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Jankowiak S, Rossnagel K, Bauer J, Schulz A, Liebers F, Latza U, Romero Starke K, Seidler A, Nübling M, Riechmann-Wolf M, Letzel S, Wild P, Arnold N, Beutel M, Pfeiffer N, Lackner K, Münzel T, Schulze A, Hegewald J. Night shift work and cardiovascular diseases among employees in Germany: five-year follow-up of the Gutenberg Health Study. Scand J Work Environ Health 2024; 50:142-151. [PMID: 38258536 PMCID: PMC11006091 DOI: 10.5271/sjweh.4139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study aimed to determine if there is an increased risk of incident cardiovascular diseases (CVD) resulting from cumulative night shift work in the German population-based Gutenberg Health Study (GHS). METHODS We examined working participants of the GHS at baseline and after five years. Cumulative night shift work in the 10 years before baseline was assessed and categorized as low (1-220 nights ≙ up to 1 year), middle (221-660 nights ≙ 1-3 years), and high (>660 nights ≙ more than 3 years) night shift exposure. Hazard ratios (HR) were estimated for incident "quality-assured CVD events" using Cox proportional hazard models. RESULTS At baseline, 1092 of 8167 working participants performed night shift work. During the follow-up, 202 incident cardiovascular events occurred. The crude incidence rates for CVD per 1000 person-years were 6.88 [95% confidence interval (CI) 4.80-9.55] for night shift workers and 5.19 (95% CI 4.44-6.04) for day workers. Cumulative incidence curves showed a higher cumulative incidence in workers exposed to night shift work compared to day workers after five years. The adjusted HR for incident CVD events were 1.26 (95% CI 0.68-2.33), 1.37 (95% CI 0.74-2.53) and 1.19 (95% CI 0.67-2.12) for employees in the low, middle and high night shift categories compared to employees without night shift work, respectively. CONCLUSIONS The observed tendencies indicate that night shift work might be negatively associated with cardiovascular health. We expect the continued follow-up will clarify the long-term impact of night shift work.
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Romero Starke K, Bolm-Audorff U, Reissig D, Seidler A. Dose-response-relationship between occupational exposure to diesel engine emissions and lung cancer risk: A systematic review and meta-analysis. Int J Hyg Environ Health 2024; 256:114299. [PMID: 38194821 DOI: 10.1016/j.ijheh.2023.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In 2012, the International Agency for Research on Cancer (IARC) concluded that diesel engine emissions (DEE) emissions cause cancer in humans. However, there is still controversy surrounding this conclusion, due to several studies since the IARC decision citing a lack of evidence of a dose-response relationship. OBJECTIVES Through a systematic review, we aimed to evaluate all evidence on the association between occupational DEE and lung cancer to investigate whether there is an increased risk of lung cancer for workers exposed to DEE and if so, to describe the dose-response relationship. METHODS We registered the review protocol with PROSPERO and searched for observational studies in relevant literature databases. Two independent reviewers screened the studies' titles/abstracts and full texts, and extracted and assessed their quality. Studies with no direct DEE measurement but with information on length of exposure for high-risk occupations were assigned exposure values based on the DEE Job-Exposure-Matrix (DEE-JEM). After assessing quality and informativeness, we selected appropriate studies for the dose-response meta-analysis. RESULTS Sixty-five reports (from thirty-seven studies) were included in the review; one had a low risk of bias (RoB) (RR per 10 μg/m3-years: 1.014 [95%CI 1.007-1.021]). There was an increased, statistically significant risk of lung cancer with increasing DEE exposure for all studies (RR per 10 μg/m3-years = 1.013 [95%CI 1.004-1.021]) as well as for studies with a low RoB in the exposure category (RR per 10 μg/m3-years = 1.008 [95% CI1.001-1.015]). We obtained a doubling dose of 555 μg/m3-years for all studies and 880 μg/m3-years for studies with high quality in the exposure assessment. DISCUSSION We found a linear positive dose-response relationship for studies with high quality in the exposure domain, even though all studies had an overall high risk of bias. Current threshold levels for DEE exposure at the workplace should be reconsidered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Ulrich Bolm-Audorff
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Romero Starke K, Schubert M, Kaboth P, Gerlach J, Hegewald J, Reusche M, Friedemann D, Zülke A, Riedel-Heller SG, Zeeb H, Seidler A. Traffic noise annoyance in the LIFE-adult study in Germany: Exposure-response relationships and a comparison to the WHO curves. Environ Res 2023; 228:115815. [PMID: 37003550 DOI: 10.1016/j.envres.2023.115815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Noise annoyance is the second-highest cause of lost disability-adjusted life-years due to environmental noise in Europe. Evidence on exposure-response relationships (ERRs) for traffic noise annoyance with more accurate exposure values is still needed. OBJECTIVES In an analysis of the population-based LIFE-Adult study in Leipzig, Germany, we aimed to investigate the effect of road, railway (train and tram), and aircraft noise on high annoyance (HA). METHODS Traffic exposure data was taken for 2012 and data on noise annoyance was evaluated between 2018 and 2021. HA was defined according to international standardized norms. We calculated risk estimates using logistic regression, controlling for age, sex, and socioeconomic status, and compared our ERRs with those from the last WHO review on this topic. RESULTS Aircraft noise had the highest relative risk for noise-related HA (OR = 12.7, 95% CI: 9.37-17.10 per 10 dB Lden increase). The road and railway traffic risk estimates were similar to each other (road: OR = 3.55, 95% CI: 2.78-4.54; railway: OR = 3.31, 95% CI: 2.77-3.97 per 10 dB Lden increase). Compared to the WHO curves, the proportion of highly annoyed individuals was somewhat lower for road and rail traffic noise, but higher for aircraft noise. DISCUSSION Aircraft noise is particularly annoying. There were differences between our study's ERRs and those in the WHO review, especially for aircraft noise. These differences may be partly explained by the improved accuracy of the exposure values, as we considered secondary road networks and tram noise, and by a lack of a nighttime flight ban at the Leipzig airport. Geographical, regional and climatic variations, inconsistency in HA cut-offs, as well as temporal developments in the annoyance experience may also explain the differences. Since ERRs serve as a basis for decision making in public policies, regular updates of the curves based on new evidence is recommended.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Gerlach
- Chair of Transport Ecology, Institute of Transport Planning and Road Traffic, Technische Universität Dresden, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Federal Institute for Occupational Safety and Health, Unit 3.1 Prevention of Work-related Diseases, Berlin, Germany
| | - Matthias Reusche
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
| | | | - Andrea Zülke
