Dose-response relationship between cumulative physical workload and osteoarthritis of the hip – a meta-analysis applying an external reference population for exposure assignment

Seidler, Andreas; Lüben, Laura; Hegewald, Janice; Bolm-Audorff, Ulrich; Bergmann, Annekatrin; Liebers, Falk; Ramdohr, Christina; Romero Starke, Karla; Freiberg, Alice; Unverzagt, Susanne

doi:10.1186/s12891-018-2085-8

Table 3 Cumulative exposure assignments among men for the single exposure categories

From: Dose-response relationship between cumulative physical workload and osteoarthritis of the hip – a meta-analysis applying an external reference population for exposure assignment

Study, country	Median age (ref. population: 47.3 years, range 25–70 yrs.)	Exposure parameter of the included study (not used for analysis)	Cases, n	Control subjects/Participants^a, n (%)	Median exposure percentile	OR (95% CI)	Assigned exposure parameter a^b [tons]	Assigned exposure parameter b^c [tons]	Assigned exposure parameter c^d [numbers × 1000]	Assigned age-corrected^eexposure a. [tons]	Assigned age-corrected^eexposure b. [tons]	Assigned age-corrected^eexposure c. [numbers × 1000]
Coggon et al. [3], GB	mean 68 years (≥ 45 years)^f	Duration of lifting loads ≥25 kg	210 (total)	210 (total)
		0 years	91	115 (54.8%)	27.4	1.0 -	0	0	0	0	0	0
		1–9 years	22	28 (13.3%)	61.5	0.8 (0.4–1.7)	353	194	12	615	246	15
		10–19 years	14	15 (7,1%)	71.7	1.5 (0.6–3.8)	1299	968	41	1331	1054	46
		≥ 20 years	83	52 (24.8%)	87.6	2.3 (1.3–4.4)	4632	4354	170	5505	5168	191
Croft et al. [5, 6], GB	range 60–75 years	Duration of lifting or moving weights > 25.4 kg by hand	49 (total)	262^g (total)
		< 1 years	9	71 (27.1%)	13.6	1.0 -	0	0	0	0	0	0
		1–19 years	14	106 (40.5%)	47.4	1.2 (0.5–2.9)	8	0	0.6	8	0	0.3
		≥ 20 years	26	85 (32.4%)	83.8	2.5 (1.1–5.7)	3380	3252	107	4449	3818	124
Elsner et al. [7], Germany	ca. 51 years (43% ≤45 yrs.)	Lifting > 20 kg frequently or almost always	134 (total)	95 (total)
		No	73	61 (64.2%)	32.1	1.0 -	0	0	0	0	0	0
		Yes	61	34 (35.8%)	82.1	1.1 (0.65–2.10)	3061	2670	88	3061	2670	88
Kaila-Kangas et al. [10], Finland	ca. 51 years (range 30–97 years)	Duration of manual handling of loads > 20 kg	59 (total)	2,853^h (total)
		0 years	19	1,561ⁱ (53.6%)	26.8	1.0 -	0	0	0	0	0	0
		1–12 years	7	468ⁱ (16.1%)	61.7	1.1 (0.4–3.2)	353	194	12	353	194	12
		13–24 years	10	371ⁱ (12.7%)	76.1	2.2 (0.8–5.9)	1725	1428	65	1725	1428	65
		> 24 years	23	514ⁱ (17.6%)	91.2	2.3 (1.2–4.3)	6687	6432	278	6687	6432	278
Lau et al. [12], Hong Kong	Not reported	Lifting ≥50 kg	30 (total)	90 (total)
		No	17	80 (88.9%)	44.5	1.0 -	0	0	0.6	0	0	0
		1–10 times per week	5	4 (4.4%)	91.1	8.5 (1.6–45.3)	6687	6432	278	10,866	9076	336
		≥10 times per week	8	6 (6.7%)	96.7	9.6 (2.2–42.2)	21,837	21,823	607	24,695	24,278	727
Rubak et al. [17], Denmark	64.3 years (range ca. 40–70 yrs.)	No. of ton years (1 ton year = lifting 1 ton per day over 1 year)	957 (total)	1759 (total)
		0 ton years	390	779	22.2	1.0 -	0	0	0	0	0	0
		> 0- < 10 ton years	164	333	53.8	1.0 (0.8–1.3)	92	0	26	116	0	5
		10- < 20 ton years	153	304	71.9	0.9 (0.7–1.2)	1299	968	41	1331	1054	46
		20–115 ton years	250	343	90.3	1.4 (1.1–1.7)	6527	5980	219	8946	6668	325
Vingard et al. [26], Sweden	63 years (range 50–70 yrs.)	Lifted tons before the age of 49	233 (total)	302 (total)
		0–137 tons		60%^j	30.0	1.0 -	0	0	0	0	0	0
		138–3006 tons		20%^j	70.0	1.6 (0.9–2.7)	1054	784	34	1226	968	41
		3007–94,003 tons		20%^j	90.0	1.8 (1.1–3.0)	6101	5971	218	7177	6596	280

^aIn the study of Kaila-Kangas et al. [10], the distribution of participants is given
^bCumulative weight [in tons] lifted and/or carried, taking into account all weights ≥20 kg
^cCumulative weight [in tons] lifted and/or carried, taking into account all weights ≥20 kg that were handled at least 10 times per working day
^dCumulative number of lifting and/or carrying operations of weights ≥20 kg
^eFor studies with a mean age > 60, the reference population is restricted to individuals ≥50 years
^fAccording to Cooper et al. [4]
^gExcluding 32 control subjects with missing values
^hExcluding 257 participants with missing values
ⁱKaila-Kangas L. Personal communication. Email dated April 3, 2017
^jVingard et al. [26] do not give the numbers of cases and control subjects in the single exposure categories. Exposure categories were formed as follows: “Three exposure groups were defined on the basis of the loads in the reference group. Those unexposed and the 5% less exposed were considered to have low exposure. The rest of the exposed group was divided into two equally large groups, classified as the medium-exposure group and the high-exposure group” ([26], p. 106). In the Vingard et al. [26] study, the reference category includes all individuals with an exposure of up to 137 tons. In our reference population, a 137 ton-exposure corresponds to the 60th exposure percentile. We therefore assigned the 30th mean exposure percentile to the reference category

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