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ABSTRACT: Low-back pain is a major public health concern because of its socioeconomic burden, especially for chronic forms. The purpose of this study was to analyse the associations between low-back pain and occupational and personal factors, with a special focus on interactions between age and occupational exposures.
The study population comprised a sample of 3958 and 4526 working women and men aged 30 to 59 derived from a national health survey (2002-2003 EDS). Low-back pain was assessed using the French version of the Nordic questionnaire. Weight, height and smoking status were obtained through interview at home. Occupational exposures were self-assessed. The associations between low-back pain for more than 30 days in the previous year and occupational and personal factors were assessed using logistic models. An interaction between age and each occupational exposure was studied.
In the multivariate models, age was the only personal factor significantly associated with low-back pain for both genders. The other personal factors studied were significantly associated with low-back pain for women only. Handling heavy loads and awkward postures at work were strongly associated with low-back pain for both genders (respectively OR=1.80 [1.46-2.23] and OR=1.65 [1.34-2.03] for men, and OR=1.65 [1.32-2.06] and OR=1.28 [1.04-1.59] for women). A high level of psychological demands at work and a low level of decision latitude were also associated with low-back pain for both genders (respectively OR=1.22 [1.03-1.46] and OR=1.32 [1.11-1.57] for men, and OR=1.31 [1.10-1.56] and OR=1.27 [1.06-1.51] for women). Only the interaction between age and awkward postures for men was borderline significant.
This study showed strong associations between occupational exposures and persistent/recurrent low-back pain in a general working population in France. Targeting these exposures in prevention programs could be useful.
Revue d Épidémiologie et de Santé Publique 12/2010; 58(6):383-91. · 0.78 Impact Factor
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ABSTRACT: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters.
Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular.
Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income.
These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted.
Annals of physical and rehabilitation medicine 04/2010; 53(4):224-31, 231-8.
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Occupational and environmental medicine 06/2009; 66(5):351-2. · 3.64 Impact Factor
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Revue d Épidémiologie et de Santé Publique 11/2008; 56(5):356-7. · 0.78 Impact Factor
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ABSTRACT: To assess the effects of duration of exposure to biomechanical strains on various types of low back pain (LBP).
The population study was a random sample from the GAZEL cohort. Durations of exposure to selected biomechanical strains during subjects' working lifetime and potential confounders were assessed in 1996 by self-administered questionnaires. Data on LBP in the previous 12 months were collected in 2001. Relations between various dimensions of LBP and durations of exposure to the biomechanical strains were analysed with multivariate regression models. Polytomous models were built to determine whether some biomechanical strains were specifically associated with some types of LBP.
Analyses were performed separately for men (n = 2218) and women (n = 383). Significant associations were observed (ORs reported are those for 20 years of exposure) between LBP and durations of driving and bending/twisting for men (OR 1.24 and 1.37 respectively); LBP for more than 30 days and duration of exposure to bending/twisting for men and women (OR 2.20 and 2.00 respectively) and duration of driving for women (OR 3.15); LBP radiating to the leg and duration of driving for men (OR 1.43) and bending/twisting for women (OR 1.95); LBP radiating below the knee and duration of exposure to pulling/pushing/carrying for men (OR 1.88). Bending/twisting in both men and women, and driving for women appeared to be stronger risk factors for LBP for more than 30 days. Pulling/pushing/carrying heavy loads appeared to be a risk factor specific for LBP radiating below the knee for men.
This study suggests that exposure to biomechanical strains has long-term effects and a dose-response relation with duration of exposure and specific effects for some types of LBP.
Occupational and environmental medicine 05/2008; 65(4):268-74. · 3.64 Impact Factor
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ABSTRACT: Few prospective studies have evaluated outcomes of workers with self-reported symptoms of upper extremity musculoskeletal disorders (UEMSD). The objective was to study the three-year outcomes of workers with self-reported symptoms, with or without a positive physical examination.
In 1993-4, 598 subjects highly exposed to repetitive work filled out a Nordic-style questionnaire. They underwent a standardised physical examination at that time and again in 1996-7 by the same occupational physician. The three-year outcomes (based on physical examination) of workers with a self-administered questionnaire positive at baseline for UEMSD, with or without a positive physical examination, were studied.
The three-year incidence rate was 44.1%; one third of these incident cases had self-reported symptoms in 1993-4. Workers with a positive questionnaire had a significantly higher risk of UEMSD at physical examination three years later (80.1% UEMSD cases with positive questionnaires n = 354, vs 44.2% cases without positive questionnaires n = 69, p<0.001). Moreover, workers with positive questionnaires but without UEMSD diagnosed in 1993-4 (n = 177) also had a significantly higher risk of UEMSD at physical examination three years later (60.5% cases with positive questionnaires n = 26, vs 38.8% cases without positive questionnaires n = 52, p = 0.01). Results were similar when gender and age were taken into account.
Workers highly exposed to repetitive movements have a high risk of developing UEMSD and should be followed closely in surveillance programmes. Workers with self-reported symptoms without UEMSD diagnosed in physical examination represented only one third of new cases three years later. However, their risk of developing UEMSD was significantly increased, compared with those without symptoms.
Occupational and environmental medicine 04/2008; 65(3):205-7. · 3.64 Impact Factor
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ABSTRACT: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP.
To estimate the prevalence of LBP in the French population aged 30 to 64 years.
The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented.
More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age.
The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used.
Annales de Réadaptation et de Médecine Physique 12/2007; 50(8):640-4, 633-9.
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ABSTRACT: The terms "socioeconomic status", "socioeconomic position", "social classes" ... are widely used in epidemiology. They refer to various aspects of social position which is associated with many aspects of health. The position of individuals in the social hierarchy is multidimensional, i.e. defined by various socioeconomic factors. They can be individual (for example educational level, employment status, and occupation), household related (for example household income) or neighbourhood related (for example unemployment rate in the district of residence). These various factors can be associated with health at different periods during the life course, via a number of mechanisms, and they can possibly interact with one another. No socioeconomic indicator is better than the others or adequate in all study contexts.
This paper presents a description of various socioeconomic indicators, and describes what they measure, and the advantages and limits of each of them.
No indicator can be recommended in particular. Within the limit of available variables, the most relevant measurement depends on many elements, such as the study population and the aspect of health being investigated.
Revue d Épidémiologie et de Santé Publique 09/2007; 55(4):285-95. · 0.78 Impact Factor
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ABSTRACT: Little information is available on temporal trend in socioeconomic inequalities in cause of death mortality in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend.
We used a representative sample of 1% of the French population and compared four periods (1968-1974, 1975-1981, 1982-1988, 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30-64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (among men), upper aerodigestive tract cancers (among men), breast cancer (among women), colorectal cancer, other cancers, cardiovascular diseases, ischaemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, other causes of death. Socioeconomic inequalities were quantified with relative risks and relative indices of inequality. The relative indices of inequality measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status.
Analyses showed an increase in educational differences in all cause mortality among men (the relative indices of inequality increased from 1.96 to 2.77 from the first to the last period) and among women (the relative indices of inequality increased from 1.87 to 2.53). Socioeconomic inequalities increased for all cause of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to difference in overall mortality between the lowest and the highest levels of education increased strongly over the whole study period, especially among women.
This study shows that large socioeconomic inequalities in mortality are observed in France, and that they increase over time among men and women.
Revue d Épidémiologie et de Santé Publique 05/2007; 55(2):97-105. · 0.78 Impact Factor
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ABSTRACT: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and women (20-59 years old) participating in a study on the prevalence of work related upper limb disorders conducted by France's National Institute of Health Surveillance.
Prevalence ratios (PR) of physician-diagnosed musculoskeletal disorders of the shoulder, elbow, wrist, and hand (any of six leading disorders, rotator cuff syndrome, carpal tunnel syndrome) in manual versus non-manual workers were calculated using Cox regression models with a constant time of follow up and robust variance.
11.3% of men and 15.1% of women were diagnosed with an upper limb disorder. The risk was especially high in manual workers (PRs: 1.40 to 2.10). Physical work factors accounted for over 50% of occupational disparities overall, 62% (men) to 67% (women) for rotator cuff syndrome, and 96% (women) for carpal tunnel syndrome. The authors calculated that under lower levels of physical work exposures, up to 31% of cases among manual workers could have been prevented.
In working men and women, upper limb musculoskeletal disorders are frequent. Physical work exposures, such as repetitive and forceful movements, are an important source of risk and in particular account for a large proportion of excess morbidity among manual workers.
Occupational and environmental medicine 12/2006; 63(11):754-61. · 3.64 Impact Factor
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ABSTRACT: L’article porte sur les liens entre cancer et situation sociale, qu’il s’agisse de mortalité, d’incidence, de survie ou de
létalité, ou enfin de dépistage précoce, d’un point de vue épidémiologique.
Les indicateurs de situation sociale pris en compte sont principalement la catégorie socio-professionnelle et le niveau d’études.
Une partie importante est consacrée à une description des inégalités de mortalité selon le niveau d’études, pour les localisations
de cancer qui contribuent le plus à la mortalité prématurée. En complément, quatre exemples illustrent différentes questions
pertinentes dans le domaine du cancer: évolution temporelle des inégalités de cancer du sein, contribution relative de divers
facteurs de risque dans les inégalités d’incidence de cancers des voies aéro-digestives supérieures (VADS) touchant la population
masculine, inégalités géographiques de prise en charge, et enfin inégalités dans le dépistage du cancer du col de l’utérus.
Les inégalités sociales en matière de cancer sont particulièrement importantes en France. Un examen attentif des «causes»
potentielles des inégalités montre la complexité du sujet, différents facteurs étant susceptibles d’intervenir, dont les facteurs
de risque (tout au long de la vie), les conditions du repérage du cancer ou d’une lésion précancéreuse, et enfin le stade
au diagnostic et les filières de prise en charge. De plus, d’un cancer à un autre, les différentes «causes» des inégalités
ont des poids respectifs variables. Une réduction des niveaux d’exposition à certains facteurs de risque, particulièrement
dans les catégories sociales défavorisées, réduirait les inégalités d’incidence, donc les inégalités de mortalité. En parallèle,
une meilleure connaissance des inégalités de prise en charge, au sens large (dépistage précoce inclus), aiderait à identifier
les interventions efficaces pour une réduction des inégalités sociales en matière de cancer. Cela implique que la situation
sociale des malades, plus précisément le niveau d’études ou la catégorie socio-professionnelle, soit documentée de façon systématique.
This paper is about the role of socioeconomic factors on cancer regarding death rate, incidence, survival, and early screening.
The socioeconomic factors are mainly defined through job categories and the level of education.
A large part of this article is devoted to a description of death rate inequalities according to the level of education, for
the types of cancer which cause an early death. Men and women are studied separately. In addition, four examples of various
aspects of socioeconomic inequalities in cancer are given: first, the development of inequalities in breast cancer, then the
relative contribution of alcohol consumption, tobacco consumption and occupational exposure to inequalities in upper respiratory
and digestive tract cancer incidence among men, then geographic disparities in health care, and finally inequalities in screening
for cervical cancer.
Social inequalities in cancer are particularly important in France, at least for men. The explanations for potential causes
of inequalities are complex, since many factors can play a role: the distribution of risk factors (with a long period between
the exposure to the risk and the occurrence of the cancer), the stage at which the cancer is diagnosed and the presence of
other diseases, the type and the quality of care given. Moreover, the potential causes of inequalities vary from one cancer
to another. In order to reduce social inequalities in cancer, a decrease of the level of exposure to specific risk factors,
especially among people from a low social background, is essential. Additionally, a better knowledge of sources of inequalities
is important. It entails understanding why men and women fromlow socioeconomic status are less willing to have a cancer screening.
Finally, it is necessary to improve the systematic record of socioeconomic status in medical files.
Revue Francophone de Psycho-Oncologie 05/2006; 5(2):89-94.
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ABSTRACT: We investigated the time trends in social inequalities in breast cancer mortality with an analysis by age at death and birth cohort using a representative 1% sample of the French population and four subcohorts (1968-1974, 1975-1981, 1982-1988 and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in breast cancer mortality were studied among women aged 35-74 at the beginning of each period. In the 1970s, higher breast cancer mortality was found among higher educated women. This positive association progressively weakened and no association remained in the 1990s although it disappeared earlier among younger women. In an analysis by birth cohort, the same pattern was found among women born before 1925, whereas no association between education and mortality was observed among women born after 1925. Educational disparities in breast cancer mortality are currently changing and the previously observed positive gradient has disappeared. An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study.
British Journal of Cancer 02/2006; 94(1):152-5. · 5.04 Impact Factor
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ABSTRACT: The aim of this work was to study the effects of alcohol and tobacco consumption on laryngeal and hypopharyngeal cancer and to compare these across subsites (glottis, supraglottis, epilarynx, hypopharynx). Data from a hospital-based case-control study including 504 male cases (105 glottic cancers, 80 supraglottic cancers, 97 epilaryngeal cancers and 201 hypopharyngeal cancers) and 242 male controls with non-respiratory cancers were used for this analysis. Information about sociodemographic characteristics, detailed alcohol and tobacco consumption was collected through face-to-face interviews. Statistical analysis used logistic regression, and subsites were compared with polytomous logistic regressions. The risk of laryngeal and hypopharyngeal cancer increased with tobacco (duration and amount) and alcohol consumption; the effect of both agents was multiplicative. From the lowest to the highest consumption level, odds ratios ranged from 1.4 to 5.9 among regular drinkers and from 3 to 44 among current smokers. Risks among ex-smokers were approximately one-third of those for current smokers. Slightly elevated odds ratios were associated with consumption of black tobacco (OR=1.2) and hand-rolled cigarettes (OR=1.2). The risk of cancer was not clearly associated with the type of alcoholic beverage. Subsites did not differ significantly according to tobacco smoking, but differed according to alcohol consumption, with a significantly higher increased risk for hypopharyngeal than for glottic and supraglottic cancers.
European Journal of Cancer Prevention 07/2004; 13(3):165-72. · 2.13 Impact Factor
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ABSTRACT: Return to work is considered as a major effectiveness criterion for interventions dedicated to subacute or chronic low-back-pain sufferers. Moreover, return to work, beyond the economic and social Issues, is regarded more and more as having a therapeutic dimension. This review aims to describe the various interventions which are effective in returning patients to work.
The presentation is based on existing reviews supplemented by a selection of recent studies.
"Cognitive-behavioral therapy", "reassurance" and "back exercises" are some suggested approaches. Some of these techniques are geared specifically towards work. Others, such as "back schools" or "multidisciplinary interventions" combine different approaches.
Promoting return to work at an appropriate stage (subacute stage) could help low-back-pain sufferers to avoid prolonged disability.
Revue d Épidémiologie et de Santé Publique 05/2004; 52(2):173-88. · 0.78 Impact Factor
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ABSTRACT: To determine the predictiveness of personal and occupational factors for the onset of shoulder pain in occupations requiring repetitive work.
A sample of 598 workers in five activity sectors completed a self administered questionnaire in 1993-94 and again three years later. Both questionnaires included questions about shoulder pain. The associations between various factors at baseline and subsequent shoulder pain were studied among subjects free from shoulder pain at baseline.
The incidence of shoulder pain was associated with several independent risk factors: depressive symptoms, low level of job control, and biomechanical constraints. After adjustment for other risk factors, the presence of depressive symptoms predicted occurrence of shoulder pain. A low level of job control was also associated with the onset of shoulder pain in both sexes. For men, repetitive use of a tool was a strong predictor, while the two most important biomechanical risk factors for women were use of vibrating tools and working with arms above shoulder level.
This study used a longitudinal approach to examine different sets of risk factors for shoulder pain simultaneously. The results confirm the role of several biomechanical constraints. Psychological symptoms and a low level of job control also play a role.
Occupational and environmental medicine 02/2004; 61(1):39-44. · 3.64 Impact Factor
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ABSTRACT: The purpose of this research was to describe women's consumption of alcoholic beverages as it related to their marital status over a 5-year period (1992 through 1996) and to study alcohol consumption around the time of marriage or divorce.
The study sample comprised 4,782 women who worked for Electricité de France-Gaz de France and belonged to the GAZEL cohort. The relevant variables collected by five successive annual questionnaires included marital status and alcohol consumption characteristics. Marginal models were used, reflecting the fact that the data were not independent.
Divorcees and widows drank less than married women as measured in fewer glasses per day and fewer days per week drinking wine. Women in the oldest generation drank more than the younger women. Getting married was accompanied by an increased level of drinking, especially of wine, beginning a year before the wedding and lasting until 4 years after it. Consumption declined briefly during the year after a divorce.
These results may be useful for designing prevention programs aimed at groups of women in the general population in France.
Journal of studies on alcohol 12/2003; 64(6):784-9.
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ABSTRACT: Because medial epicondylitis has not been studied alone, we investigated its links between personal and occupational factors in repetitive work and its course. A total of 1757 workers were examined by an occupational health physician in 1993-1994. Five hundred ninety-eight of them were reexamined 3 years later. Prevalence was between 4% and 5%, with an annual incidence estimate at 1.5%. Forceful work was a risk factor (odds ratio [OR], 1.95; confidence interval [CI] = 1.15-3.32), but not exposure to repetitive work (OR, 1.11; CI = 0.59-2.10). Workers with medial epicondylitis had a significantly higher prevalence of other work-related upper-limb musculoskeletal disorders (WRMD). Risk factors differed for medial and lateral epicondylitis. The prognosis for medial epicondylitis in this population was good with a 3-year recovery rate at 81%. Medial epicondylitis was clearly associated with forceful work and other upper-limb WRMD, and its prognosis was good.
Journal of Occupational and Environmental Medicine 10/2003; 45(9):993-1001. · 2.06 Impact Factor
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ABSTRACT: BACKGROUND: The general approach of social epidemiology is based on the observation of a strong social stratification of health outcomes within populations: a similar stratification of factors associated with health must therefore also exist according to social status. To explain social differences in health, the natural approach for epidemiologists is to consider an imbalanced distribution of established risk factors according to the social position of individuals. As this approach has largely failed, two main other research areas were recently explored: (i) identification of "new" social risk factors; (ii) research of possible mechanisms of social differences in health. METHODS AND RESULTS: Identification of social risk factors: early events and life course, occupational factors, social relationships (social networks and support, discrimination, neighborhood characteristics), health care. Research of possible mechanisms of social differences in health in the context of specific theoretical frameworks: the materialist model, the psychosocial model and the eco-social model integrating the interaction between individuals'characteristics and their environment. COMPLEX METHODOLOGICAL PROBLEMS: definition and measurement of variables characterizing the social situation of individuals; quantification of social inequalities at population level. Observational methods must often rely on very long-lasting cohorts, and imply statistical methods that account for longitudinal data or are able to manage simultaneously individual and contextual data.
Revue d Épidémiologie et de Santé Publique 10/2003; 51(4):381-401. · 0.78 Impact Factor
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ABSTRACT: The objectives of this prospective study were to investigate personal and occupational predictors of sciatica and to compare the risk factors for sciatica and those for low back pain without sciatica.
The study analysed data from 841 men, initially free from low back pain, who were followed for 2 years. Subjects were participants in the French GAZEL cohort of employees of the national electricity and gas company. The predictive factors for sciatica and low back pain without sciatica were compared with a polytomous model.
Height and driving were predictors only for sciatica, and bending forward and backward at work was a predictor only for low back pain without sciatica. The odds ratio (OR) for sciatica associated with 'height >180 cm' was 3, with a 95% confidence interval (CI) of 1.4-6.5; for driving >2 h daily it was 2 (CI = 0.94-4.10) and for driving >2 h several days a week 2.7 (CI = 1.20-6.10).
This study confirmed that height and driving are risk factors for sciatica and that sciatica has specific predictors different from those for other types of low back pain. Future studies should consider sciatica separately from these.
Occupational Medicine 09/2003; 53(6):384-91. · 1.14 Impact Factor
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ABSTRACT: The objective of this study was to examine factors associated with self-reporting of chronic health problems. The self-reports were obtained from a questionnaire sent by mail to the French GAZEL cohort, composed of workers of a French company. The disorders reported in the questionnaire were compared with diagnoses from the sick-leave database of the company. Associations between self-reporting and characteristics were studied by multiple logistic regression analyses. Three types of characteristics were analyzed: individual, methodological and disorder-related (i.e., prevalence of chronic disorders in the general population, probable disability and probable life risk scores). In 1992, the cohort consisted of 16,534 subjects aged 38 to 53 years. The reporting rate (number of self-reports in the questionnaire divided by number of records in the sick-leave database for the disorder considered) varied from 8.9% to 100%. Self-reporting was associated with individual characteristics (gender, family status, place of residence, annual number of sick days and sick leaves), disorder-related characteristics (probable disability, prevalence) and methodological characteristics (precision of the formulation, delay between the last sick-day and the patient report). By body system, the characteristics associated with self-reporting varied greatly but the annual number of sick days, probable disability and precision of formulation were the variables which remained most often in the models. These characteristics should be particularly taken into consideration in the interpretation of epidemiological results based on self-reporting.
Journal of Clinical Epidemiology 02/2002; 55(1):48-59. · 4.27 Impact Factor