- Institute for Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute for Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Leipzig, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibnitz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Schubert M, Romero Starke K, Gerlach J, Reusche M, Kaboth P, Schmidt W, Friedemann D, Hegewald J, Zeeb H, Zülke A, Riedel-Heller SG, Seidler A. Traffic-Related High Sleep Disturbance in the LIFE-Adult Cohort Study: A Comparison to the WHO Exposure-Response-Curves. Int J Environ Res Public Health 2023; 20:4903. [PMID: 36981810 PMCID: PMC10049209 DOI: 10.3390/ijerph20064903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Sleep is negatively affected by environmental noise. In the present study, we investigated self-reported high sleep disturbances (being "highly sleep disturbed"-HSD) from road traffic (primary and secondary road networks), rail (train and tram) and air traffic noise in the LIFE-Adult cohort study in Leipzig, Germany. For this, we used exposure data from 2012 and outcome data of Wave 2 (collected during 2018-2021). HSD was determined and defined according to internationally standardized norms. The highest risk for transportation noise-related HSD was found for aircraft noise: the odds ratio (OR) was 19.66, 95% CI 11.47-33.71 per 10 dB increase in Lnight. For road and rail traffic, similar risk estimates were observed (road: OR = 2.86, 95% CI 1.92-4.28; rail: OR = 2.67, 95% CI 2.03-3.50 per 10 dB Lnight increase). Further, we compared our exposure-risk curves with the curves of the WHO environmental noise guidelines for the European region. The proportion of individuals with HSD for a given noise level was lower for rail traffic but higher for aircraft noise in the LIFE study than in the WHO curves. For road traffic, curves are not directly comparable because we also included the secondary road network. The results of our study add to the body of evidence for increased health risks by traffic noise. Moreover, the results indicate that aircraft noise is particularly harmful to health. We recommend reconsidering threshold values for nightly aircraft exposure.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Julia Gerlach
- Institute of Transport Planning and Road Traffic, Technische Universität Dresden, 01069 Dresden, Germany
| | - Matthias Reusche
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04107 Leipzig, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Wolfram Schmidt
- Institute of Transport Planning and Road Traffic, Technische Universität Dresden, 01069 Dresden, Germany
- Lohmeyer GmbH, 01067 Dresden, Germany
| | | | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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Seidler A, Schubert M, Freiberg A, Drössler S, S. Hussenoeder F, Conrad I, Riedel-Heller S, Romero Starke K. Psychosocial Occupational Exposures and Mental Illness. Dtsch Arztebl Int 2022; 119:709-715. [PMID: 36345690 PMCID: PMC9835701 DOI: 10.3238/arztebl.m2022.0295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the exposure-risk relationship between psychosocial occupational stress and mental illness. METHODS We conducted a systematic review with meta-analyses as an update of a systematic review published in 2014. The study protocol was registered in PROSPERO (CRD42020170032). Literature searches were carried out in the MEDLINE, PsycINFO, and Embase databases. All procedural steps were performed independently by two reviewers; discordances were solved by consensus. All of the included full texts were subject to a methodological appraisal. Certainty of evidence was determined with the GRADE procedure. RESULTS The pooled risk of depression was found to be approximately doubled in workers exposed to high job strain, which is defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI [1.68; 2.35], heterogeneity [I2] = 24.7%, n = 8). In particular, high work demands are associated with incident depression (ES = 13.8 [1.19; 1.61], I2 = 69.0%, n = 9) and with incident anxiety disorder (ES = 1.79 [1.44; 2.23], I2 = 48.1%, n = 5). There were only a small number of methodologically adequate studies available on burnout, somatoform disorders, suicidal ideation, and suicide. Thus, no pooled risk estimates were calculated, although some individual studies showed a considerably increased risk. CONCLUSION Psychosocial occupational stress is clearly associated with depression and anxiety disorders.
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Affiliation(s)
- Andreas Seidler
- *All authors are co-first authors.,Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, TU Dresden, Dresden, Germany,*Poliklinik für Arbeits- und Sozialmedizin Medizinische Fakultät der TU Dresden Fetscherstraße 74, 01307 Dresden Germany
| | - Melanie Schubert
- *All authors are co-first authors.,Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Stephanie Drössler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Felix S. Hussenoeder
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Ines Conrad
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, TU Dresden, Dresden, Germany
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Romero Starke K, Hegewald J, Schmauder S, Kaboth P, Uhlmann LM, Reissig D, Kaufmann KK, Wegge J, Marquardt G, Seidler A. Health and Care Dependency of Older Adults in Dresden, Germany: Results from the LAB60+ Study. Int J Environ Res Public Health 2022; 19:11777. [PMID: 36142050 PMCID: PMC9517330 DOI: 10.3390/ijerph191811777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
As the population in Europe ages, an increased focus on the health of older adults is necessary. The purpose of the population-based LAB60+ study was to examine the current health and care situation of the population of older adults in Dresden, Germany, and to assess the effect of age, gender, and socioeconomic status (SES) on health outcomes. In the first half of 2021, 2399 out of 6004 randomly sampled residents of Dresden aged 60 years or older answered questions on their chronic conditions, care dependency, health-related quality of life (HRQoL), and well-being, among others. Of the participants, 91.6% were afflicted with at least one chronic condition, and 73.1% had multimorbidities. More than one-tenth (11.3%) of participants were care dependent. Lower levels of HRQoL and well-being were observed compared to a published German reference population, perhaps because of the ongoing COVID-19 pandemic. Gender differences were observed for some chronic health conditions, and women had a higher risk for lower HRQoL, well-being, and depressivity compared to men. A low SES was associated with a higher risk of the vast majority of health outcomes. Particularly, socioeconomic factors and gender-related inequalities should be considered for the development of prevention and health-promoting measures during late life.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Federal Institute for Occupational Safety and Health (BAuA), 10317 Berlin, Germany
| | - Stefanie Schmauder
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Lena Marie Uhlmann
- Work and Organisational Psychology, Technische Universität Dresden, 01069 Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | | | - Jürgen Wegge
- Work and Organisational Psychology, Technische Universität Dresden, 01069 Dresden, Germany
| | - Gesine Marquardt
- Social and Health Care Buildings and Design, Technische Universität Dresden, 01069 Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, Jöckel KH, Greiser KH, Michels KB, Krause G, Albrecht S, Öztürk I, Kuss O, Berger K, Lampl BMJ, Leitzmann M, Zeeb H, Starke KR, Schipf S, Meinke-Franze C, Ahrens W, Seidler A, Klee B, Pischon T, Andreas Deckert AD, Schmidt B, Mikolajczyk R, Karch A, Bohn B, Brenner H, Holleczek B, Dragano N. Authors' response: Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health 2022; 48:588-590. [PMID: 36153787 PMCID: PMC10539105 DOI: 10.5271/sjweh.4061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We thank van Tongeren et al for responding to our study on occupational disparities in SARS-CoV-2 infection risks during the first pandemic wave in Germany (1). The authors address the potential for bias resulting from differential testing between occupational groups and propose an alternative analytical strategy for dealing with selective testing. In the following, we want to discuss two aspects of this issue, namely (i) the extent and reasons of differential testing in our cohort and (ii) the advantages and disadvantages of different analytical approaches to study risk factors for SARS-CoV-2 infection. Our study relied on nationwide prospective cohort data including more than 100 000 workers in order to compare the incidence of infections between different occupations and occupational status positions. We found elevated infection risks in personal services and business administration, in essential occupations (including health care) and among people in higher