Exposure–Response Relationship and Doubling Risk Doses—A Systematic Review of Occupational Workload and Osteoarthritis of the Hip
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Literature Searches
- Studies do not address the topic, or address non-idiopathic hip osteoarthritis;
- No occupational exposure data are available;
- Studies do not provide an exposure-response estimation.
2.2. Classification of Quality Level of Published Studies
2.3. Statistical Analysis
- Step 1: Estimation of the average (median) exposure values for each exposure category defined in published studiesIn order to extrapolate a steady course of the exposure–response relationship, we first had to estimate the median exposure values for each exposure category (which were not provided in the published studies). Since in all published studies the distribution of the cumulative workloads is distorted, we assumed that they follow a log-normal distribution. Based on an optimal fit to the described distribution of the study population in each exposure category, we simulated a steady distribution of occupational workload for each study and extrapolated the median exposure values for each exposure category.
- Step 2: Extrapolation of a steady course of the exposure–response relationshipThe estimated median exposure values of each exposure category were used to extrapolate a steady course of the exposure–response relationship for the published studies. We assume that the published exposure–response relationships follow a linear exponential function in which OR/RR = exß, where x = cumulative exposure dose and ß = regression coefficient. This assumption serves as the basis of almost all statistical models used for exposure–response estimation (such as logistic regression, Cox model and Poisson regression analysis).
- Step 3: Quantification of the doubling risk dosesThe possible doubling risk doses can then be read off directly from the estimated exposure–response curve.
3. Results
4. Discussion
- First, doubling risk doses of work-related hip OA can be quantified only in two studies that state both an exposure–response relationship and cumulative exposure doses. This limited number of studies may limit the generalization of our findings, and indicates some selections. However, the selection criteria are only the quality criteria presented in this paper. The two studies [13,18] selected in this analysis exhibit the highest methodological quality levels of all studies published to date (large sample size, highest quality score for case ascertainment, good quality score for exposure assessment methods, complete adjustment of relevant confounders). Were we to include more studies in the analysis, we would have to lower our quality requirements and introduce more bias or uncertainties into the analysis. This does not appear reasonable.
- Second, we assume that doubling risk doses exist at high exposure levels. However, we are unsure whether they can in fact be achieved in empirical studies. In the study by Rubak et al. [18] for example, the highest effect estimate reaches a level of OR = 1.35. We do not know whether the effect estimate would ever reach OR ≥ 2 at higher exposure levels. However, the conservative monotonic dose–response assumption may assist us in extrapolating a minimum possible value for the doubling risk dose. In fact, this value is more likely to be higher, if indeed it exists at all.
- Third, although cumulative exposure doses were stated in the two studies referenced in this analysis [13,18], we must make certain assumptions concerning the average (median) exposure values in each exposure category. Our analysis indicates that different assumptions of the exposure values in the highest exposure category have an influence upon the estimated values of doubling risk doses. This analysis nevertheless provides a range of possible values for doubling risk doses that can serve as an orientation in future for quantifying the possible main cause of work-related hip OA.
- Fourth, we would point out that workers subject to higher physical loads (such as farmers, transportation workers, construction workers, etc.) differ from the general population. They are often healthier and have a lower susceptibility to disease (typical healthy worker effect). Doubling risk doses quantified among the general populations in this analysis cannot therefore be extrapolated to all working groups, especially to workers subject to a higher physical workload. The values stated in this analysis are more likely to indicate underestimated minimum doubling risk doses for workers subject to high physical workloads.
