Occupational health indicators

April 2015
Maladies chroniques
et traumatismes
Occupational
health
Occupational health indicators
Upper limb musculoskeletal diseases in France
Julien Brière1, Natacha Fouquet1,2, Catherine Ha1, Ellen Imbernon1, Julie Plaine1, Stéphanie Rivière1, Yves Roquelaure2,
Madeleine Valenty1
1/ French Institute for Public Health Surveillance (InVS), Occupational health department (DST), Saint-Maurice, France
2/ LUNAM University, University of Angers, Laboratory of ergonomics and epidemiology in occupational health (LEEST), Angers, France
In 2009, the department of occupational health (DST) of the
French Institute of Public Health Surveillance (Institut de
veille sanitaire, InVS) established a nationwide program for
the regular production of indicators intended to report health
problems related to the workplace environment, working
conditions, and exposures, as well as their trends over time.
This document, the third in this series, covers musculoskeletal
diseases (MSD) of the upper limbs.
I Picture 2 I
Shoulder pain
These diseases cover a wide range of periarticular conditions
affecting the soft tissue (muscles, tendons, nerves, vessels, and
cartilage) and are manifested principally by pain and often daily
functional discomfort. Their severity is associated with their
consequences – both medical, because they frequently become
chronic, and occupational, as a source of inability to perform
one’s job. MSDs today are one of the most worrisome issues
in occupational health, in France as in Europe.
© Von Schonertagen / Fotolia
I Picture 1 I
Among MSDs, those of the upper limbs account for the vast
majority recognized as occupational diseases by the main
private-sector social insurance fund (RGSS). This document,
divided into 3 parts – health indicators, indicators of exposure
to the principal risk factors, and indicators of compensation –
concerns only indicators related to these upper limb diseases.
The principal results for each of these three aspects are
described below.
Wrist pain
Health indicators
© Von Schonertagen / Fotolia
Beyond the individual factors (age, sex, diabetes, etc.), two
major types of occupational factors play a role in their onset:
biomechanical factors (such as static loads, forceful motions,
extreme postures, highly repetitive movements, vibrations, etc.)
and psychosocial and organizational constraints (for example,
strong psychological demand, low social support, little decision
latitude, and pace constraints).
Overall, both prevalence and incidence rates increase with age,
regardless of sex or specific site. The MSDs most frequently
diagnosed by occupational physicians are those of the shoulder,
followed by carpal tunnel syndrome (CTS) of the wrists, and
then MSDs of the elbow.
In 2011, the prevalence rates of upper limb MSDs attributed
to work by occupational physicians was 1.8% among men and
1.2% among women. Between 2006 and 2012, we observed a
rising trend, due especially to the increase in shoulder MSDs.
Occupational health indicators. Upper limb musculoskeletal diseases in France — french institute for public health surveillance / p. 1
Exposure indicators
I Figure 1 I
Distribution of MSDs of shoulder, elbow and carpal
tunnel reported in work-related diseases (WRD)
according to sex in 2011
I picture 4 I
Industrial work
48 % Shoulder 50 %
34 % Elbow 23 %
18 %
Carpal 27 %
tunnel
Source: Surveillance programme of WRD, 2011
The incidence rate of CTS requiring surgery (attributable to
work or not) was 3.7‰ among women and 1.6‰ among men,
with wide variations between regions. This rate was higher in
the regions of the northeast quarter of France, followed by the
Atlantic coast regions.
The broad activity sectors most affected by these upper limb
MSDs were farming and the industrial sector (manufacturing,
mining, and electricity and water distribution) for both sexes,
as well as construction for men. Manual workers, skilled or
unskilled, were the occupational category most affected by
this type of disease.
I Picture 3 I
Work with vibrating tools
Source: www.en.wikipedia.org
The proportion of workers exposed to the combination of three
types of biomechanical exposures (forceful motions, difficult
postures, and highly repetitive movements) was high: 15% of
women and 14% of men.
One in four workers were in "job strain" situations, as defined
by Karasek and Theorell’s model (30% of women and 20% of
men).
Overall, the youngest (20-29 years) were the most highly
exposed. Half of all men in this age group were exposed to
the combination of awkward posture and forceful exertion.
Women more often performed highly repetitive tasks, and men
tasks requiring force.
Regardless of sex, a gradient according to socio-occupational
category was observed: unskilled workers, skilled workers, and
sales workers were most affected by cumulative exposures,
while managers and professionals were less affected.
Predictive factors for shoulder pain or MSD differed according
to sex. Among men, these were especially physical factors
and low social support from colleagues. Among women, we
find physical factors but also organizational constraints and
individual factors such as obesity.
Source: www.en.wikipedia.org
The existence of upper limb musculoskeletal symptoms and
diseases affects occupational outcomes and, especially, early
departure from the labor force: compared with asymptomatic
workers, those with a diagnosed upper limb MSD are twice as
likely to have left the work force several years later and three
times more likely to be receiving disability payments.
Predictive factors for the onset of CTS several years later
included overtime work, use of vibrating hand tools, exposure
to cold, and low support from their supervisors. For women,
predictive factors for CTS were more often organizational in
nature.
p. 2 / french institute for public health surveillance — Occupational health indicators. Upper limb musculoskeletal diseases in France
I Figure 2 I
Biomechanical exposure (at least a difficult posture, at least one forceful motion and highly repetitive movements) and
exposure to job strain according to age group, 2002-2005
Fréquences d'exposition croisées pour l'âge
40%
Frequency of exposure to a job strain
20-29 years
50-59 years
30%
30-39 years
40-49 years
20-29 years
40-49 years
20%
50-59 years
30-39 years
10%
0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Frequency of exposure to at least a difficult posture, at least one forceful motion and highly repetitive movements
Men
Women
Source: French Musculoskeletal Disorders Surveillance Program – 2002-2005
Indicators of compensation
Upper limb MSDs account for a predominant proportion of
the compensated occupational diseases: over the 1997-2012
period, an average of 70% for the RGSS (main social insurance
fund) and more than 80% for the agricultural workers’ social
insurance fund (MSA).
