Academic journal article Scandinavian Journal of Work, Environment & Health

Self-Reported Skin Problems and the Healthy Worker Effect in the General Working Population of Norway: A Three-Year Prospective Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Self-Reported Skin Problems and the Healthy Worker Effect in the General Working Population of Norway: A Three-Year Prospective Study

Article excerpt

Population-based prospective studies focusing on skin problems due to occupational skin exposures are scarce but highly needed to assess the epidemiology of workrelated skin diseases. In a three-year prospective study of the general working population of Norway, we previously reported evidence of an association between self-reported occupational skin exposure and skin problems (1). However, such an association was weaker for responders reporting skin exposure at baseline (2006) only, compared to those reporting exposure at follow-up only (2009), and at both baseline and follow-up.

Healthy worker survivor effect is a phenomenon in which workers with health problems are more likely than healthy coworkers to leave high-exposure jobs, either by ending employment or being transferred (2). This selection away from exposed jobs may reduce the impact of skin exposure on a given person, but on the other hand it may lead to the biased conclusion that the occupational skin exposure is not associated with skin problems.

First, the occurrence of skin problems at baseline could have influenced an eventual loss to follow-up. Whilst different mechanisms of loss to follow-up have been described, the most problematic occurs if dropouts are related to the outcome of the study leading to an underestimation of the association between occupational skin exposure and skin problems (attrition bias) (3, 4).

Second, the occurrence of skin problems at baseline could have led to changes in patterns of skin exposure at follow-up (for example, avoidance of hazardous exposure at work, implementation of preventive measures, or both).

We sought, therefore, to (i) assess whether a potential healthy worker survivor effect have an impact on the response frequency at follow-up and (ii) examine whether the occurrence of skin problems at baseline predicts quitting a job due to health problems and changes in patterns of self-reported skin exposure at follow-up.

Methods

Study design and population

This three-year prospective study comprised a random sample of the general working population of Norway taken from the Survey of Level of Living-Working Conditions (Statistics Norway) 2006 and 2009. Only originally identified members are followed-up to the end of study period. Table 1 shows details of this survey (5, 6).

Eligibility

Eligible responders included Norwegian residents aged 18-69 years (66 years in 2006), covering the general working age population. In 2006, the source population consisted of 2 941 281 persons. A gross sample of 18 679 individuals, independent of employment status, was randomly drawn from this group, and 12 550 (67%) persons were then interviewed. Of these, 9961 were enrolled in paid work in 2006. In 2009 the source population consisted of 3 079 157 persons. A gross sample of 20 136 individuals, independent of employment status, was randomly drawn from this population, of which 7 881 did not respond at baseline. The interviewer was unable to reach 19% of respondents despite several attempts, 16% did not want to participate, and 3% were unable to participate. A total of 12 255 (61%) persons were then interviewed (table 1, figure 1).

Panel data for statistical analysis

The panel data comprised responders participating in both surveys, totalling 9375 persons (response frequency: 50.2% of the gross and 74.4% of the baseline cross-sectional sample). Responders who were enrolled in paid work at baseline (N=9961) constituted the study population for attrition analyses (figure 1). Responders in the panel dataset at baseline and follow-up who were enrolled in paid work at baseline comprised the study population of those quitting a job due to health problems in 2009 (N=7559). Responders in the panel sample who were enrolled in paid work at both baseline and follow-up constituted the population for self-reported patterns of skin exposure at follow-up (N=6745).

Demographic variables

Sex and age were based on data from the National Registry of Norway. …

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