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. 2001 Dec;58(12):774–779. doi: 10.1136/oem.58.12.774

Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry

U Siebert 1, D Rothenbacher 1, U Daniel 1, H Brenner 1
PMCID: PMC1740083  PMID: 11706143

Abstract

OBJECTIVES—To assess the potential of a healthy worker survivor effect due to differential occupational mobility in a cohort of construction workers.
METHODS—A cohort of 10 809 male employees in the German construction industry aged 15-64 years was followed up for occupational mobility, early retirement due to permanent disability, and total mortality from 1986 to 1994. Using the Cox's proportional hazards model of relative rates (RRs) with 95% confidence intervals (95% CIs) of occupational mobility, early retirement and total mortality were estimated according to medical diagnoses at baseline after adjustment for various covariates.
RESULTS—During follow up, 2472 subjects changed employment, 359 employees were granted a disability pension for health reasons and 188 subjects died. A wide range of chronic diseases was associated with increased rates of early retirement and total mortality but not occupational mobility. However, a healthy worker survivor effect was identified related to disorders of the back and spine (ninth revision of the international classification of diseases, ICD-9, code 720-4), a common predictor of both occupational mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR 1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders of the back and spine. Differential occupational mobility preceded differential early retirement due to permanent disability by more than one decade.
CONCLUSIONS—These findings show the need to consider a healthy worker survivor effect due to occupational mobility in occupational epidemiological research. Furthermore these results underline the necessity of further health promotion targeting work related conditions in the construction industry.


Keywords: healthy worker survivor effect; construction workers; occupational mobility; early retirement

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Selected References

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  1. Arndt V., Rothenbacher D., Brenner H., Fraisse E., Zschenderlein B., Daniel U., Schuberth S., Fliedner T. M. Older workers in the construction industry: results of a routine health examination and a five year follow up. Occup Environ Med. 1996 Oct;53(10):686–691. doi: 10.1136/oem.53.10.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arrighi H. M., Hertz-Picciotto I. The evolving concept of the healthy worker survivor effect. Epidemiology. 1994 Mar;5(2):189–196. doi: 10.1097/00001648-199403000-00009. [DOI] [PubMed] [Google Scholar]
  3. Damlund M., Gøth S., Hasle P., Munk K. Low-back pain and early retirement among Danish semiskilled construction workers. Scand J Work Environ Health. 1982;8 (Suppl 1):100–104. [PubMed] [Google Scholar]
  4. Fox A. J., Collier P. F. Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Br J Prev Soc Med. 1976 Dec;30(4):225–230. doi: 10.1136/jech.30.4.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Frank J. W., Brooker A. S., DeMaio S. E., Kerr M. S., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2918–2929. doi: 10.1097/00007632-199612150-00025. [DOI] [PubMed] [Google Scholar]
  6. Frank J. W., Kerr M. S., Brooker A. S., DeMaio S. E., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2908–2917. doi: 10.1097/00007632-199612150-00024. [DOI] [PubMed] [Google Scholar]
  7. Garg A., Moore J. S. Epidemiology of low-back pain in industry. Occup Med. 1992 Oct-Dec;7(4):593–608. [PubMed] [Google Scholar]
  8. Garg A., Moore J. S. Prevention strategies and the low back in industry. Occup Med. 1992 Oct-Dec;7(4):629–640. [PubMed] [Google Scholar]
  9. Holmström E. B., Lindell J., Moritz U. Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain. Spine (Phila Pa 1976) 1992 Jun;17(6):663–671. doi: 10.1097/00007632-199206000-00005. [DOI] [PubMed] [Google Scholar]
  10. Holmström E. B., Lindell J., Moritz U. Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain. Spine (Phila Pa 1976) 1992 Jun;17(6):672–677. doi: 10.1097/00007632-199206000-00006. [DOI] [PubMed] [Google Scholar]
  11. Hunting K. L., Welch L. S. Occupational exposure to dust and lung disease among sheet metal workers. Br J Ind Med. 1993 May;50(5):432–442. doi: 10.1136/oem.50.5.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Latza U., Karmaus W., Stürmer T., Steiner M., Neth A., Rehder U. Cohort study of occupational risk factors of low back pain in construction workers. Occup Environ Med. 2000 Jan;57(1):28–34. doi: 10.1136/oem.57.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Rothenbacher D., Arndt V., Fraisse E., Daniel U., Fliedner T. M., Brenner H. Chronic respiratory disease morbidity in construction workers: patterns and prognostic significance for permanent disability and overall mortality. Eur Respir J. 1997 May;10(5):1093–1099. doi: 10.1183/09031936.97.10051093. [DOI] [PubMed] [Google Scholar]
  14. Rothenbacher D., Arndt V., Fraisse E., Zschenderlein B., Fliedner T. M., Brenner H. Early retirement due to permanent disability in relation to smoking in workers of the construction industry. J Occup Environ Med. 1998 Jan;40(1):63–68. doi: 10.1097/00043764-199801000-00012. [DOI] [PubMed] [Google Scholar]
  15. Rothenbacher D., Brenner H., Arndt V., Fraisse E., Zschenderlein B., Fliedner T. M. Disorders of the back and spine in construction workers. Prevalence and prognostic value for disability. Spine (Phila Pa 1976) 1997 Jul 1;22(13):1481–1486. doi: 10.1097/00007632-199707010-00011. [DOI] [PubMed] [Google Scholar]
  16. Sorock G. S., Courtney T. K. Epidemiologic concerns for ergonomists: illustrations from the musculoskeletal disorder literature. Ergonomics. 1996 Apr;39(4):562–578. doi: 10.1080/00140139608964481. [DOI] [PubMed] [Google Scholar]
  17. Stenlund B., Goldie I., Hagberg M., Hogstedt C., Marions O. Radiographic osteoarthrosis in the acromioclavicular joint resulting from manual work or exposure to vibration. Br J Ind Med. 1992 Aug;49(8):588–593. doi: 10.1136/oem.49.8.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stenlund B., Goldie I., Hagberg M., Hogstedt C. Shoulder tendinitis and its relation to heavy manual work and exposure to vibration. Scand J Work Environ Health. 1993 Feb;19(1):43–49. doi: 10.5271/sjweh.1505. [DOI] [PubMed] [Google Scholar]

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