The number of workers with upper limb MSDs receiving
compensation for them multiplied by six between 1997 and
2012 for the RGSS and by three between 1997 and 2010 at
the MSA.
Musculoskeletal diseases were also the leading cause of work
days lost from sick-leaves; in 2011, nine million work days
were lost for these diseases, 84% of the total number of days
of temporary disability from occupational diseases.
Although CTS ranked first in the RGSS compensation data,
musculoskeletal diseases of the shoulder took over first place for
upper limb MSDs reported in the work-related disease program
(WRD) and in the Pays de la Loire MSD surveillance network.
Nonetheless in recent years, the compensation data showed
greater growth for shoulder MSDs than for those elsewhere in
the upper limb. Nonetheless, it should be noted that the recent
modification of RGSS Table 57A (concerning the definition of
shoulder diseases compensated as occupational diseases) will
make it more difficult to monitor this compensation indicator.
I Picture 6 I
Work in building industry
The proportion of upper limb MSDs among all occupational
diseases indemnified by the RGSS was higher for women than
men.
I Picture 5 I
Work in civil engineering
Source: www.pixabay.com
Source: www.en.wikipedia.org
Occupational health indicators. Upper limb musculoskeletal diseases in France — french institute for public health surveillance / p. 3
I Table 1 I
Under-reporting rate of shoulder and elbow MSDs and of CTS by sex, computed from the surveillance programme of
WRD, in 2009
Men
% [variation range]
Women
% [variation range]
Total
% [variation range]
Shoulder MSD
73 [66-79]
64 [56-73]
69 [63-74]
Elbow MSD
75 [69-82]
70 [59-79]
73 [67-79]
CTS
64 [55-72]
56 [47-64]
59 [52-64]
Sources: Surveillance programme of WRD, 2009
Extractions of the general social security scheme and the salaried agricultural workers scheme, 2009
Data from the Pays de la Loire MSD surveillance network and
the WRD surveillance program have enabled us to confirm the
scale of CTS under-reporting by estimating its under-reporting
as an occupational disease. The CTS under-reporting rate is
estimated at 42% for men and 44% for women, while its
occupational disease rate is under-reported by 64% for men
and 56% for women.
References
Conclusion
[2] Briere J, Chevalier A, Charbotel B, Imbernon E, DST.
Des indicateurs en santé travail. Les accidents mortels d’origine
professionnelle en France [Internet]. 2011. 24 p. Available on:
http://opac.invs.sante.fr/index.php?lvl=notice_display&id=9881
This document makes it possible to compare the principal
epidemiologic indicators available for work-related
musculoskeletal diseases: indicators of exposure, health impact,
and compensation.
These data are necessary to guide effective prevention programs
for musculoskeletal diseases, which require the mobilization
of all stake-holders in companies. These include not only
members of the committees for health, safety, and working
conditions (CHSCT) and the occupational health department,
but also company directors, who are legally responsible for
these risks (Labor Code, article L4121-1), and supervisors, as
well as workers themselves.
[1] Chevalier A, Ducamp S, Gilg Soit Ilg A, Goldberg M,
Goldberg S, Houot M, et al. Des indicateurs en santé travail.
Risques professionnels dus à l’amiante [Internet]. 2010. 23 p.
Available on: http://opac.invs.sante.fr/index.php?lvl=notice_
display&id=422
[3] Parent-Thirion A, European Foundation for the Improvement
of Living and Working Conditions. Fourth European working
conditions survey. Dublin: European Foundation for the
Improvement of Living and Working Conditions; 2007.
[4] CnamTS, Direction des risques professionnels. Risque
MP 2011 : statistiques de sinistralité tous CTN et par CTN
[Internet]. Paris: Risque MP 2011 : statistiques de sinistralité
tous CTN et par CTN; 2012 p. 14. Available on: http://
www.risquesprofessionnels.ameli.fr/fileadmin/user_upload/
document_PDF_a_telecharger/etudes_statistiques/MP_2011/
Risque%20MP%202011-%20tous%20CTN%20et%20par%20
CTN%20%28n-2012-181%29.pdf
To learn more
You can consult the full report from which this brochure (in French): Brière J, Fouquet N, Ha C, Imbernon E, Plaine J, Rivière S,
et al. Des indicateurs en santé travail. Les troubles musculo-squelettiques du membre supérieur en France. Saint-Maurice :
Institut de veille sanitaire ; 2015. 51 p. Disponible à partir de l’URL : http://www.invs.sante.fr
Key words: musculoskeletal disorders, MSD, work-related disease, WRD, carpal tunnel syndrome,
rotator cuff syndrome, epicondylitis
Suggested citation:
Brière J, Fouquet N, Ha C, Imbernon E, Plaine J, Rivière S, et al. Occupational health indicators. Upper limb musculoskeletal diseases in France. Saint-Maurice :
Institut de veille sanitaire ; 2015. 4 p. Disponible à partir de l’URL : http://www.invs.sante.fr
French Institute for Public Health Surveillance (Institut de veille sanitaire), 12rue du Val d’Osne 94415 Saint-Maurice Cedex France –
Tel.: 33 (0)1 41 79 67 00 – Fax: 33 (0)1 41 79 67 67 – www.invs.sante.fr – ISSN: 1956-5488 – ISBN-NET : 979-10-289-0135-6 – Design/Production: Communication
department – InVS – Legal deposit: april 2015