日光温室作业人员工作相关肌肉骨骼疾患患病特征及影响因素

Prevalence characteristics and influencing factors of work-related musculoskeletal disorders in solar greenhouse workers

[背景]日光温室作业过程中劳动强度大、重复性劳动多,累及四肢、颈、上背、下背等多个部位。该人群工作相关肌肉骨骼疾患(WMSDs)的患病和多部位共患病问题值得关注。[目的]探讨日光温室作业人员WMSDs患病和多部位共患病特征以及可能的影响因素。[方法]选取我国西北某地区722名日光温室作业人员作为研究对象。通过问卷调查和体格检查,收集研究对象基本信息和各部位WMSDs的患病情况。采用累积暴露指数矩阵模型将作业人员分为低、中、高三个累积暴露水平。不同累积暴露水平组间患病率的差异采用卡方检验,每两个部位WMSDs患病之间的关联强度采用log-binomial模型计算现患比(PR),多部位WMSDs患病率在不同暴露水平组间的比较采用Wilcoxon秩和检验。多部位WMSDs的影响因素分析采用多分类logistic回归模型。[结果]日光温室作业人员WMSDs患病率为78.7%(568/722),主要患病部位为下背部、腿部、颈部和肩部,患病率依次为47.6%、46.0%、27.1%、23.8%。低、中、高三个累积暴露水平组分别为121、196和405人。下背部、腿部和肩部的WMSDs患病率在不同暴露水平组间差异具有统计学意义(P <0.05),且随累积暴露水平升高而升高(下背部,χ_(趋势)^(2)=11.144,P <0.05;腿部,χ_(趋势)^(2)=6.767,P <0.05;肩部,χ_(趋势)^(2)=15.666,P <0.05)。log-binomial模型分析发现,下背部和腿部(PR值分别为1.57和1.43)、颈部和肩部(PR值分别为2.00和2.07)间共患病关联较强。WMSDs多部位的患病情况显示50.4%(364/722)的作业人员出现2个及以上部位WMSDs的共患病现象。多分类logistic回归分析结果显示,2个部位共患WMSDs的影响因素为高水平累积暴露(OR=2.41,95%CI:1.34~4.33)和女性(OR=3.27,95%CI:2.07~5.16),3个及以上部位共患WMSDs的影响因素包括中水平累积暴露(OR=3.78,95%CI:1.70~8.39)、高水平累积暴露(OR=7.34,95%CI:3.41~15.80)和女性(OR=5.66,95%CI:3.48~9.22)。[结论]本研究中日光温室作业人员下背部、腿部、颈部和肩部WMSDs患病率高,存在颈部-肩部、下背部-腿部共患病模式。累积暴露水平较高和女性作业人员2个及以上部位WMSDs共患病现象较多。

In the process of greenhouse working,labor intensity is high and repetitive work involves multiple body parts such as limbs,neck,upper back,and lower back.The prevalence and comorbidity of work-related musculoskeletal disorders(WMSDs) in greenhouse workers are wo rthy of attention.This study is conducted to investigate the prevalence and comorbidity,as well as potential influencing factors of WMSDs in greenhouse workers.A total of 722 greenhouse workers were selected as the subjects for a cross-sectional epidemiological survey.Through questionnaire survey and physical examination,basic information of the subjects and the prevalence of WMSDs were collected.The participants were divided into low,medium,and high cumulative exposure groups by cumulative exposure index matrix.Chi-square test was used to analyze the difference of prevalence among different cumulative exposure levels,the correlation between the prevalence of WMSDs in paired sites was calculated as prevalence ratio(PR) by using the log-binomial model,the prevalence of multi-site WMSDs in each group was compared by Wilcoxon rank sum test,and the influencing factors of multi-site WMSDs were evaluated by multiclassification logistic regression model.The prevalence rate of WMSDs in the greenhouse workers was 78.7%(568/722).The main affected sites of body were lower back,legs,neck,and shoulders,and associated prevalence rates were 47.6%,46.0%,27.1%,and 23.8%,respectively.By constructing a cumulative exposure index matrix,the low,medium,and high cumulative exposure groups contained 121,196,and 405 workers respectively.The prevalence rates of WMSDs in lower back,legs,or shoulders were significantly different among groups with different exposure levels(P<0.05),and the prevalence rates increased with higher cumulative exposure levels(lower back,χ_(trend)^(2)=11.144,P<0.05;legs,χ_(trend)^(2)=6.767,P<0.05;shoulders,χ_(trend)^(2)=15.666,P<0.05).The results of log-binomial model found that lower back and legs(PR values were 1.57 and 1.43,respectively) as well as neck and shoulders(PR values were 2.00 and 2.07,respectively) among the main affected parts have a strong association with comorbidities.The prevalence of multi-site WMSDs showed that 50.4% of the workers had comorbidity of two or more sites of WMSDs.The results of multi-classification logistic regression analysis indicated that the influencing factors of WMSDs in two sites involved high-level cumulative exposure(OR=2.41,95% CI:1.34-4.33) and female(OR=3.27,95% CI:2.07-5.16);the influencing factors of WMSDs in three or more sites also included medium-level cumulative exposure(OR=3.78,95% CI:1.70-8.39),high-level cumulative exposure(OR=7.34,95% CI:3.41-15.80),and fem ale(OR=5.66,95% CI:3.48-9.22).In this study,the prevalence rates of WMSDs in lower back,legs,neck,and shoulders are high among selected solar greenhouse workers,and WMSDs comorbidity of lower back-legs and neck-shoulders are identified.Greenhouse workers with high cumulative exposure level and female workers report more WMSDs comorbidities in two or more sites.