Prevalence of low back pain in three occupational groups in Shanghai, People's Republic of China
Introduction
Low back pain (LBP) is among the most common work-related health problems in economically developed countries (Waddell, 1994). The lifetime incidence of LBP has been estimated to be as high as 85% of the adult population (Von Korff, Dworkin, LeResche, & Kruger, 1988) with an estimated 18% annual prevalence of back pain lasting at least one week in American adults (Guo et al., 1995). There is considerably less information about the magnitude and impact of LBP among adult, employed populations in developing nations. This situation has been argued to be the result of an overbalance of research on populations in the most economically developed (or highest income) countries. This lack of research leaves a profound gap in the knowledge of “LBP in the rest of the world,” where the bulk of the world's working population resides (Volinn, 1997).
The People's Republic of China (PRC) is the world's largest economically developing country. Its estimated 600 million workers compose the largest, single-nation labor force Leigh et al., 1999, Takala, 1999. Despite this economic and labor pre-eminence among developing countries, there have been relatively few studies of occupational LBP in the PRC. A recent review of existing literature on LBP in PRC workers, published in both English and Chinese, concluded that many studies were substantially limited by methodological or reporting flaws (Jin et al., 2000). Specific limitations included the lack of a clear and potentially generalizable definition of LBP, the absence of a systematic approach to documenting manual materials handling, and the often incomplete reporting of study methods including population characteristics, inclusion/exclusion criteria, participation rates, and other design details that would permit replication of the investigation.
To begin to address these limitations, a cross-sectional study of LBP prevalence was conducted in three Chinese occupational groups representing a diversity of workplace exposures: garment workers, battery and kiln factory workers, and teachers. The objectives of the study were to describe the prevalence of low back pain among employees in a variety of Chinese work environments and to identify work-related and personal factors potentially associated with LBP.
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Participants
Six work environments in the Shanghai municipality were recruited for the study: an apparel manufacturer; the mold department of a battery factory; the brick kiln department of a fire retardant materials factory; and three primary schools. To be eligible for the study, subjects had to meet the following criteria: (a) at least 12 months employment at the work site; and (b) absence of a physician's current diagnosis of cancer, infection, neurological diseases, or traumatic injury (Bigos et al.,
Results
The demographic characteristics of the garment factory workers, battery and kiln product workers, and primary school teachers are summarized in Table 1. A total of 383 of 492 subjects (78%) agreed to be examined and interviewed. Three subjects from the group of garment workers were excluded because of pelvic inflammatory diseases; no other subjects were excluded because of diseases or injury. Study participation was 62% for teachers, 79% for garment workers, and 93% for battery and kiln product
Discussion
The results indicate that the overall annual prevalence of LBP lasting more than one day among all three work groups is considerable: 50%. This prevalence figure (50%) is higher than the median prevalence (30%) reported among 50 other Chinese employed populations (Jin et al., 2000). Caution is urged however when comparing these studies due to the differences in LBP definitions and study methods.
The LBP prevalence for garment workers in the past seven days (45%) and past year (74%) was higher
Acknowledgements
We are indebted to Drs. Yao Zhenjun and Lu Yaogang who performed the physical examinations for this study and to the following study interviewers: Jia Xiaodong, Gao Fei, Yan Xiaorong, Zhao Xinping, Zheng Ling, and Shen Xuan. Drs. David Lombardi, Glenn Pransky, Gordon Smith, Jeffrey Katz, and Ms. Helen Wellman provided helpful comments on earlier drafts of the manuscript. Ms. Patti Boelsen prepared the manuscript for submission. This research was completed while Dr. Sorock was a research
Kezhi Jin Ph.D. is Lecturer in the Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China. He is currently a post-doctoral fellow at the Harvard School of Public Health in Boston and the Liberty Mutual Research Institute for Safety in Hopkinton, MA. He has published work on occupational disease and injury including low back pain.
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Kezhi Jin Ph.D. is Lecturer in the Department of Occupational Health, School of Public Health, Fudan University, Shanghai, China. He is currently a post-doctoral fellow at the Harvard School of Public Health in Boston and the Liberty Mutual Research Institute for Safety in Hopkinton, MA. He has published work on occupational disease and injury including low back pain.
Gary S. Sorock Ph.D. is Associate Professor of Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts. He specializes in the epidemiology of occupational injuries.
Theodore K. Courtney M.S., CSP is Director of the Quantitative Analysis Unit at the Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts and Instructor on Injury, Safety and Ergonomics at the Harvard University School of Public Health, Boston, Massachusetts. He received the 2003 William Floyd Medal from the Ergonomics Society for significant contributions to ergonomics research. His recently published work includes: examining US occupational morbidity in large surveillance data systems; comparative studies on fall-related injuries in the US, UK, and Sweden; research on disabling injuries in construction workers; and studies of occupational fatalities in the People's Republic of China.