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  • Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures

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Exposure assessment
Original article
Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures
  1. Ann Marie Dale1,
  2. Christine C Ekenga2,
  3. Skye Buckner-Petty1,
  4. Linda Merlino3,
  5. Matthew S Thiese4,
  6. Stephen Bao5,
  7. Alysha Rose Meyers6,
  8. Carisa Harris-Adamson7,
  9. Jay Kapellusch8,
  10. Ellen A Eisen7,
  11. Fred Gerr3,
  12. Kurt T Hegmann4,
  13. Barbara Silverstein5,
  14. Arun Garg8,
  15. David Rempel9,10,
  16. Angelique Zeringue11,
  17. Bradley A Evanoff1
  1. 1 Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
  2. 2 George Warren Brown School, Washington University in Saint Louis, St Louis, Missouri, USA
  3. 3 Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
  4. 4 Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
  5. 5 Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
  6. 6 Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
  7. 7 Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
  8. 8 Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA
  9. 9 Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, California, USA
  10. 10 Department of Bioengineering, University of California Berkeley, Berkeley, California, USA
  11. 11 Mercy Healthcare, Virtual Care Center, Chesterfield, Missouri, USA
  1. Correspondence to Dr Ann Marie Dale, Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA; amdale{at}wustl.edu

Abstract

Background There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures.

Objective This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study.

Methods 2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET.

Results Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose–response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method.

Conclusion Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the ‘gold standard’ method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.

  • carpal tunnel syndrome
  • job exposure matrix
  • occupational epidemiology
  • exposure-response models
  • validity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/oemed-2017-104744

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    Footnotes

    • Contributors AMD and BAE designed the study and made significant contributions to the writing and formatting of the paper. CE is the primary author. SPB is the primary data analyst with significant contributions from AZ. All other authors were integral in the design of the study, data collection and biomechanical data analysis for their respective cohorts that were used in the pooled data as part of the Upper Extremity MSD Consortium. These authors also provided feedback on the final manuscript. These same authors were integral to the publication of the comparison paper by Harris-Adamson et al.

    • Funding This study was supported by research funding from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (R01OH008017, R01OH009712 and 1R01 OH011076-01A1), and in part by T32CA190194 (PI: Colditz), the Foundation for Barnes-Jewish Hospital, and the Siteman Cancer Center.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH nor the National Institute for Occupational Safety and Health (NIOSH).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Washington University in St Louis.

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

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