Upper body and lower limbs musculoskeletal symptoms and health inequalities in Europe: an analysis of cross-sectional data

BACKGROUND Musculoskeletal disorders are the most frequent occupational diseases in Europe. However, their multifactorial aetiology poses several challenges concerning not only the estimation of relative prevalence rates across occupational groups but also how the co-occurrence of known risk factors might differ between disorders of the upper and lower limbs. Against this background, the following objectives are pursued: (1) to estimate the relative odds and prevalence rates of self-reported disorders of the upper limbs and/or shoulders and neck (upper body) and the lower limbs for major ISCO-88 occupational groups, (2) to evaluate to what extent the associations between known risk factors differ for musculoskeletal disorders of the upper body and the lower limbs. METHODS Statistical analysis of cross-sectional data from the European Working Conditions Survey 1995-2010. The probability of reporting upper body and lower limbs pain in the survey sample 2010 is estimated by mixed logistic regression models using the Markov chain Monte Carlo Sampler. Independent variables include some known physical and psychosocial risk factors. RESULTS Concerning the first objective, an excess risk of reporting musculoskeketal disorders of the upper body was observed among craft workers (ISCO 7), machine operators (ISCO 8) and workers in elementary occupations (ISCO 9). Concerning musculoskeletal disorders of the lower limbs, service and sales workers (ISCO 5) and workers in ISCO groups 7, 8 and 9 reported symptoms more frequently. Regarding the second objective, similar association patterns were observed for upper body and lower limbs symptoms. Major physical risk factors associated with both symptom types were very frequent exposure to tiring positions, carrying heavy loads and performing repetitive tasks. Standing appears to be an important risk factor for lower limbs symptoms only. CONCLUSIONS Results suggest that the unequal burden of exposure has not changed substantially across occupational groups since 1995, and that there is urgent need of delivering and evaluating the effects of specific interventions targeting workers at high risk of developing musculoskeletal disorders.