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Original Article
Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study
  1. Marie Vestergaard Vad1,2,
  2. Poul Frost2,
  3. Jacob Rosenberg3,
  4. Johan Hviid Andersen1,
  5. Susanne Wulff Svendsen1
  1. 1 Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
  2. 2 Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
  3. 3 Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
  1. Correspondence to Dr Marie Vestergaard Vad, Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Noerrebrogade 44, Building 2C, DK-8000 Aarhus C, Denmark; marivd{at}


Objectives To evaluate exposure–response relationships between occupational mechanical exposures and first-time lateral and medial inguinal hernia repair and effects of lifestyle factors. To estimate if occupational mechanical exposures advance the repairs.

Methods This longitudinal study was based on a cohort of men aged 18–65 years with questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. We estimated occupational mechanical exposures using a job exposure matrix. First-time inguinal hernia repairs from 1998 to 2014 were identified in the Danish Hernia Database. We used Cox regression analyses and calculated excess fractions among the exposed and rate advancement periods (RAPs).

Results Among 17 967 men, we identified 382 lateral and 314 medial repairs. The risk of lateral repairs increased with time spent standing/walking with an HR of 1.45 (95% CI 1.12 to 1.88) for ≥6 hours/day versus <4 hours/day, corresponding to an excess fraction of cases of 31% in the group with ≥6 hours/day. This group had a RAP of 6.7 (95% CI 2.6 to 10.8) years. Medial repairs were not associated with occupational mechanical exposures. A body mass index ≥30 kg/m2 showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes.

Conclusions Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would be preventable if the time spent standing/walking could be reduced from ≥6 to <4 hours/day. The repairs might even be postponed by 6–7 years.

  • body mass index
  • groin hernia
  • herniorrhaphy
  • lifting
  • rate advancement period
  • physical activity
  • smoking
  • standing
  • work

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  • Contributors All authors have contributed to this study according to the ICMJE recomendations.

  • Funding The study was funded by The Danish Working Environment Fund; Project number: 2013002392/5.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.