Falls and fractures in women at work

BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.     

Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system

Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention.     

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.     

The incidence of fall injury events among the elderly in a defined population

Falls are a leading cause of death from injury among older persons in the United States, and about one in three older persons falls each year. Yet, reliable estimates of the incidence of fall injury events in a population-based setting are not readily available. Therefore, the authors analyzed population-based surveillance data, between July 1985 and June 1987, from the Study to Assess Falls Among the Elderly, Miami Beach, Florida. The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 per 1,000 for females. Compared with males, females had a higher incidence of fractures other than skull. Males were nearly twice as likely to die, however, following a fall injury event than were females. Of those fall injury events identified through the surveillance system, about 42% resulted in hospital admission. The mean length of hospital stay was 11.6 days overall and was 15.5 days for hip fracture, 9.8 days for skull fracture/intracranial injury, 11.2 days for all other fractures, and 9.1 days for all other injuries. About 50% of fall injury events that occurred at home and required hospital admission resulted in a person being discharged to a nursing home.     

Hospitalization for fractures and bone loss in adults. Why do we regard these phenomena as dull?

The epidemiology of serious fractures in adults relates less to the frequency of forceful accidents and more directly to the loss of bone in middle-aged and older people. To support this statement, hospital discharge rates for fractures in recent years are examined from different geographic areas. Rates for the United States rise with age, so that serious fractures form 10 percent of all hospital discharges at 85 years and older. Saskatchewan data suggest that rates for men remain low until 60 years; for women the figures began to rise at 45 years, before many had reached the menopause. Rates are lower among women than men in Saskatchewan until around 50 years, surpassing those of men at age 55 and older. Among Medicare enrollees in 1967 in the United States, women had higher discharge rates for fractures than men of the same age and race. Whites also had higher rates than blacks, so much so that white males had higher rates than black women of the same age. Such data confirm the past impression that blacks who survive into the older ages are a biological elite, more able to maintain bone strength than whites of either sex, although by no means being exempt from bone loss with age. A fractured femur was the most frequent diagnosis, forming a higher percentage of all fractures in women than men, and rising steeply with age in both sexes. The pattern of fractures by sex differs from the epidemiology of forceful accidents, which more often involve men than women. Bone loss with age, or osteoporosis, is perhaps the most powerful host factor to dominate the picture of fractures in the elderly. The existing possibilities for preventing or slowing this change are thus assessed; women may no longer accept as natural the widespread bone loss and accompanying fractures that lower the quality of life in later years.     

Reports of work related musculoskeletal injury among home care service workers compared with nursery school workers and the general population of employed women in Sweden.

OBJECTIVES--To describe the nationwide occurrence of work related musculoskeletal injuries among all home care service workers in Sweden, and to identify relative risks and risk factors of the injuries. METHODS--The study was based on work related injuries reported to the Swedish occupational injury information system in 1990-1. The work related musculoskeletal injuries were divided into overexertion accidents and musculoskeletal diseases. The incidence of the injuries in female home care service workers was compared with those in nursery school workers and all other employed women in Sweden. RESULTS--In home care service workers, the annual incidence of injury from overexertion accidents and musculoskeletal diseases were 19.2 and 15.1 per 1000 workers, respectively, which was higher than those in nursery school workers and all employed women in Sweden. For five injury locations including the back, all the age standardised relative risks (SRR) of overexertion accidents exceeded 4.0, and most of those for musculoskeletal diseases were 1.5 or more in home care service workers compared with all other employed women in Sweden. Total duration of sick leave due to overexertion accidents was 7.7 times, and musculoskeletal diseases 3.5 times, longer than in nursery school workers. National loss due to sick leave resulting from only musculoskeletal injuries in home care service workers was about 8.2% of the total work related sick leave in all employed women in Sweden, although the number of home care service workers represented only some 5% of this population. Lifting other people was most frequently reported as the main risk cause of overexertion accidents in both kinds of workers. CONCLUSIONS--The results support the hypothesis that home care service workers have higher annual injury incidence of musculoskeletal injuries than nursery school workers due to physically stressful tasks that are far less common in nursery school workers.     