occupational status positions (ie, managers and highly skilled workers) during the first pandemic wave in Germany (2). Van Tongeren's et al main concern is that the correlations found could be affected by a systematic bias because people in healthcare professions get tested more often than employees in other professions. A second argument is that better-off people could be more likely to use testing as they are less affected by direct costs (prices for testing) and the economic hardship associated with a positive test result (eg, loss of earnings in the event of sick leave). We share the authors' view that differential testing must be considered when analysing and interpreting the data. Thus, in our study, we examined the proportion of tests conducted in each occupational group as part of the sensitivity analyses (see supplementary figure S1, accessible at www.sjweh.fi/article/4037). As expected, testing proportions were exceptionally high in medical occupations (due to employer requirements). However, we did not observe systematic differences among non-medical occupations or when categorising by skill-level or managerial responsibility. This might be explained by several reasons. First, SARS-CoV-2 testing was free of charge during the first pandemic wave in Germany, but reporting a risk contact or having symptoms was a necessary condition for testing ( https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html (accessed 5 September 2022). The newspaper article cited by van Tongeren et al is misleading as it refers to a calendar date after our study period. Second, different motivation for testing due to economic hardship in case of a positive test result is an unlikely explanation, because Germany has a universal healthcare system, including paid sick leave and sickness benefits for all workers (3). Self-employed people carry greater financial risks in case of sickness. We therefore included self-employment in the multivariable analyses to address this potential source of bias. While the observed inverse social gradient may be surprising, it actually matches with findings of ecological studies from Germany (4, 5), the United States (6, 7) as well as Spain, Portugal, Sweden, The Netherlands, Israel, and Hong Kong (8), all of which observed higher infection rates in wealthier neighbourhoods during the initial outbreak phase of the pandemic. One possible explanation is the higher mobility of managers and better educated workers, who are more likely to participate in meetings and engage in business travel and holiday trips like skiing. Given the increasing number of studies providing evidence for this hypothesis, we conclude that the inverse social gradient in our study likely reflects different exposure probabilities and is not a result of systematic bias. This also holds true for the elevated infection risks in essential workers, which is actually corroborated by a large body of research (9-11). Regarding differential likelihood of testing, van Tongeren et al state that "[i]t is relatively simple to address this problem by using a test-negative design" (1). As van Tongeren et al describe, this is a case-control approach only including individuals who were tested (without considering those who were not tested). However, the proposed analytical strategy can lead to another (more serious) selection bias if testing proportions and/or testing criteria differ between groups (12). This can be easily illustrated when comparing the results based on a time-incidence design with those obtained by a test-negative design as shown in table 1 (see PDF). Both approaches show similar results in terms of vertical occupational differences. Infection was more common if individuals had a high skill level or had a managerial position, but associations were stronger in the time-incidence design and did not reach statistical significance in the test-negative design (as indicated by the confidence intervals overlapping "1"). Unfortunately, the test-negative approach relies on a strongly reduced sample size and thus results in greater statistical uncertainty and loss of statistical power (13). In contrast, the test-negative design yields a different picture when estimating the association between essential occupation and infection risk: In this analysis, essential workers did not differ from non-essential workers in their chance of being infected with SARS-CoV-2 (the test-negative design even exhibits a lower chance for essential workers). This is rather counter-intuitive and is not in accordance with what we know about the occupational hazards of healthcare workers during the pandemic (14). The main problem is that proportions of positive tests are highly unreliable when testing proportions and/or testing criteria differ between groups. As essential workers were tested more often without being symptomatic (due to employer requirements), a lower proportion of positive tests in this group does not necessarily correspond to a lower risk of infection. Consequently, we are not convinced that the test-negative design should be the 'gold standard' for studying risk factors for SARS-CoV-2 infections (15). Especially problematic is the loss of statistical power (increasing the probability of a type II error) and the low validity of the test-positivity when test criteria and/or test proportions differ between groups. References 1. van Tongeren M, Rhodes S, Pearce N. Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health 2022;48(7):586-587. https://doi.org/10.5271/sjweh.4052. 2. Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, et al. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022;48:446-56. https://doi.org/10.5271/sjweh.4037. 3. Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 2017;390:882-97. https://doi.org/10.1016/S0140-6736(17)31280-1. 4. Wachtler B, Michalski N, Nowossadeck E, Diercke M, Wahrendorf M, Santos-Hövener C, et al. Socioeconomic inequalities in the risk of SARS-CoV-2 infection - First results from an analysis of surveillance data from Germany. J Heal Monit 2020;5:18-29. https://doi.org/10.25646/7057. 5. Plümper T, Neumayer E. The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts. Eur J Public Health 2020;30:1176-80. https://doi.org/10.1093/eurpub/ckaa168. 6. Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shahjouei S, et al. Racial, Economic, and Health Inequality and COVID-19 Infection in the United States. J Racial Ethn Heal Disparities 2021;8:732-42. https://doi.org/10.1007/s40615-020-00833-4. 7. Mukherji N. The Social and Economic Factors Underlying the Incidence of COVID-19 Cases and Deaths in US Counties During the Initial Outbreak Phase. Rev Reg Stud 2022;52. https://doi.org/10.52324/001c.35255. 8. Beese F, Waldhauer J, Wollgast L, Pförtner T, Wahrendorf M, Haller S, et al. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic-A Scoping Review. Int J Public Health 2022;67:1-14. https://doi.org/10.3389/ijph.2022.1605128. 9. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Heal 2020;5:e475-83. https://doi.org/10.1016/S2468-2667(20)30164-X. 10. Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2020;173:120-36. https://doi.org/10.7326/M20-1632. 11. Stringhini S, Zaballa M-E, Pullen N, de Mestral C, Perez-Saez J, Dumont R, et al. Large variation in anti-SARS-CoV-2 antibody prevalence among essential workers in Geneva, Switzerland. Nat Commun 2021;12:3455. https://doi.org/10.1038/s41467-021-23796-4. 12. Accorsi EK, Qiu X, Rumpler E, Kennedy-Shaffer L, Kahn R, Joshi K, et al. How to detect and reduce potential sources of biases in studies of SARS-CoV-2 and COVID-19. Eur J Epidemiol 2021;36:179-96. https://doi.org/10.1007/s10654-021-00727-7. 13. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Editio. New York: Routledge; 2013. https://doi.org/10.4324/9780203771587. 14. The Lancet. The plight of essential workers during the COVID-19 pandemic. Lancet 2020;395:1587. https://doi.org/10.1016/S0140-6736(20)31200-9. 15. Vandenbroucke JP, Brickley EB, Pearce N, Vandenbroucke-Grauls CMJE. The Evolving Usefulness of the Test-negative Design in Studying Risk Factors for COVID-19. Epidemiology 2022;33:e7-8. https://doi.org/10.1097/EDE.0000000000001438.
