Background Analysis of baseline cross-sectional data from the CUPID study has demonstrated widely varying prevalence of disabling wrist/hand pain (DWHP) by country and occupation, which correlated with differences in the prevalence of disabling low back pain. This suggested that DWHP might be importantly driven by general propensity to musculoskeletal pain. We tested the hypothesis, using longitudinal data from the CUPID study.

Methods Men and women from 47 occupational groups in 18 countries completed a baseline questionnaire about personal risk factors, including “pain propensity”, which was quantified by the number (0 to 8) of anatomical sites other than wrist/hand that had been painful in the past 12 months. Additional group-level risk factors were derived from the individual data (e.g. mean pain propensity score) and from information provided by the lead investigator in each country (e.g. on local unemployment rates). After a mean interval of 14 months, participants from 45 groups provided follow-up information on DWHP in the past month. Associations of DWHP with baseline risk factors were analysed by random intercept Poisson regression.

Results Data were available for 9,082 participants (response rate at follow-up 76%). In an analysis that included all significant personal and group-level risk factors, pain propensity showed by far the strongest association with DWHP at follow-up (prevalence rate ratio for 6+ vs. 0 painful sites 3.7, 95% CI: 3.0–4.4; population attributable fraction for 1+ painful site 49.8%). The prevalence of DWHP at follow-up varied 100-fold across the 45 occupational groups, and correlated strongly with the mean pain propensity score (Spearman correlation coefficient = 0.86).

Conclusions Major international variation in the prevalence of DWHP is driven principally by differences in general propensity to musculoskeletal pain. If ways could be found to modify such propensity, the impacts on DWHP could be much greater than from ergonomic interventions in the workplace.