Long-term exposure to heavy physical work, disability pension due to musculoskeletal disorders and all-cause mortality: 20-year follow-up\u2014introducing Helsinki Health Study job exposure matrix

Jenni Ervasti,Eero Lahelma,Tea Lallukka,Anne Kouvonen,Ossi Rahkonen,Olli Pietiläinen,Minna Mänty

doi:10.1007/s00420-018-1393-5

Abstract

PurposeWe developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality.MethodsExposure to heavy physical effort at work during 1996–2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8–10 years (1996–2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis.ResultsThere were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05–2.05), third (SHR = 2.73, 95% CI 2.00–2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88–3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23–4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99–2.41) had a higher risk of premature mortality than those in the lowest quartile.ConclusionsEight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men.

Highlights

Demanding work has been widely shown to be a risk factor for disability pension (Karpansalo et al 2002; Krokstad et al 2002; Labriola et al 2009; Lahelma et al 2012), and is linked to a higher risk of disability pension due to musculoskeletal disorders (Karkkainen et al 2013; Lahelma et al 2012)
The second highest exposure (65–82%) to heavy physical effort was associated with a higher risk of premature mortality (SHR = 2.29, 95% confidence intervals (CI) 1.24–4.26) compared to employees in the lowest quartile of average level of exposure (Table 2)
The highest exposure (> 82%) to heavy physical effort was marginally associated with higher risk of premature mortality (SHR = 1.54, 95% CI 0.99–2.41) (Table 2)

Summary

Introduction

Demanding work has been widely shown to be a risk factor for disability pension (Karpansalo et al 2002; Krokstad et al 2002; Labriola et al 2009; Lahelma et al 2012), and is linked to a higher risk of disability pension due to musculoskeletal disorders (Karkkainen et al 2013; Lahelma et al 2012). Less is known about how long-time continuous exposure to physically demanding work affects the risk of disability pension. One among Finnish twins (Ropponen et al 2014), and another among two Swedish birth cohorts (Kjellberg et al 2016), showed that long-term exposure to physically demanding work was associated with a higher risk of disability pension due to musculoskeletal disorders. A recent study with Danish register cohort data found that lifting-years, but not kneeling- or vibration-years, were associated with an increased risk of all-cause disability pension (Sundstrup et al 2017). The study did not separately examine musculoskeletal disorder-related disability pensions

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