Table 4 Hip osteoarthritis and occupations which involve heavy lifting: construction work
ReferenceStudy populationAge (years)Participation rateExposure measured by:Diagnostic criteriaAdjusted for: Matched by:ComparisonsResults, OR (95% CI)DesignQuality of the study (+, ++, +++); strength/weakness
Typpö, 198524Cases: 224 hip OA (22 construction workers) Controls: 255 without hip OA (14 construction workers) within a population of 91916–86, mean: 57Present occupation: job title described in questionnairesRetrospective radiological hip OA mild, moderate, severeConstruction workers vs others1.54 (0.8 to 2.98)Case-control+ Strength: none. Weakness: participation rate missing. No statistical testing. No adjustment for potential confounders. Only data for part of the study population (n = 505)
Vingård 19912738095 construction workers (223 OA) Controls: 91057 Low exposure group: (320 OA)Born 1905–45Register-basedJob title Same occupation in 1960 and 1970Hospitalised in 1981–3 ICD-8 713.00 (hipOA)Age, countyConstruction workers vs low exposureRR 1.66 (1.32 to 1.87)Cohort++ Strength: design and material well described. High number of participants. Weakness: exposure classification (job title + exposure (light, medium, heavy), risk of misclassification). Case definition (hospitalised because of hipOA, risk of selection bias)
Vingaard 199226Cases: 140 males with disability pension due to hip OA (27 construction workers) Controls: 298 males from the general populationBorn 1915–3473%Interview Occupational history Job titlePrimary diagnosis made by a physician hip OAAgeConstruction workers vs controlsRR 7.0 (3.5 to 14.3)Case-control++ Strength: description of material and design. Weakness: diagnosis from physician certificates (risk of misclassification). Subjects in heavy occupations may have an increased risk of getting disability pension (risk of selection bias). Exposure to high workload on hips, not especially related to heavy-lifting (risk of misclassification)
Croft 199216Cases: 245 with hipOA Controls: 294 without hip OA60–7568%Blinded interview Occupational history Job title and durationJoint-space All <2.5 mm Severe <1.5 mmAge, sport, BMIEmployment in years vs <1 year Severe cases (<1.5 mm)1.5 (0.7 to 3.4)Case-control+++ Strength: use of intravenous urograms avoiding risk of selection bias. Weakness: number of severe cases relatively small. Exposure measurement, lift >25.4 kg, frequency not further explained (risk of misclassification)
1–9 years3.3 (1.2 to 9.2)
⩾10 years0.5 (0.1 to 2.3)
Jensen 199432Male construction workers: total 3281 (hip OA 30) Total males: 1251590 (hip OA 9674)20–59 in 1981Register-basedJob title in 1981Hospitalised 1981–90 ICD-8 713.00 hip OAAgeConstruction workers vs othersSHR 151 (102 to 216)Cohort++ Strength: high number of participants. The design avoids information bias. Weakness: only job title included (risk of misclassification) Main job registered in 5-year periods (risk of misclassification of trade). Use of diagnostic code as case definition (risk of misclassification)
Coggon 199815Cases: 210 males, 401 females (23 construction workers) waiting for hip replacement in three English districts. Controls: 210 males, 401 females (13 construction workers), random sample from general practice in same area45–91, mean: 7068%Interview Occupation held for >1 year from school age Job titleCases waiting for surgeryConstruction workers1.5 (0.8 to 2.8)Case-control+ Strength: description of the study. Results reported on construction work are only a small part of the study. Weakness: only numbers of construction workers mentioned. No analysis made. Case definition (waiting list for THR, risk of selection bias). Participation rate relatively low. Retrospective exposure measurement (risk of recall bias). No adjustment for confounders
  • THR, total hip replacement; SHR, standardised hospitalisation ratio; BMI, body mass index (weight/height2); OA, osteoarthritis.

  • +, Poor quality score 1–5; ++, medium quality score 6–10; +++, high quality score >10.