Academic journal article Scandinavian Journal of Work, Environment & Health

Time Trends in Incidence and Prevalence of Carpal Tunnel Syndrome over Eight Years According to Multiple Data Sources: Pays De la Loire Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Time Trends in Incidence and Prevalence of Carpal Tunnel Syndrome over Eight Years According to Multiple Data Sources: Pays De la Loire Study

Article excerpt

Carpal tunnel syndrome (CTS) is one of the most common musculoskeletal disorders of the upper-extremities (UE-MSD) in working populations (1-4). As in many industrialized countries, CTS is a leading cause of surgery and occupational diseases (OD) in France (5-6).

Certain personal characteristics (eg, age and gender) and medical conditions (eg, obesity and diabetes mellitus) increase the risk of CTS (7-8), and certain working conditions exposing workers to biomechanical constraints are also risk factors for CTS (eg, repetitive movements, handarm transmitted vibration, forceful manual exertion, and bending/twisting of the wrist) (1, 3, 9, 10). A substantial number of cases of CTS diagnosed in the population of working age are thus related to personal characteristics rather than working conditions and would have occurred in the workforce whether workers were exposed to jobs at high risk of CTS or not. Other numbers of cases of CTS occurring in excess among workers in jobs at high risk in comparison with the general population can be considered as "attributable to work". The proportion increases with the relative risk of CTS in such jobs and can be estimated by the attributable fraction of risk. Using data from a pilot study on surgically treated CTS (SURG-CTS) involving 1500 people (1053 women, 447 men) undergoing surgical release in two large hand surgery settings of the Pays de la Loire region in 2002-2003, we estimated the average population attributable fraction of SURG-CTS to work to be 24.2% [95% confidence interval (95% CI) 16.8-30.8] after adjustment for the main personal risk factors (age, gender, body mass index and diabetes mellitus) (11). Higher values of unadjusted population attributable fraction of CTS (defined by neurophysiological criteria) were found in selected occupational categories, such as male blue-collar workers (50%, 95% CI 41-57) (12).

Reduction of the incidence of CTS is a priority for occupational health due to its human and social as well as economic costs (13). Several recent studies have suggested a decline in the incidence of work-related MSD in the North-American and European working populations (14, 15). However, there is little information regarding the non-occupational and occupational factors influencing observed time trends in the incidence of CTS (14-16). Reduction of the prevalence of well-documented, non-occupational risk factors for CTS in the population of working age, such as obesity, might result in a decline in the incidence of CTS, whether the cases are attributable to work or not. Improvement of working conditions by reducing exposure to occupational risk factors might also contribute to reducing the incidence of CTS. The impact will depend on the proportion of cases attributable to work and the combined effects of occupational and non-occupational risk factors when present in combination.

Surveillance programs are needed to monitor time trends and assess the efficacy of preventive interventions (15). Workers' compensation claims are commonly used to describe time trends in CTS, but underestimate the true incidence of disease (17) and do not capture cases of CTS classified as not related to work. Few reliable indicators of the frequency of CTS are available, for example surgical release of the median nerve, and none can assess the true frequency accurately (18). Santé publique France, the French Public Health Agency, therefore implemented an epidemiological UE-MSD surveillance program in the Pays de la Loire region (Loire Valley area, west central France) based on multiple data sources (18).

To demonstrate whether a decline in the frequency of UE-MSDs has occurred in the French Pays de la Loire region or not, we used data from the surveillance program for CTS to evaluate time trends of prevalence and incidence of CTS over an 8-year period according to multiple sources of information.

Methods

Study design

This descriptive study is based on information from three independent data sources collected between 2004 and 2011 covering the working age population (20-59 years) of the Pays de la Loire region. …

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