Occupational demands associated with rotator cuff disease surgery in the UK Biobank

Abstract

Objectives: Physically-demanding occupations may increase rotator cuff disease (RCD) risk and need for surgery. We linked a job-exposure matrix (JEM) to the UK Biobank cohort study to measure physical occupational exposures and estimate associations with RCD surgery.

Methods: Jobs and UK Standard Occupational Classification (SOC) codes were recorded during the UK Biobank verbal interview. Lifetime job histories were captured through a web-based survey. UK SOC codes were linked to a JEM based on the US O*NET database. O*NET-based scores [static strength, dynamic strength, general physical activities, handling/moving objects (range=1-7), time spent using hands, whole body vibration, and cramped/awkward positions (range=1-5)] were assigned to jobs. RCD surgeries were identified through linked national hospital inpatient records. Multivariable Cox regression was used to calculate hazard ratios (HR) as estimates of associations with RCD surgery. Among those with lifetime job histories, associations were estimated for duration of time with greatest exposure (top quartile of exposure).

Results: Of 277 808 people reporting jobs, 1997 (0.7%) had an inpatient RCD surgery. After adjusting for age, sex, race, education, area deprivation, and body mass index, all O*NET variables considered were associated with RCD surgery (HR per point increase range=1.10-1.45, all P<0.005). A total of 100 929 people reported lifetime job histories, in which greater exposures were significantly associated with RCD surgery after >10 years of work (eg, HR for 11-20 versus 0 years with static strength score ≥4 = 2.06, 95% confidence interval 1.39-3.04).

Conclusions: Workplace physical demands are an important risk factor for RCD surgery, particularly for workers with more than a decade of exposure.

Figure 1

Selection of UK Biobank study populations with current job titles and lifetime job histories. *There were 63 614 participants with information on both current job title at baseline and lifetime job history.

Figure 2

Distribution of O*NET variables among the 277 808 people in the UK Biobank with current job titles at baseline enrollment visit. For ‘Static Strength’, ‘Dynamic Strength’, ‘Handling and Moving Objects’, and ‘Performing General Physical Activities’, scores of 7 represent the greatest level of that ability or activity needed for job performance. For the evaluation of jobs, O*NET provides example tasks that correspond to different values, including for ‘Static Strength’ 1=Push an empty shopping cart and 6=Lift 75-pound bags of cement onto a truck; for ‘Dynamic Strength’ 2=Use pruning shears to trim a brush and 6=Perform a gymnastics routine using the rings; for ‘Handling and Moving Objects’ 2=Change settings on copy machines and 6=Load boxes on an assembly line; and for ‘Performing General Physical Activities’ 1=Walk between work stations in a small office and 6=Climb up and down poles to install electricity. For ‘Spend Time Using Your Hands to Handle, Control, or Feel Objects, Tools, or Controls’, ‘Cramped Work Space, Awkward Positions’, ‘Exposed to Whole Body Vibration’, and ‘Making Repetitive Motions’ scores of 1 represent no time spent under specified conditions and scores of 5 represent continual/almost continual time spent under specified conditions.