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Affiliation(s)
- Marvin Reuter
- Dr. Marvin Reuter, Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Duesseldorf Moorenstrasse 5, 40225 Düsseldorf,
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Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, Jöckel KH, Greiser KH, Michels KB, Krause G, Albrecht S, Öztürk I, Kuss O, Berger K, Lampl BMJ, Leitzmann M, Zeeb H, Starke KR, Schipf S, Meinke-Franze C, Ahrens W, Seidler A, Klee B, Pischon T, Deckert A, Schmidt B, Mikolajczyk R, Karch A, Bohn B, Brenner H, Holleczek B, Dragano N. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022; 48:446-456. [PMID: 35670286 PMCID: PMC9888438 DOI: 10.5271/sjweh.4037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify the occupational risk for a SARS-CoV-2 infection in a nationwide sample of German workers during the first wave of the COVID-19 pandemic (1 February-31 August 2020). METHODS We used the data of 108 960 workers who participated in a COVID follow-up survey of the German National Cohort (NAKO). Occupational characteristics were derived from the German Classification of Occupations 2010 (Klassifikation der Berufe 2010). PCR-confirmed SARS-CoV-2 infections were assessed from self-reports. Incidence rates (IR) and incidence rate ratios (IRR) were estimated using robust Poisson regression, adjusted for person-time at risk, age, sex, migration background, study center, working hours, and employment relationship. RESULTS The IR was 3.7 infections per 1000 workers [95% confidence interval (CI) 3.3-4.1]. IR differed by occupational sector, with the highest rates observed in personal (IR 4.8, 95% CI 4.0-5.6) and business administration (IR 3.4, 95% CI 2.8-3.9) services and the lowest rates in occupations related to the production of goods (IR 2.0, 95% CI 1.5-2.6). Infections were more frequent among essential workers compared with workers in non-essential occupations (IRR 1.95, 95% CI 1.59-2.40) and among highly skilled compared with skilled professions (IRR 1.36, 95% CI 1.07-1.72). CONCLUSIONS The results emphasize higher infection risks in essential occupations and personal-related services, especially in the healthcare sector. Additionally, we found evidence that infections were more common in higher occupational status positions at the beginning of the pandemic.
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Affiliation(s)
- Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany,
Correspondence to: Dr. Marvin Reuter, Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Duesseldorf Moorenstrasse 5, 40225 Düsseldorf, Germany. [E-Mail: ]
| | - Mariann Rigó
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany
| | - Maren Formazin
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Falk Liebers
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Ute Latza
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany
| | - Karin Halina Greiser
- German Cancer Research Centre (DKFZ) Heidelberg, Div. of Cancer Epidemiology, Heidelberg, Germany
| | - Karin B. Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Gérard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany,Institute for Infectious Disease Epidemiology, TWINCORE, Hannover, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Stefan Albrecht
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Germany
| | - Ilter Öztürk
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Benedikt MJ Lampl
- Regensburg Department of Public Health, Germany,Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Karla Romero Starke
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Andreas Seidler
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Pischon
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University,Heidelberg, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany
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Nuebling M, Hegewald J, Starke KR, Lincke HJ, Jankowiak S, Liebers F, Latza U, Letzel S, Riechmann-Wolf M, Gianicolo E, Beutel M, Pfeiffer N, Lackner K, Münzel T, Wild PS, Seidler A. The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance). BMC Public Health 2022; 22:24. [PMID: 34991529 PMCID: PMC8740453 DOI: 10.1186/s12889-021-12240-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up. Methods At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R2) to estimate the predictive performance of the questionnaires. Results The models’ R2 was comparable to the original baseline analyses at both t0 and t1 (R2 range: ERI 0.10–0.43; COPSOQ 0.10–0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R2 range: ERI 0.07–0.19; COPSOQ 0.07–0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t0 or t1 confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions. Conclusions Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12240-3.
