CI：1.190--1.346,P〈0.01）, and 1 protective factor： sufficient rest time（OR=0.274,95%CI = 1. 073 ~ 1. 433, P 〈0.01）. Conclusions Work organization may have comprehensive effects on WMSDs. Such a pattern of associations suggests that relative cohort studies may provide more evidence for the mechanism of how work organization affects the prevalence of WMSDs.