Objective Occupations requiring high physical demands may lead to greater risk of rotator cuff disease (RCD) and corresponding surgical treatment. We linked a job-exposure matrix (JEM) to the UK Biobank to measure physical occupational exposures and estimate associations with incident RCD surgery.

Methods Job titles at baseline and UK Standard Occupational Classification (SOC) codes were recorded during a verbal interview. Lifetime job histories were captured through a web-based survey. UK SOC codes were linked to a JEM based on the US O*NET database. O*NET-based scores for physical demands were assigned to jobs including: static strength, dynamic strength, general physical activities, handling/moving objects (range=1–7), time spent using hands, whole body vibration, and cramped/awkward positions (range=1–5). RCD surgeries were identified through national hospital inpatient records. Cox regression was used to calculate hazard ratios (HRs) as estimates of associations with RCD surgery accounting for confounders. Among those with lifetime job histories, associations were estimated with duration of time with high exposure (i.e. above cut-offs identifying approximately the top quartile of exposure).

Results Job titles were available for 277,808 people, of which 1,345 (0.5%) had a subsequent inpatient RCD surgery. After adjusting for age, sex, race, education, deprivation, and body mass index, all O*NET variables considered were associated with RCD surgery (HR per point increase range=1.10–1.45, all P<0.005). More frequent occupational manual labor self-reported in the UK Biobank verbal interview was also associated with RCD surgery (HR for ‘Always’ vs. ‘Never/rarely’=2.12; 95%CI=1.79–2.50). Lifetime job histories were available for 100,929 people, in which high exposures were significantly associated with RCD surgery after more than 10 years of work (Ex. HR for 11–20 years vs. 0 years with static strength score≥4=2.06, 95%CI=1.39–3.04).

Conclusion Numerous occupational physical exposures were associated with incident RCD surgery. Associations were strongest in workers with more than a decade of high exposure.