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Affiliation(s)
- Matthias Nuebling
- FFAW: Freiburg Research Centre for Occupational Sciences, Bertoldstr. 63, D-79098, Freiburg, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hans-Joachim Lincke
- FFAW: Freiburg Research Centre for Occupational Sciences, Bertoldstr. 63, D-79098, Freiburg, Germany
| | - Sylvia Jankowiak
- Division Work and Health, Federal Institute for Occupational Safety and Health BAuA, Berlin, Germany
| | - Falk Liebers
- Division Work and Health, Federal Institute for Occupational Safety and Health BAuA, Berlin, Germany
| | - Ute Latza
- Division Work and Health, Federal Institute for Occupational Safety and Health BAuA, Berlin, Germany
| | - Stephan Letzel
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Merle Riechmann-Wolf
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Center of Thrombosis and Hemostatis (CTH), University Medical Center Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Philipp S Wild
- Center of Thrombosis and Hemostatis (CTH), University Medical Center Mainz, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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Bahns C, Bolm-Audorff U, Seidler A, Romero Starke K, Ochsmann E. Occupational risk factors for meniscal lesions: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:1042. [PMID: 34911509 PMCID: PMC8672613 DOI: 10.1186/s12891-021-04900-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Meniscal lesions are common and are associated with the development of knee osteoarthritis. Knee-straining activities at work such as kneeling or squatting cause high biomechanical stresses on the knee joints that can lead to acute or chronic injuries. The objective of this systematic review is to update the evidence on the potential relationship between occupational risk factors and meniscal lesions. METHODS We searched the Medline, Embase and Web of Science databases until August 2021 to identify epidemiological observational studies on the association between occupational risk factors and meniscal lesions. Study selection, data extraction and risk of bias assessment were performed independently by two reviewers. Effect measures were extracted from individual studies and pooled with random effects meta-analysis. Heterogeneity analyses were conducted. We used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the overall quality of evidence. RESULTS The database search resulted in 11,006 references, and 46 additional studies were identified through hand search. Twenty-two studies (represented in 25 publications) met the predefined eligibility criteria and nine records were included in the meta-analysis. There was only one study with an overall low risk of bias. Significant associations between occupational risk factors and the development of meniscal lesions were found for kneeling (effect size (ES) 2.15, 95% CI 1.67-2.76), squatting (ES 2.01, 95% CI 1.34-3.03), climbing stairs (ES 2.28, 95% CI 1.58-3.30), lifting and carrying weights ≥ 10 kg (ES 1.63, 95% CI 1.35-1.96), lifting and carrying weights ≥ 25 kg (ES 1.56, 95% CI 1.08-2.24), playing football on a professional level (ES 5.22, 95% CI 3.24-8.41), working as a hard coal miner (ES 5.23, 95% CI 2.16-12.69) and floor layers (ES 1.99, 95% CI 1.43-2.78). The overall quality of evidence according GRADE was moderate to low. CONCLUSION We found consistent evidence of an increased risk of meniscal lesions by occupational knee-straining exposures. Our findings are important for the development of preventive strategies to reduce work-related knee disorders and work absence. TRIAL REGISTRATION PROSPERO (registration no. CRD42020196279 ).
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Affiliation(s)
- Carolin Bahns
- Luebeck Institute of Occupational Health (LIOH), University of Luebeck, Luebeck, Germany. .,Department of Therapy Science I, Brandenburg Technical University Cottbus - Senftenberg, Senftenberg, Germany.
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety, Regional Government of South Hesse, Wiesbaden, Germany.,Associate Professor of Occupational Medicine, University Medical Center Giessen, Justus-Liebig-University, Giessen, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Elke Ochsmann
- Luebeck Institute of Occupational Health (LIOH), University of Luebeck, Luebeck, Germany
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11
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Romero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Glob Health 2021; 6:e006434. [PMID: 34916273 PMCID: PMC8678541 DOI: 10.1136/bmjgh-2021-006434] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Increased age has been reported to be a factor for COVID-19 severe outcomes. However, many studies do not consider the age dependency of comorbidities, which influence the course of disease. Protection strategies often target individuals after a certain age, which may not necessarily be evidence based. The aim of this review was to quantify the isolated effect of age on hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death. METHODS This review was based on an umbrella review, in which Pubmed, Embase and preprint databases were searched on 10 December 2020, for relevant reviews on COVID-19 disease severity. Two independent reviewers evaluated the primary studies using predefined inclusion and exclusion criteria. The results were extracted, and each study was assessed for risk of bias. The isolated effect of age was estimated by meta-analysis, and the quality of evidence was assessed using Grades of Recommendations, Assessment, Development, and Evaluation framework. RESULTS Seventy studies met our inclusion criteria (case mortality: n=14, in-hospital mortality: n=44, hospitalisation: n=16, admission to ICU: n=12, mechanical ventilation: n=7). The risk of in-hospital and case mortality increased per age year by 5.7% and 7.4%, respectively (effect size (ES) in-hospital mortality=1.057, 95% CI 1.038 to 1.054; ES case mortality=1.074, 95% CI 1.061 to 1.087), while the risk of hospitalisation increased by 3.4% per age year (ES=1.034, 95% CI 1.021 to 1.048). No increased risk was observed for ICU admission and intubation by age year. There was no evidence of a specific age threshold at which the risk accelerates considerably. The confidence of evidence was high for mortality and hospitalisation. CONCLUSIONS Our results show a best-possible quantification of the increase in COVID-19 disease severity due to age. Rather than implementing age thresholds, prevention programmes should consider the continuous increase in risk. There is a need for continuous, high-quality research and 'living' reviews to evaluate the evidence throughout the pandemic, as results may change due to varying circumstances.
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Affiliation(s)
- Karla Romero Starke
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Technische Universität Chemnitz, Chemnitz, Sachsen, Germany
| | - David Reissig
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety, Regional Government of South Hesse, Wiesbaden, Germany
| | - Stefanie Schmauder
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), Hamburg, Germany
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Andreas Seidler
- Faculty of Medicine, Institute and Policlinic for Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
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Hegewald J, Starke KR, Garthus-Niegel S, Schulz A, Nübling M, Latza U, Jankowiak S, Liebers F, Rossnagel K, Riechmann-Wolf M, Letzel S, Arnold N, Beutel M, Gianicolo E, Pfeiffer N, Lackner K, Münzel T, Wild P, Seidler A. Correction: Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study. PLoS One 2021; 16:e0258075. [PMID: 34570815 PMCID: PMC8476000 DOI: 10.1371/journal.pone.0258075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Freiberg A, Schubert M, Romero Starke K, Hegewald J, Seidler A. A Rapid Review on the Influence of COVID-19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population. Int J Environ Res Public Health 2021; 18:8567. [PMID: 34444316 PMCID: PMC8393482 DOI: 10.3390/ijerph18168567] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods.
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Affiliation(s)
- Alice Freiberg
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität, 01307 Dresden, Germany; (M.S.); (K.R.S.); (J.H.); (A.S.)