Female seafarers adopt the high risk lifestyle of male seafarers

OBJECTIVE: To study the mortality of women in an occupation known to have a high mortality among men. METHODS: A total of 6788 female seafarers of all job categories who had been employed on Danish merchant ships, passenger ships, and privately owned ferries between 1986 and 1993, were followed up until the end of 1993. RESULTS: Standardised mortality ratio (SMR) was 1.20 (95% confidence interval (95% CI) 0.89 to 1.58) for all causes of death and job categories together. For women in traditionally male jobs, SMR was 2.82 (1.41- 5.05), whereas galley and catering staff had SMRs close to the general female population. The high mortality among women in traditional male jobs could be explained by a high risk of fatal accidents including occupational accidents. In the whole cohort, there were fewer deaths from natural causes than expected but an excess risk of death due to lung cancer, heart diseases, and non-natural deaths. CONCLUSION: The increased mortality could primarily be explained by an excess risk of fatal accidents and suicide. Especially, female seafarers entering traditional male jobs had a high risk of fatal accidents, not only at sea but also ashore. An excess risk of dying of lung cancer and heart diseases probably reflects a high tobacco consumption. Female seafarers are probably influenced by their occupation towards hazardous behaviour and a high risk lifestyle but people with a high risk lifestyle may also be attracted by or forced into high risk jobs such as traditional male jobs at sea.     

The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden

OBJECTIVE: The objective of this study was to examine the economics of administering calcium and vitamin D3 to post-menopausal women in Sweden. We focus primarily on the cost-effectiveness of treating older women for whom clear evidence of efficacy is available. We supplement this information, however, with estimates of the cost-effectiveness of treating certain high-risk groups of younger women, while acknowledging the greater uncertainty involved. METHODS: We developed a Markov model for analyzing the occurrence and timing of hip fractures, based almost entirely on peer-reviewed data from Sweden. In a 3-year randomized clinical trial, the combination of calcium and vitamin D3 was shown to reduce the risk of hip fractures by 27%. Costs for treating hip fractures were based on 1,080 women who were hospitalized in Stockholm. RESULTS: Treatment of 70-year-old women was cost saving at efficacy as low as two-thirds that seen in the clinical trials, and upwards. Even at modest rates of efficacy, treatment of the high-risk 50- and 60-year-old cohorts was generally cost-effective and in some cases even cost saving. Particularly cost-effective was treatment of women with identified osteoporosis or a maternal family history of hip fracture. CONCLUSION: Simulation results suggest a role for lifetime treatment of older women with calcium and vitamin D3 in Sweden. While there is more uncertainty underlying the treatment of younger women, our simulation results suggest that treatment may also be cost saving or at least cost-effective for many cohorts of high-risk 50- and particularly 60-year-old women, in particular those with osteoporosis or a maternal family history of hip fracture.     

Tuberculosis among immigrants in the United Kingdom: the role of occupational health services.

Immigrant workers in the United Kingdom account for 7.8% of the working population. Their health problems fall into three groups--imported diseases, occupational accidents, and acquired diseases. In the latter group, tuberculosis is still a major problem. A retrospective study tracing notifiable cases of tuberculosis to points of entry at Heathrow Airport indicates that the majority of immigrants acquire the disease after entry. The occupational health services have a great role to play in detecting the new cases very early and in providing appropriate screening and follow-up. Proper co-ordination between occupational and community health services will give the best results and lead to a rapid decline of the disease.     

Occupational risks of bladder cancer among white women in the United States

The relation between occupation and bladder cancer in women was examined based on data collected during the National Bladder Cancer Study, a population-based, case-control study conducted in 10 areas of the United States. Occupational hazards among women have received little attention in previous bladder cancer studies, in part because most studies have included too few females to accurately estimate risks. In this large case-control study, 652 white female bladder cancer patients and 1,266 white female controls were interviewed to obtain lifetime occupational histories. Patterns of bladder cancer risk by occupation in women tended to be similar to those previously observed among men. Increased risk was apparent for women ever employed in metal working and fabrication occupations (relative risk (RR) = 1.5; 95% confidence interval (CI) 0.9-2.6). Within this summary occupation category, punch and stamping press operatives had a significant trend in risk with increasing duration of employment (p = 0.012); the RR for women employed 5 years or more was 5.6 (95% CI 1.4-26.4). The authors also observed an increased risk for women employed as chemical processing workers (RR = 2.1; 95% CI 0.9-5.1 = with a significant, contrast, a decreased risk was apparent for female textile workers (RR = 0.6; 95% CI 0.3-1.1) with a significant, negative trend in risk with increasing duration of employment (p = 0.031); the relative risk for textile workers employed 10 years or more was 0.4. The authors estimate that 11% of bladder cancer diagnosed among white women in the United States is attributable to occupational exposures; this percentage is considerably lower than the 21-25% previously reported for white men in this study.     

A selection strategy was developed for fracture reduction programs in frail older people

ObjectivesThe aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.Study Design and SettingTwo thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.ResultsOur fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.ConclusionThe index could help rationalize fracture prevention programs for frail older people.     

Increased risk of lung cancer among male professional drivers in urban but not rural areas of Sweden.

