The Healthy Worker Survivor Effect: Target Parameters and Target Populations

Brown, Daniel; Picciotto, Sally; Costello, Sadie; Neophytou, Andreas M.; Izano, Monika A.; Ferguson, Jacqueline; Eisen, Ellen A.

doi:10.1007/s40572-017-0156-x

Cited by 43 publications

(38 citation statements)

References 52 publications

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“…We additionally excluded studies that included blue-collar women in the overall study population but failed to specify results or an exposure unique to blue-collar women. Lastly, we excluded those studies for which we were unable to discern whether blue-collar women were grouped with office and clerical workers in their analyses ( Brown et al, 2017 , Bromet et al, 1992 ).…”

Section: Methodsmentioning

confidence: 99%

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Elser

Falconi

Bass

et al. 2018

SSM - Population Health

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Despite the implications of gender and sex differences for health risks associated with blue-collar work, adverse health outcomes among blue-collar workers has been most frequently studied among men. The present study provides a “state-of-the-field” systematic review of the empiric evidence published on blue-collar women's health. We systematically reviewed literature related to the health of blue-collar women published between January 1, 1990 and December 31, 2015. We limited our review to peer-reviewed studies published in the English language on the health or health behaviors of women who were presently working or had previously worked in a blue-collar job. Studies were eligible for inclusion regardless of the number, age, or geographic region of blue-collar women in the study sample. We retained 177 studies that considered a wide range of health outcomes in study populations from 40 different countries. Overall, these studies suggested inferior health among female blue-collar workers as compared with either blue-collar males or other women. However, we noted several methodological limitations in addition to heterogeneity in study context and design, which inhibited comparison of results across publications. Methodological limitations of the extant literature, alongside the rapidly changing nature of women in the workplace, motivate further study on the health of blue-collar women. Efforts to identify specific mechanisms by which blue-collar work predisposes women to adverse health may be particularly valuable in informing future workplace-based and policy-level interventions.

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Section: Methodsmentioning

confidence: 99%

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Elser

Falconi

Bass

et al. 2018

SSM - Population Health

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“…The observed effects across participants aged ≥47 years are more susceptible to healthy worker effect survivor bias,35 originally describing actively employed to have lower mortality rates, than the population as a whole, due to the fact that unhealthy individuals more often leave the workforce 36. Similarly, migrations out of high OPA jobs are expected for workers not physically capable to maintain employment due to deterioration of health.…”

Section: Discussionmentioning

confidence: 99%

Associations between occupational relative aerobic workload and resting blood pressure among different age groups: a cross-sectional analysis in the DPhacto study

et al. 2019

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ObjectiveHigh levels of occupational physical activity (OPA) increase heart rate, blood pressure (BP) and the risk of hypertension. Older workers may be more vulnerable to high levels of OPA due to age-related degeneration of the cardiovascular system and cardiorespiratory fitness. This study investigates the association of relative aerobic workload (RAW) with resting BP and examines if this relation is moderated by age.DesignCross-sectional epidemiological study.SettingData were collected among employees of 15 Danish companies in the cleaning, manufacturing and transport sectors.Participants2107 employees were invited for participation, of these 1087 accepted and 562 (42% female and 4% non-Westerns) were included in the analysis based on the criteria of being non-pregnant, no allergy to bandages, sufficient amount of heart rate data corresponding to ≥4 work hours per workday or 75% of average work hours, and no missing outcome and confounder values.Primary and secondary outcome measuresThe primary outcome measure was BP.ResultsHeart rate reserve was estimated from ambulatory 24-hour heart rate measures covering 2.5 workdays per participant (SD 1.0 day). Age significantly moderated the association between RAW and BP. Mean intensity and duration of high RAW (≥30% heart rate reserve) showed positive associations with diastolic BP and negative associations with pulse pressure (PP) among participants ≥47 years old. Tendencies towards negative associations between RAW and BP were seen among participants <47 years old.ConclusionsMean intensity and duration of RAW increased diastolic BP among participants ≥47 years old. Negative associations with PP may be due to healthy worker selection bias. Prevention of hypertension should consider reductions in RAW for ageing workers.

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“…16 Some workers may not have good health to seek jobs; therefore, they do not ask for jobs (self-selection). 21 In fact, this source (HWSE) and the healthy hire effect (employer selection for healthy workers) are the most important sources for the appearance of HWE. 2,3,12,15 In the occupational morbidity (non-fatal outcomes) studies such as workers with asthma or musculoskeletal disorders, it is a common phenomenon to find sick workers leaving the employment or transferring to lessexposed occupations.…”

Section: Healthy Worker Survivor Effect (Hwse)mentioning

confidence: 99%

“…10 The longitudinal studies are more prone to have HWSE among sick workers who leave their work compared to the cross-sectional studies that include all workers, even the sick workers, who may subsequently leave during the period of follow-up. 21 However, the cross-sectional studies may only include the active workers (healthier workers), as the workers with poorer health may have already left the workplace before the beginning of the study; therefore, the effects of the exposure may be underestimated. Finally, if the HWSE was not considered, there might be 'an underestimation of the risk of disease for exposed workers.…”

Section: Healthy Worker Survivor Effect (Hwse)mentioning

confidence: 99%

A comprehensive review of the healthy worker effect in occupational epidemiological studies

Algarni

2020

Int J Res Med Sci

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The reduction of mortality and morbidity rates among occupational cohort studies may be attributed to the presence of the healthy worker effect (HWE). Occupational epidemiologic studies investigating worker’s health are prone to the risk of having the HWE phenomenon and this special form of bias has been debated over the years. Hence, it’s imperative to explore in-depth the magnitude and sources of HWE, and further, elucidate the factors that may affect HWE and strategies reducing HWE. The HWE should be considered as a mixed bias between selection and confounding bias. The validity threats due to the HWE among morbidity studies are the same as the mortality studies. The consequent reduction due to the HWE in the association between the exposure and outcome may lead to underestimating some harmful exposures in the workplace or occupational settings. Healthy hire effect and healthy worker survivor effect are the main sources of HWE. Several factors can increase or decrease the probability of HWE; therefore, the investigators should consider them among future occupational epidemiological studies. Many strategies can help in reducing the impact of HWE, but each strategy has its weaknesses and strengths. Not all strategies can be applied among all occupational epidemiological studies. Mathematical procedures still need further investigations to be validated. HWE is a consequence of inappropriate comparison groups in nature. The usage of the general population as a reference group is not an appropriate choice. By considering the HWE sources and factors and using appropriate strategies, the impact of HWE may be reduced.

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The Healthy Worker Survivor Effect: Target Parameters and Target Populations

Cited by 43 publications

References 52 publications

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Associations between occupational relative aerobic workload and resting blood pressure among different age groups: a cross-sectional analysis in the DPhacto study

A comprehensive review of the healthy worker effect in occupational epidemiological studies

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