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Riechmann-Wolf M, Jankowiak S, Schulz A, Hegewald J, Starke KR, Liebers F, Rossnagel K, Poplawski A, Arnold N, Nübling M, Seidler A, Beutel M, Pfeiffer N, Lackner K, Münzel T, Bogner K, Wild PS, Latza U, Letzel S. Correction to: Self‑reported cardiovascular health of teachers: results from the 5‑year follow‑up of the Gutenberg Health Study cohort. Int Arch Occup Environ Health 2021; 94:2021. [PMID: 34331127 PMCID: PMC9172730 DOI: 10.1007/s00420-021-01747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Merle Riechmann-Wolf
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany. .,Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Sylvia Jankowiak
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Andreas Schulz
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Janice Hegewald
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Karla Romero Starke
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Falk Liebers
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Karin Rossnagel
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Alicia Poplawski
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Natalie Arnold
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Nübling
- FFAW: The Freiburg Research Center for Occupational Sciences, Freiburg, Germany
| | - Andreas Seidler
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Manfred Beutel
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Karl Lackner
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Thomas Münzel
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Kathrin Bogner
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany
| | - Philipp S Wild
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Ute Latza
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Stephan Letzel
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany.,Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
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15
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Romero Starke K, Mauer R, Karskens E, Pretzsch A, Reissig D, Nienhaus A, Seidler AL, Seidler A. The Effect of Ambient Environmental Conditions on COVID-19 Mortality: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18126665. [PMID: 34205714 PMCID: PMC8296503 DOI: 10.3390/ijerph18126665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
Weather conditions may have an impact on SARS-CoV-2 virus transmission, as has been shown for seasonal influenza. Virus transmission most likely favors low temperature and low humidity conditions. This systematic review aimed to collect evidence on the impact of temperature and humidity on COVID-19 mortality. This review was registered with PROSPERO (registration no. CRD42020196055). We searched the Pubmed, Embase, and Cochrane COVID-19 databases for observational epidemiological studies. Two independent reviewers screened the title/abstracts and full texts of the studies. Two reviewers also performed data extraction and quality assessment. From 5051 identified studies, 11 were included in the review. Although the results were inconsistent, most studies imply that a decrease in temperature and humidity contributes to an increase in mortality. To establish the association with greater certainty, future studies should consider accurate exposure measurements and important covariates, such as government lockdowns and population density, sufficient lag times, and non-linear associations.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
- Correspondence:
| | - René Mauer
- Institute for Medical Informatics and Biometry (IMB), Faculty of Medicine Carl Gustav Carus, Technische Universität, 01307 Dresden, Germany;
| | - Ethel Karskens
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - Anna Pretzsch
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
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16
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Schubert M, Ludwig J, Freiberg A, Hahne TM, Romero Starke K, Girbig M, Faller G, Apfelbacher C, von dem Knesebeck O, Seidler A. Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2021; 18:ijerph18126183. [PMID: 34201024 PMCID: PMC8226580 DOI: 10.3390/ijerph18126183] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
- Correspondence:
| | - Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.L.); (O.v.d.K.)
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
| | - Taurai Monalisa Hahne
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (T.M.H.); (C.A.)
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
- Institute of Sociology, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
| | - Gudrun Faller
- Department of Community Health, Hochschule für Gesundheit, 44801 Bochum, Germany;
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (T.M.H.); (C.A.)
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.L.); (O.v.d.K.)
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
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17
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Romero Starke K, Friedrich S, Schubert M, Kämpf D, Girbig M, Pretzsch A, Nienhaus A, Seidler A. Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021; 18:ijerph18105159. [PMID: 34068014 PMCID: PMC8152277 DOI: 10.3390/ijerph18105159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
- Correspondence:
| | - Sophie Friedrich
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Anna Pretzsch
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
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18
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Hegewald J, Romero Starke K, Garthus-Niegel S, Schulz A, Nübling M, Latza U, Jankowiak S, Liebers F, Rossnagel K, Riechmann-Wolf M, Letzel S, Arnold N, Beutel M, Gianicolo E, Pfeiffer N, Lackner K, Münzel T, Wild P, Seidler A. Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study. PLoS One 2021; 16:e0251260. [PMID: 33961688 PMCID: PMC8104925 DOI: 10.1371/journal.pone.0251260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women. METHODS A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five "work-privacy conflict" questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors. RESULTS We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74-1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83-1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54-3.98) for incident cardiovascular disease among women in the fully adjusted model. CONCLUSIONS Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.
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Affiliation(s)
- Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
- Institute of Sociology, Faculty of Behavioral and Social Sciences, TU Chemnitz, Chemnitz, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
- Institute of Sociology, Faculty of Behavioral and Social Sciences, TU Chemnitz, Chemnitz, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Andreas Schulz
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Nübling
- FFAW: The Freiburg Research Centre for Occupational Sciences, Freiburg, Germany
| | - Ute Latza
- Division Work and Health, Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Sylvia Jankowiak
- Division Work and Health, Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Falk Liebers
- Division Work and Health, Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Karin Rossnagel
- Division Work and Health, Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Merle Riechmann-Wolf
- Institute for Teachers’ Health, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social, Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Natalie Arnold
- Center for Cardiology I, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Medicine 2, Preventive Cardiology and Preventive Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology I, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Philipp Wild
- Department of Medicine 2, Preventive Cardiology and Preventive Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
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19
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Petereit-Haack G, Bolm-Audorff U, Romero Starke K, Seidler A. Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2020; 17:E9369. [PMID: 33327657 PMCID: PMC7765156 DOI: 10.3390/ijerph17249369] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.
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Affiliation(s)
- Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Giessen, Justus-Liebig-University, 35392 Giessen, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
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20
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Riechmann-Wolf M, Jankowiak S, Schulz A, Hegewald J, Romero Starke K, Liebers F, Rossnagel K, Poplawski A, Arnold N, Nübling M, Seidler A, Beutel M, Pfeiffer N, Lackner K, Münzel T, Bogner K, Wild PS, Latza U, Letzel S. Self-reported cardiovascular health of teachers: results from the 5-year follow-up of the Gutenberg Health Study cohort. Int Arch Occup Environ Health 2020; 94:251-259. [PMID: 33106930 PMCID: PMC8332549 DOI: 10.1007/s00420-020-01576-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Objectives Following an exploratory approach, we examined cardiovascular disease risk factors at baseline and the 5-year incidence proportion of self-reported doctor-diagnosed cardiovascular diseases (CVD) in teachers and other occupational groups of the Gutenberg Health Study. Methods Study participants lived in the region of Mainz, Germany. Data from 6510 working participants without prevalent CVD at baseline (2007–2012) were analyzed. Participants were teachers (n = 215), other professionals from the health, social or educational (HSE) fields (n = 1061) or worked outside the HSE fields (n = 5234). For occupational comparisons, we estimated prevalence ratios (PR) for each CVD risk factor at baseline with robust Poisson regression analyses. We calculated crude CVD incidence rates based on the observed 5-year CVD cumulative incidence at follow-up and estimated age-weighted incidence proportions. All analyses were stratified by sex. Results Male non-HSE workers showed a higher prevalence of smoking and physical inactivity than male teachers (PR 2.26; 95%-CI: 1.06–4.82/PR 1.89; 95%-CI: 1.24–2.87). In contrast, non-HSE workers and other HSE professionals were less likely to have reported an unhealthy alcohol intake than teachers. Differences were attenuated after SES-adjustment. We did not detect occupational group-specific differences in CVD incidence. However, there were only two cases of CVD among the teachers. Conclusion Particularly male teachers showed a healthier lifestyle regarding physical inactivity and smoking. Nevertheless, occupational-medical care practitioners and researchers need to be aware of the relatively heightened prevalence of unhealthy alcohol intake in female and male teachers, and in absolute terms, the high hypertension prevalence in male teachers.
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Affiliation(s)
- Merle Riechmann-Wolf
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany. .,Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Sylvia Jankowiak
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Andreas Schulz
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Janice Hegewald
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Karla Romero Starke
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Falk Liebers
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Karin Rossnagel
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Alicia Poplawski
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Natalie Arnold
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Nübling
- FFAW: The Freiburg Research Center for Occupational Sciences, Freiburg, Germany
| | - Andreas Seidler
- IPAS Dresden: Institute and Polyclinic of Occupational and Social Medicine, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Manfred Beutel
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Karl Lackner
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Thomas Münzel
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Kathrin Bogner
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany
| | - Philipp S Wild
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Ute Latza
- Federal Institute for Occupational Safety and Health, BAuA Berlin, Berlin, Germany
| | - Stephan Letzel
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116, Mainz, Germany.,Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Romero Starke K, Petereit-Haack G, Schubert M, Kämpf D, Schliebner A, Hegewald J, Seidler A. The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression. Int J Environ Res Public Health 2020; 17:E5974. [PMID: 32824596 PMCID: PMC7460443 DOI: 10.3390/ijerph17165974] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/21/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
Increased age appears to be a strong risk factor for COVID-19 severe outcomes. However, studies do not sufficiently consider the age-dependency of other important factors influencing the course of disease. The aim of this review was to quantify the isolated effect of age on severe COVID-19 outcomes. We searched Pubmed to find relevant studies published in 2020. Two independent reviewers evaluated them using predefined inclusion and exclusion criteria. We extracted the results and assessed seven domains of bias for each study. After adjusting for important age-related risk factors, the isolated effect of age was estimated using meta-regression. Twelve studies met our inclusion criteria: four studies for COVID-19 disease severity, seven for mortality, and one for admission to ICU. The crude effect of age (5.2% and 13.4% higher risk of disease severity and death per age year, respectively) substantially decreased when adjusting for important age-dependent risk factors (diabetes, hypertension, coronary heart disease/cerebrovascular disease, compromised immunity, previous respiratory disease, renal disease). Adjusting for all six comorbidities indicates a 2.7% risk increase for disease severity (two studies), and no additional risk of death per year of age (five studies). The indication of a rather weak influence of age on COVID-19 disease severity after adjustment for important age-dependent risk factors should be taken in consideration when implementing age-related preventative measures (e.g., age-dependent work restrictions).
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
| | - Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
| | - Alexandra Schliebner
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (M.S.); (D.K.); (A.S.); (J.H.); (A.S.)
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Romero Starke K, Seidler A, Hegewald J, Klimova A, Palmer K. Retirement and decline in episodic memory: analysis from a prospective study of adults in England. Int J Epidemiol 2020; 48:1925-1936. [PMID: 31280313 DOI: 10.1093/ije/dyz135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Work has been associated with cognitive health. We examined whether retirement from work is associated with a decrease in episodic memory and whether this effect differs when considering workers' occupational class. METHODS In this prospective study using the English Longitudinal Study of Ageing (ELSA), we examined 1629 persons aged 50-75 years who were in paid work at baseline. A two-slope random effects linear regression centred at retirement was used to study the effect of retirement on episodic memory. The potential effect modification by occupational class was examined. RESULTS While memory trajectories show slightly decreasing memory scores before and afterretirement, the decreasing rates for both periods were similar [episodic memory β2b-β2a= -0.03, 95% confidence interval (CI) -0.08, 0.02]. When stratifying by occupational class, there was also no substantial difference in episodic memory trajectories before and after retirement. However, the lower occupational class showed a clear decline in episodic memory with time (pre-retirement β2a = -0.11, 95% CI -0.19, -0.03; post-retirement β2b = -0.13, 95% CI -0.19, -0.07) which was not evident for the higher occupational classes. CONCLUSIONS Our results show no observable difference in trajectories of change in episodic memory before and after retirement. However, the steeper memory decline in workers belonging to the lower occupational class may limit their prospect of prolonging their working lives. Hence enrichment programmes for the prevention of memory decline for these workers should be considered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katie Palmer
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Romero Starke K, Hegewald J, Schulz A, Garthus-Niegel S, Nübling M, Wild PS, Arnold N, Latza U, Jankowiak S, Liebers F, Rossnagel K, Riechmann-Wolf M, Letzel S, Beutel M, Pfeiffer N, Lackner K, Münzel T, Seidler A. Cardiovascular health outcomes of mobbing at work: results of the population-based, five-year follow-up of the Gutenberg health study. J Occup Med Toxicol 2020; 15:15. [PMID: 32536961 PMCID: PMC7291638 DOI: 10.1186/s12995-020-00266-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
Background The aim of this study was to determine if there is an increased risk of incident cardiovascular disease (CVD) resulting from workplace mobbing measured with two mobbing instruments in the Gutenberg Health Study. Methods In this prospective study, we examined working persons younger than 65 years for the presence of mobbing at baseline and at a 5-year follow-up using a single-item and a 5-item instrument. We used multivariate models to investigate the association between mobbing and incident CVD, hypertension, and change in arterial stiffness and further stratified the models by sex. Results After adjustment for confounders, mobbed workers appeared to have a higher risk of incident CVD than those not mobbed (single-item HR = 1.28, 95% CI 0.73–2.24; 5-item HR = 1.57, 95% CI 0.96–2.54). With the 5-item instrument, men who reported mobbing had a higher risk of incident CVD (HR = 1.77, 95% CI 1.01–3.09), while no association was observed for women (HR = 1.05, 95% CI 0.38–2.91). There was no difference in risks between men and women with the single-item instrument. No association between mobbing and incident hypertension and arterial stiffness was seen. Conclusions Our results show an indication of an increased risk of incident CVD for those mobbed at baseline when using the whole study population. Differences in risks between men and women when using the five-item instrument may be due to the instrument itself. Still, it is essential to detect or prevent workplace mobbing, and if present, to apply an intervention to halt it in order to minimize its adverse effects on CVD.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.,Institute for Sociology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.,Institute for Sociology, Technische Universität Chemnitz, Chemnitz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Matthias Nübling
- FFAW: The Freiburg Research Centre for Occupational and Social Medicine, Freiburg, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Mainz, Germany.,Center of Thrombosis and Hemostatis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Natalie Arnold
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Ute Latza
- Division Work and Health, Federal Institute for Occupational Safety and Health, BAuA, Berlin, Germany
| | - Sylvia Jankowiak
- Division Work and Health, Federal Institute for Occupational Safety and Health, BAuA, Berlin, Germany
| | - Falk Liebers
- Division Work and Health, Federal Institute for Occupational Safety and Health, BAuA, Berlin, Germany
| | - Karin Rossnagel
- Division Work and Health, Federal Institute for Occupational Safety and Health, BAuA, Berlin, Germany
| | - Merle Riechmann-Wolf
- Institute for Teachers' Health, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Deparment of Ophtalmology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Mainz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Seidler A, Romero Starke K, Freiberg A, Hegewald J, Nienhaus A, Bolm-Audorff U. Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2020; 17:ijerph17041243. [PMID: 32075183 PMCID: PMC7068556 DOI: 10.3390/ijerph17041243] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/16/2022]
Abstract
Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.
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Affiliation(s)
- Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
- Correspondence: ; Tel.: +49-351-3177-441
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Public Health and Hazardous Substances, Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Gießen, Justus-Liebig-University, 35392 Gießen, Germany
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Schubert M, Hegewald J, Freiberg A, Starke KR, Augustin F, Riedel-Heller SG, Zeeb H, Seidler A. Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2019; 16:ijerph16183336. [PMID: 31510007 PMCID: PMC6765874 DOI: 10.3390/ijerph16183336] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023]
Abstract
Children and adolescents may be particularly vulnerable to environmental influences such as noise which can affect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Difficulties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9–10 years and 15–17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total difficulties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04–1.19), respectively 9% (95% CI 1.02–1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total difficulties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Franziska Augustin
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany.
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28344 Bremen, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
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Romero Starke K, Kofahl M, Freiberg A, Schubert M, Groß ML, Schmauder S, Hegewald J, Kämpf D, Stranzinger J, Nienhaus A, Seidler A. The risk of cytomegalovirus infection in daycare workers: a systematic review and meta-analysis. Int Arch Occup Environ Health 2019; 93:11-28. [PMID: 31359142 DOI: 10.1007/s00420-019-01464-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk of cytomegalovirus infection. METHODS We searched the Medline and Embase databases using search strings defined according to the population, exposure, comparison, and outcomes (PECO) applicable to our research questions in order to find studies published since 2000. Two independent reviewers evaluated the search hits using predefined inclusion and exclusion criteria. A manual search was performed to identify additional relevant literature. We extracted the resulting studies and assessed them in eight domains of bias. The pooled CMV seroprevalence for daycare workers compared to the general population was calculated. RESULTS After evaluating the 6879 records, six methodologically adequate studies were identified: five cross-sectional studies and one cohort study. The pooled seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, PR = 1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers. CONCLUSIONS Our findings suggest a higher CMV seroprevalence for daycare workers compared to the general population. Notwithstanding the need for longitudinal and intervention studies, preventative efforts are needed. A pooled PR of 1.54 is compatible with a doubled seroconversion risk corresponding to a vocational probability of 50% if the substantial underestimation of the actual occupational seroconversion risk by prevalence-based estimators is considered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Marlen Kofahl
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Mascha Luisa Groß
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefanie Schmauder
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Johanna Stranzinger
- Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), Basic Principles of Prevention and Rehabilitation, Section Occupational Health, Hamburg, Germany
| | - Albert Nienhaus
- Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), Basic Principles of Prevention and Rehabilitation, Section Occupational Health, Hamburg, Germany.,Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Romero Starke K, Kofahl M, Freiberg A, Schubert M, Groß ML, Schmauder S, Hegewald J, Kämpf D, Stranzinger J, Nienhaus A, Seidler A. Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2019; 16:E1392. [PMID: 30999694 PMCID: PMC6517978 DOI: 10.3390/ijerph16081392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
Objective: In this systematic review, we aimed to summarize the evidence on the association between being a daycare educator working with children and the possible increased risk of parvovirus B19 infection compared to the general population. Methods: The Medline and Embase databases were searched using a defined search to find studies published since 2000. Two reviewers evaluated the search hits using predefined inclusion and exclusion criteria. The resulting studies were extracted and were assessed in eight domains of bias. A pooled relative risk (RR) of parvovirus infection for daycare workers compared to the general population was calculated. Results: After evaluating the 7781 search hits and manual search, four methodologically-adequate studies were identified: three cross-sectional studies and one retrospective cohort study. Of the three studies investigating the risk of infection, one evaluated parvovirus B19 seroconversion rates for daycare workers. There was an indication for an increased risk for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98-1.27) using prevalence estimators. Furthermore, daycare workers had a higher seroconversion rate compared to the unexposed population (RR = 2.63, 95% 1.27-5.45) in the low risk of bias study. Conclusions: Our findings suggest a higher risk of parvovirus B19 infection for daycare workers compared to an unexposed comparison population, which necessitate preventative efforts. Considering the underestimation of the occupational seroconversion risk by prevalence-based estimators, parvovirus B19 infections among daycare workers might mostly be occupationally acquired.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Marlen Kofahl
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Mascha Luisa Groß
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Stefanie Schmauder
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Johanna Stranzinger
- Section Occupational Health, Basic Principles of Prevention and Rehabilitation, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Section Occupational Health, Basic Principles of Prevention and Rehabilitation, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany.
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
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Seidler A, Lüben L, Hegewald J, Bolm-Audorff U, Bergmann A, Liebers F, Ramdohr C, Romero Starke K, Freiberg A, Unverzagt S. Dose-response relationship between cumulative physical workload and osteoarthritis of the hip - a meta-analysis applying an external reference population for exposure assignment. BMC Musculoskelet Disord 2018; 19:182. [PMID: 29859083 PMCID: PMC5984732 DOI: 10.1186/s12891-018-2085-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background There is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far. Methods This study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581–8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies. Results In men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20–3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22–3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87–39.91) per 106 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women. Conclusions Under specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies. Electronic supplementary material The online version of this article (10.1186/s12891-018-2085-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Laura Lüben
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, Wiesbaden, Germany.,Justus-Liebig-University, Gießen, Germany
| | - Annekatrin Bergmann
- Institute for Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Falk Liebers
- Federal Institute of Occupational Safety and Health, Berlin, Germany
| | - Christina Ramdohr
- Institute for Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Susanne Unverzagt
- Institute for Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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