OBJECTIVES: To study the risk of lung cancer in different subgroups of professional drivers in urban and rural areas of Sweden. METHODS: Information on occupation and geographical region was obtained from the Swedish census of 1970 and data on the incidence of lung cancer between 1971 and 1984 from the National Swedish Cancer Registry. Professional drivers were separated into bus, taxi, and long and short distance lorry drivers. Comparisons of cumulative incidence of lung cancer were made between each particular group of drivers and gainfully employed men in the same region. RESULTS: Taxi drivers, and long and short distance lorry drivers in Stockholm County showed increased relative risks (RRs) of lung cancer with the highest risk among the short distance lorry drivers (RR 2.0, 95% confidence interval (95% CI) 1.5 to 2.6). These categories of drivers also showed increased risks in the other two large conurbations in Sweden. In the rest of the country (mainly rural areas) there were no increased RRs for any category of driver. The RR for bus drivers was not increased in any region. After adjustment for assumed differences in smoking habits the RRs remained significantly increased for lorry drivers in Stockholm but not for other groups of drivers in other areas. However, the RRs remained numerically higher in large conurbations than in rural regions for all groups of drivers. CONCLUSIONS: These findings suggest that some factors present in the urban environment play a substantial part in the excess of lung cancer among short distance lorry drivers in urban areas of Sweden. Exposure to motor exhaust fumes may have contributed to this excess.     

Effects of Statins on Relative Risk of Fractures for Older Adults: An Updated Systematic Review With Meta-Analysis

ObjectivesBasic and translational studies have found statin treatment may have beneficial effects on bone metabolism; however, whether statins reduce the risk of fractures in older adults is still in debate. Therefore, we aimed to summarize the up-to-date evidence on risk of fracture among older individuals with statin use.DesignSystematic literature review and meta-analysis.Setting and ParticipantsTwenty-one observational studies and 2 randomized controlled trials (RCTs) comprising 1,783,123 participants aged at least 50 years were retrieved from PubMed, Embase, and the Cochrane Library.MeasuresWe estimated summary relative risks (RRs) with 95% confidence intervals (CIs) using the random-effects model. Subgroup analysis was performed to explore the potential source of heterogeneity.ResultsMeta-analysis of observational studies suggested that statin treatment was significantly associated with reduced risk of all fractures (RR 0.80, 95% CI 0.72–0.88), among which hip fracture (RR 0.73, 95% CI 0.64–0.82) and lower extremity fracture (RR 0.69, 95% CI 0.54–0.88) showed consistent results, whereas no significant decreased risk was observed with respect to other fracture sites. Subgroup analyses showed that among the statin users, fracture risk was reduced in both genders, older adults ≥50 years old, those with short drug duration (< year) or medium to high statin dose (>90 defined daily dose), those taking atorvastatin, and in Europeans and Americans. Meta-analysis of RCTs revealed no significant effect of statin treatment on the risk of fractures (RR 1.00, 95% CI 0.87–1.15).Conclusions and ImplicationsOverall, the findings of this updated meta-analysis indicated no solid evidence supporting that statins have a beneficial effect associated with reduced risk of fractures for older adults. Our findings should be further confirmed in future larger population-based prospective cohort studies or well-designed RCTs.     

Stomach cancer and occupation in Sweden: 1971-89

Objectives: To examine the relation between gastric cancer and occupation among men and women gainfully employed in 1970 in Sweden for the period 1971–89 and, more specifically, to evaluate whether any excess of incidence of gastric cancer had also occurred among the subcohort of people reporting the same occupation in 1960 and 1970.

Methods: In both sexes and cohorts, relative risks adjusted for age, period of diagnosis, and geographical risk area were computed for occupational codes specified at one, two, or three level (occupational sector, occupational group, and occupation, respectively). Relative risks were calculated with all other occupations as reference and then, to take socioeconomic status into account, solely other occupations within the same occupational sector were used.

Results: Among men, occupations with increased risk included miners and quarrymen, construction and metal processing workers, supporting the possible causative role of dusty environments in stomach cancer. In men, the results also provide support for increased risks among electrical and mechanical engineers, fishermen, petrol station workers, motor vehicle drivers, butchers and meat preparers, dockers, freight handlers, launderers and dry cleaners. Furthermore, it is worth noting interesting results for women, whose occupational risks have been studied less. Excess risks were found for practical nurses, cashiers, bank employees, engineering and electronic industry workers, food industry, housekeeping and cleaning workers. Due to the many occupations studied, several significant associations may be expected by chance.

Conclusions: The study is explorative but provides support for the relations suggested previously between occupational exposure to dusty environments and stomach cancer, together with some new high risk occupations which should be further studied.

