Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort
- Carisa Harris-Adamson1,2,
- Ellen A Eisen1,
- Ann Marie Dale3,
- Bradley Evanoff3,
- Kurt T Hegmann4,
- Matthew S Thiese4,
- Jay M Kapellusch5,
- Arun Garg6,
- Susan Burt7,
- Stephen Bao8,
- Barbara Silverstein8,
- Fred Gerr9,
- Linda Merlino9,
- David Rempel10,11
- 1Department of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
- 2Department of Physical Therapy, Samuel Merritt University, Oakland, California, USA
- 3Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, Missouri, USA
- 4Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
- 5Occupational Science and Technology Department, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- 6Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- 7National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
- 8Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
- 9Department of Occupational and Environmental Health, University of Iowa, College of Public Health, Iowa City, Iowa, USA
- 10Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, California, USA
- 11Department of Bioengineering, University of California Berkeley, Berkeley, California, USA
- Correspondence to Dr Carisa Harris-Adamson, Department of Physical Therapy, Samuel Merritt University, 450 30th Street Suite 3708, Oakland, CA 94609, USA; and Professor David Rempel, Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, 1301 South 46th Street Bldg 163 Richmond, CA 94804, USA;
- Received 8 January 2013
- Revised 27 February 2013
- Accepted 12 April 2013
- Published Online First 3 May 2013
Background Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes.
Objective This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors.
Methods 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis.
Results Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12).
Conclusions Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort.