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Related Experiment Videos

Adjusting for the healthy worker selection effect in cross-sectional studies

L Punnett1

  • 1Department of Work Environment, University of Massachusetts Lowell 01854, USA.

International Journal of Epidemiology
|October 1, 1996
PubMed
Summary

Women in repetitive garment work face higher musculoskeletal disorder risks. A healthy worker selection effect may inflate initial estimates, suggesting true risks could be five times higher.

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Area of Science:

  • Occupational health
  • Epidemiology
  • Musculoskeletal disorders

Background:

  • Cross-sectional study identified higher musculoskeletal disorder risk in garment assembly workers compared to hospital workers.
  • Potential bias suspected if symptomatic garment workers leave employment more frequently.

Purpose of the Study:

  • To investigate and adjust for potential selection bias in a cross-sectional study of musculoskeletal disorders.
  • To estimate the true relative risk of musculoskeletal disorders in repetitive manual work.

Main Methods:

  • Utilized retrospective data on symptom onset and employment duration.
  • Calculated age and calendar period-specific onset rates, conditional on continued employment.

Main Results:

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  • Observed increasing rates and relative risk for garment work over a 20-year period.
  • Trends were not explained by age, employment length, or documented changes in work demands.

Conclusions:

  • Healthy worker selection effect is the most plausible explanation for observed trends.
  • This effect likely inflated the initial risk estimate; true relative risk may be around five.
  • Proposed method can help estimate and reduce selection bias in similar cross-sectional studies lacking longitudinal data.