     

The risk of acute myocardial infarction: interactions of types of physical activity

BACKGROUND: Leisure time physical activity has previously been shown to be protective against cardiovascular disease. We estimated the influence of exercise, occupational physical activity, and household work with regard to risk of acute myocardial infarction (MI). Special interest was focused on potential interaction among these aspects of physical activity. METHOD: We analyzed data from a large population-based case-control study conducted in Stockholm, Sweden, 1992-1994. Cases comprised 1204 men and 550 women, age 45-70 years, who experienced their first MI during the study period. The controls, 1538 men and 777 women, were randomly selected from the study base, matched on sex, age, and hospital catchment area. The results were adjusted for several potential confounding factors. RESULTS: Exercise, walking or standing at work, and doing demanding household work were all associated with decreased risk of acute MI; the estimated relative risks (RRs) ranged from 0.31 to 0.90 when all cases (fatal and nonfatal) were considered. In contrast, lifting or carrying at work, and an occupational workload perceived to be strenuous, were related to an increased risk of MI (RRs ranging from 1.10-1.57). We observed a synergistic benefit from exercise and walking or standing at work, and from household work and walking or standing at work. CONCLUSION: Aerobic physical activities such as exercise or walking at work seemed to reduce the risk of MI, whereas anaerobic activities such as heavy lifting at work were related to increased risk of MI.     

The health consequences of teenage fertility

A review of the literature on the health consequences of teenage pregnancy and childbirth shows remarkable similarity in findings from studies conducted in the United States, Canada, Britain, France and Sweden. In particular, results of studies conducted since 1970 have tended to indicate that the increased risk of maternal complications from pregnancy and delivery among teenagers--especially those older than 15--is associated more with socioeconomic factors than with the biological effects of age. Smaller differences in maternal mortality between teenagers and older women exist in England and Wales than in the United States and France; this finding suggests that England and Wales may have minimized the age or socioeconomic factors contributing to a difference in rates. Inadequate prenatal care may be a major cause of pregnancy-related complications for mothers, since teenagers in all countries are more likely than older mothers to seek care late in the pregnancy or not all. There is a very marked association between young age of mother and low birth weight in all countries. Sweden has the lowest rate of low birth weight at all maternal ages, and the United States generally has the highest. Some of the apparent effect of young maternal age on birth weight may be because the birth is likely to be the mother's first, and first births have a higher incidence of prematurity. As in the case of maternal health, inadequate prenatal care has been singled out as an important determinant of both prematurity and low birth weight. Late fetal death rates in the United States, England and Wales, and France are slightly higher among teenagers than among women in their 20s. In Canada and Sweden, however, no substantially increased risk for young women is found. Perinatal death rates, which one might expect to be influenced more by environmental factors than are late fetal deaths, show a more marked increase among infants of teenagers than do rates of late fetal deaths. Again, Sweden does not fit the pattern. Studies that separate data for young teens and older teenage mothers also indicate that increased perinatal and late fetal mortality rates may occur only among very young teenage mothers. There is no evidence of an overall increase in congenital malformations among babies born to teenagers. When individual birth defects are examined, some studies have shown increased rates of cardiovascular and central nervous system malformations among the children of teenage mothers.(ABSTRACT TRUNCATED AT 400 WORDS)     

Differences by region of birth in SARS-CoV-2 vaccine coverage and positive SARS-CoV-2 test among 400 000 healthcare workers and the general population in Sweden

BackgroundGlobally SARS-CoV-2 vaccine coverage varies among healthcare workers.MethodsBased on Swedish registers, data on vaccination status as of 31 October 2021 were analysed for all adults aged 35–64 years, 3 861 565 individuals, in Sweden by healthcare worker occupation group and region of birth.ResultsFor both men and women vaccination coverage decreased in a graded manner by healthcare worker group with physicians having the highest coverage (96%), followed by registered nurses, licensed practical nurses, and nurse aides. Coverage also differed by region of birth for all groups of healthcare workers and non-healthcare workers with those born in Sweden with Sweden born parents having the highest coverage, and those born outside Sweden but within EU the lowest.ConclusionThe difference in vaccine coverage by region of birth among healthcare workers, regardless of whether it results from socioeconomic inequalities or sociocultural beliefs, puts them at a great occupational hazard and increased risk of nosocomial transmission.     

Occupation and oral cancer among women in the South

A case-control interview study among 232 North Carolina women with oral or pharyngeal cancer and 410 matched controls evaluated the contribution of occupation to the high risk of this cancer among females in the South. Review of detailed occupational histories found no overall elevated odds ratios for employment in the textile, apparel, or hosiery industry, the major employer of women in the area. Risks also did not increase with years worked in the industry. The findings thus fail to confirm an association reported in surveys in the United States and Great Britain. A new clue to occupational factors was suggested by the excess risk associated with the electronics industry in coastal North Carolina, independent of the participants' tobacco habits.