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Diagnosis Criteria | Diagnostic Quality Score * (Evidence Level) |
---|---|
Anamnesis/questionnaire: hip pain without clinical check | 1 |
Hip pain and clinical reduction of movement without radiographic features or Radiographic features without clinical examination, without THR (total hip replacement) | 2 |
Hip pain with clinical reduction of movement and clearly defined radiographic features (joint space narrowing or Kellgren–Lawrence-score grade 2 and above or comparable criteria) or diagnosis with indication for THR (total hip replacement) | 3 |
Exposure Assessment | Exposure Quality Score * |
---|---|
Profession, job title, classification of occupation | 1 |
Qualitative specification of exposure in different work activities (lifting, climbing stairs, sitting) | 2 |
Quantitative specification of exposure in different work activities/physical strains with information on intensity (e.g., load weight steps) and duration | 3 |
Quantitative specification of exposure (as above) with additional plausibility check (e.g., information on daily work output or special controls through video analysis) | 4 |
Quantitative, measured exposure with quantitative assessment or modeling of hip joint strain | 5 |
Design | Study | Outcome Assessment | Study Population | Quality Score of | Confounders Controlled | Exposure Parameter Estimated | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Sample Size | Age (Years) | Exposure Assessment | Hip OA Ascertainment | Age | Sex | BMI | Prior Injury | ||||
Cross- sectional | Kaila-Kangas 2011 [9] | Prevalence | 6556 | 30–97 | 3 | 2 | ✓ | ✓ | ✓ | ✓ | Lifting/carrying/pushing |
Population based case-control | Coggon 1998 [10] | Incidence | 611 cases 611 controls | 45–91 | 3 | 3 | ✓ | ✓ | ✓ | ✓ | Lifting |
Croft 1992 [11] | Prevalence | 245 cases 294 controls | 60–75 | 3 | 2 | ✓ | ✓ | Lifting/moving | |||
Pope 2003 [12] | Prevalence | 352 cases 3002 controls | 18–85 | 3 | 1 | ✓ | ✓ | Lifting/moving | |||
Vingard 1991 [13] | Incidence | 239 cases 302 controls | 50–70 | 3 | 3 | ✓ | ✓ | ✓ | ✓ | Lifting | |
Roach 1994 [14] | Prevalence | 99 cases 233 controls | Mean 68 | 3 | 3 | ✓ | ✓ | ✓ | Heavy work | ||
Vingard 1997 [15] | Prevalence | 230 cases 273 controls | 50–70 | 3 | 3 | ✓ | ✓ | ✓ | Lifting | ||
Cohort (including nested case-control) | Ratzlaff 2011 [16] | Incidence | 2918 | 45–85 | 2 | 3 | ✓ | ✓ | ✓ | ✓ | Peak hip joint force |
Rubak 2013 [17] | Incidence | 1.9 million | 31–71 | 3 | 3 | ✓ | ✓ | Physical work | |||
Rubak 2014 [18] | Incidence | 1776 cases 1776 controls | 41–69 | 3 | 3 | ✓ | ✓ | ✓ | ✓ | Lifting |
Design | Study | Exposure Assessment Methods | Exposure Values Assessed | OR/RR * | |||||
---|---|---|---|---|---|---|---|---|---|
Weight Handled | Frequency (n) | Duration (years) | Exposure Doses | Male | Female | Both Sexes | |||
Cross-sectional | Kaila-Kangas 2011 [9] | Personal interview for lifetime work history (99%) | >20 kg | ≥10 times/day | 0 | Not available | 1 | 1 | 1 |
1–12 | 1.1 (0.4–3.2) | 1.6 (0.7–3.5) | 1.4 (0.7–2.6) | ||||||
13–24 | 2.2 (0.8–5.9) | 3.8 (1.7–8.1) | 2.8 (1.5–5.0) | ||||||
>24 | 2.3 (1.2–4.3) | 1.2 (0.7–2.1) | 1.8 (1.1–2.4) | ||||||
Population based case-control | Coggon 1998 [10] | Personal interview for lifetime work history | ≥25 kg | >10 times/week | 0 | Not available | 1 | 1 | 1 |
0.1–9.9 | 0.8 (0.4–1.7) | 1.1 (0.6–1.7) | 0.9 (0.6–1.4) | ||||||
