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Workplace Policies and Prevalence of Knee Osteoarthritis: The Johnston County Osteoarthritis Project
  1. Jiu-Chiuan Chen (jcchen{at}
  1. University of North Carolina at Chapel Hill, School of Public Health, United States
    1. Laura Linnan
    1. Department of Behavior and Health Education, School of Public Health, UNC-Chapel Hill, United States
      1. Leigh F Callahan
      1. Thurston Arthritis Research Center, School of Medicine, UNC-Chapel Hill, United States
        1. Edward H Yelin
        1. Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, United States
          1. Jordan B Renner
          1. Thurston Arthritis Research Center, School of Medicine, UNC-Chapel Hill, United States
            1. Joanne M Jordan
            1. Thurston Arthritis Research Center, School of Medicine, UNC-Chapel Hill, United States


              Background: Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organizational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in U.S. Methods: The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits (paid sick leave; disability payment) policies and KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analyzed in participants (n=1639) aged <65 and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index, and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favorable policies and adjust for this potential bias accordingly. Results: Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering jobswitch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paidsick leave (adjusted OR: 0.58, 95%CI: 0.37-0.91) and disability payment policies (adjusted OR: 0.54, 95%CI: 0.35-0.85). Even among those without overt knee, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment. Conclusion: The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies.

              • knee joints
              • occupational exposures
              • organizational policies
              • osteoarthritis

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