Abstract
BackgroundIn higher income countries, work-related squatting and heavy lifting have been associated with increased arthritis risk. Here, we address the paucity of data regarding associations between arthritis and work-related physical stressors in lower- and middle-income countries.MethodsData were extracted from the Study on global AGEing and adult health (SAGE) Wave 1 (2007–10) for adults (aged ≥50 years) from Ghana, India, Russia and South Africa for whom detailed occupation data was available (n = 21,389; 49.2% women). Arthritis cases were identified using a symptom-defined algorithm (current) and self-reported doctor-diagnosis (lifetime). A sex-specific Job Exposure Matrix was used to classify work-related stressors: heavy physical work, kneeling/squatting, heavy lifting, arm elevation and awkward trunk posture. Using the International Standard Classification of Occupations, we linked SAGE and the Job Exposure Matrix. Logistic regression was used to investigate associations between arthritis and work-related stressors, adjusting for age (10 year age groupings), potential socioeconomic-related confounders, and body mass index. Excess exposure risk due to two-way interactions with other risk factors were explored.ResultsDoctor-diagnosed arthritis was associated with heavy physical work (adjusted odds ratios [OR] 1.12, 95%CI 1.01–1.23), awkward trunk posture (adjusted OR 1.23, 95%CI 1.12–1.36), kneeling or squatting (adjusted OR 1.25, 95%CI 1.12–1.38), and arm elevation (adjusted OR 1.66, 95%CI 1.37–2.00). Symptom-based arthritis was associated with kneeling or squatting (adjusted OR 1.27, 95%CI 1.08–1.50), heavy lifting (adjusted OR 1.33, 95%CI 1.11–1.58), and arm elevation (adjusted OR 2.16, 95%CI 1.63–2.86). Two-way interactions suggested excess arthritis risk existed for higher body mass index, and higher income or education.ConclusionsMinimization of occupational health risk factors is common practice in higher income countries: attention should now be directed toward reducing work-related arthritis burden in lower- and middle-income countries.
Highlights
In higher income countries, work-related squatting and heavy lifting have been associated with increased arthritis risk
Minimization of occupational health risk factors is common practice in higher income countries: attention should be directed toward reducing work-related arthritis burden in lower- and middle-income countries
We have reported that higher arthritis prevalence was associated with lower educational attainment in over 44,000 residents from six lower- and middle-income countries (LMICs) enrolled in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) [12]
Summary
Work-related squatting and heavy lifting have been associated with increased arthritis risk. Very little is known about the relationship between physical work-related stressors and arthritis in lower- and middle-income countries (LMICs) This is despite occupational risk factors associated with osteoarthritis, such as repetitive trauma, knee bending or lifting heavy weights, being more prevalent in occupational groups such as farmers and unskilled workers [6,7,8], and may be more often experienced by workers in LMICs. There appears an inextricable link between occupation and education in higher income countries [9,10,11], which may plausibly exist in LMICs with clear consequences for arthritis. We have reported that higher arthritis prevalence was associated with lower educational attainment in over 44,000 residents from six LMICs enrolled in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) [12]. The potential bi-directional relationship between poverty and arthritis presents a concerning situation for populations of LMICs
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