The association of socioeconomic status and psychosocial and physical workplace factors with musculoskeletal injury in hospital workers

Am J Ind Med. 2007 Apr;50(4):245-60. doi: 10.1002/ajim.20429.


Background: The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers.

Methods: Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education-income as a predictor.

Results: Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). "Other Clinical" occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7-12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1-1.9) and all injuries (OR 1.3; 95%CI, 1.04-1.5), per SD change in score.

Conclusions: In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case-Control Studies
  • Ergonomics
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Musculoskeletal Diseases / epidemiology*
  • Musculoskeletal Diseases / physiopathology
  • Occupational Health / statistics & numerical data*
  • Personnel, Hospital / psychology
  • Personnel, Hospital / statistics & numerical data*
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Social Class*
  • Surveys and Questionnaires
  • United States / epidemiology
  • Workload* / psychology
  • Workplace* / psychology