title: Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk?
abstract: OBJECTIVE
  The aim was to explore whether "adjustment" for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures.
  
  
  METHODS
  This cross-sectional study of 733 subjects in 12 health care and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models.
  
  
  RESULTS
  Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion >/=45 degrees and forceful pinch increased the odds in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation >/=4% time and lifting >/=4.5kg >3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (women OR 5.18, 95% CI 1.70-15.81 and men OR 3.63, 95% CI 1.08-12.18).
  
  
  CONCLUSIONS
  Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.
authors.affiliation: Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, PO Box 44330, Olympia, Washington, United States. silb235@lni.wa.gov
authors.forename: Barbara
authors.initials: B
authors.lastname: Silverstein
authors.forename: Z Joyce
authors.initials: ZJ
authors.lastname: Fan
authors.forename: Caroline K
authors.initials: CK
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Bao
authors.forename: Ninica
authors.initials: N
authors.lastname: Howard
authors.forename: Peregrin
authors.initials: P
authors.lastname: Spielholz
authors.forename: David
authors.initials: D
authors.lastname: Bonauto
authors.forename: Eira
authors.initials: E
authors.lastname: Viikari-Juntura
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D003430:Cross-Sectional Studies; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009140:Musculoskeletal Diseases; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D000070636:Rotator Cuff Injuries; D017678:Sex Distribution; D000070599:Shoulder Injuries; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000293:injuries; D014861:Washington / Q000453:epidemiology