10–19.9 | 1.5 (0.6–3.8) | 1.4 (0.7–2.9) | 1.2 (0.7–2.2) | ||||||
≥ 20 | 2.3 (1.3–4.4) | 0.8 (0.4–1.5) | 1.5 (1.0–2.3) | ||||||
Croft 1992 [11] | Personal interview for lifetime work history | >25.4 kg | Not provided | <1 | Not available | 1 (all cases) | |||
1–19 | 0.9 (0.6–1.4) | ||||||||
≥20 | 1.2 (0.7–1.9) | ||||||||
<1 | 1 (severe cases) | ||||||||
1–19 | 1.2 (0.5–2.9) | ||||||||
≥20 | 2.5 (1.1.5.7) | ||||||||
Pope 2003 [12] | Personal interview for lifetime work history | >23 kg | Not provided | 0 | Not available | 1 | |||
1–12 | 1.02 (0.58–1.80) | ||||||||
≥13 | 1.74 (1.06–2.86) | ||||||||
Vingard 1991 [13] | Questionnaire for lifetime work history | Total load lifted | Per week | 0–137 tons | 1 | ||||
138–3006 tons | 1.58 (0.93–2.66) | ||||||||
3007–94,003 tons | 1.84 (1.12–3.03) | ||||||||
Population based case-control | Roach 1994 [14] | Questionnaire for the number of years of heavy work | Not provided | Not provided | 0 | Not available | 1 | ||
15–24 | 2.2 | ||||||||
25–34 | 3.0 | ||||||||
>34 | 2.2 | ||||||||
Vingard 1997 [15] | Questionnaire for lifetime work history | Not provided | 0–20,328 | Not provided | Not available | 1.0 | |||
20,329–44,088 | 1.1 (0.7–1.7) | ||||||||
44,089–95,040 | 1.5 (0.9–2.5) | ||||||||
Cohort (including nested case-control) | Ratzlaff 2011 [16] | Questionnaire for lifetime work and leisure time activities, estimation of lifetime CPFI ** | Standing, running, squatting, carrying | 1st quintile | 1 | ||||
2nd quintile | 1.11 (0.63–1.83) | ||||||||
3rd quintile | 1.3 (0.72–2.11) | ||||||||
4th quintile | 1.58 (0.86–2.52) | ||||||||
5th quintile | 1.80 (0.95–2.82) | ||||||||
Rubak 2013 [17] | Complete work history by pension register, development of industry exposure matrix (IEM) | Lifting, walking, whole-body vibration | 0 (point years) | 1 | 1 | ||||
>0 to <5 | 1.13 (0.98–1.31) | 0.96 (0.8–1.06) | |||||||
5 to <15 | 1.14 (1.00–1.31) | 0.96 (0.87–1.05) | |||||||
15 to <25 | 1.19 (1.04–1.36) | 0.94 (0.85–1.04) | |||||||
25 to <35 | 1.27 (1.11–1.48) | 0.99 (0.88–1.10) | |||||||
35–86 | 1.33 (1.17–1.53) | 1.01 (0.88–1.16) | |||||||
Cohort (including nested case-control) | Rubak 2014 [18] | Self-reported lifetime job title, job-exposure matrix (JEM) for load lifted | Total load lifted | Per day | 0 (ton-years) | 1 | 1 | ||
>0 to <10 | 0.99 (0.75–1.30) | 1.15 (0.87–1.53) | |||||||
10 to <20 | 0.89 (0.67–1.17) | 0.81 (0.61–1.09) | |||||||
20–115/86 | 1.35 (1.05–1.74) | 1.00 (0.72–1.41) |
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Sun, Y.; Nold, A.; Glitsch, U.; Bochmann, F. Exposure–Response Relationship and Doubling Risk Doses—A Systematic Review of Occupational Workload and Osteoarthritis of the Hip. Int. J. Environ. Res. Public Health 2019, 16, 3681. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193681
Sun Y, Nold A, Glitsch U, Bochmann F. Exposure–Response Relationship and Doubling Risk Doses—A Systematic Review of Occupational Workload and Osteoarthritis of the Hip. International Journal of Environmental Research and Public Health. 2019; 16(19):3681. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193681
Chicago/Turabian StyleSun, Yi, Annette Nold, Ulrich Glitsch, and Frank Bochmann. 2019. "Exposure–Response Relationship and Doubling Risk Doses—A Systematic Review of Occupational Workload and Osteoarthritis of the Hip" International Journal of Environmental Research and Public Health 16, no. 19: 3681. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193681