Predictors of permanent work disability after surgery for rotator cuff disease
Introduction: Shoulder disorders have increasing impact on utilization of secondary health services. In Sweden, the number of operations for rotator cuff disease has increased by 10％ each year since 1998. Little is known about the influence of workrelated exposures on postoperative prognosis. We conducted a nationwide register-based follow-up study of the risk of permanent work disability after surgery for rotator cuff disease in relation to formal education level as a proxy for physical work demands. Methods: From the Danish National Patient Register we extracted all patients who had first-time shoulder surgery under a primary diagnosis in ICD-10 group M75 (shoulder lesions) or M19 (other arthrosis), 1996-2005. The study was limited to patients aged 18-63 years on admission. Patients were excluded if they had left the labour market before admission. From the admission date, the patients were followed up in the Danish National Register on Public Transfer Payments (DREAM) with respect to transition to flex-job (supported jobs for persons with permanently reduced work capacity) or disability pension. As an indicator of formal education level and thereby physical work demands, we used DREAM-data on unemployment insurance fund membership. We fitted Cox proportional hazards models to study associations between education level and incidence of permanent work disability. Hazard ratios (HRs) and 95％ confidence intervals (CIs) were adjusted for age, gender, diagnosis, surgical procedure, surgery year, administrative region, and -in sub-analyses -duration of sickness absence compensation in the year prior to admission. Patients were censored at the time of death, emigration, leave of absence granted for study or training, retirement due to age, voluntary early retirement, or two years after admission. Results: The study included 22,751 patients, 48.1％ women, 51.9％ men. Of these, 19.2％ had higher or medium-level education, 35.7％ vocational education and training, 32.5％ low education level, and 12.6％ missing information on education level. Within two years after surgery, 9.5％ of the patients had left the labour market, namely 6.3％ among patients with higher or medium-level education, 9.1％ among patients with vocational education and training, 13.3％ among patients with low education level, and 5.4％ among patients with missing information on education. In multivariate analyses using ‘higher or medium-level education as a reference, the HR was 1.6 (95％ CI 1.4-1.8) and 2.2 (1.9-2.5) for ‘vocational education and training and ‘low education level, respectively. For ‘missing information on education the HR was 0.9 (0.7-1.1). When adjusted for duration of sickness absence compensation, these HRs changed to 1.4 (1.2-1.6), 1.5 (1.3-1.7), and 1.3 (1.1-1.6). Discussion: After surgery for rotator cuff disease, the risk of leaving the labour market prematurely was substantial and increased with decreasing education level. Results suggested that when planning shoulder surgery and postoperative rehabilitation, attention should be given to facilitate return to work for patients with low education level, possibly by modifying physical work loads.
S. W. Svendsen P. Frost L. D. Jensen
Danish Ramazzini Center, Department of Occupational Medicine, Aarhus UniversityHospital Danish Ramazzini Center, Department of Occupational Medicine, Aarhus University Hospital
国际会议
17th World Congress on Ergonomics(第十七届国际人类工效学大会)
北京
英文
1-5
2009-08-09（万方平台首次上网日期，不代表论文的发表时间）