首页|下背痛及其不良工效学因素的结构方程分析与建模

下背痛及其不良工效学因素的结构方程分析与建模

Structural equation analysis and modeling of adverse ergonomic factors for lower back pain

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目的 基于大样本流行病学调查和结构方程分析方法,建立我国职业人群下背痛与各类危险因素的结构方程模型,为此类疾患的预防工作奠定基础.方法 筛选2018年6月至2023年12月使用《中文版肌肉骨骼疾患电子问卷》调查的73 497份全国职业流行病学个案数据.通过不良工效学因素及其来源分类标准和验证性因子分析分别提取下背痛相关的个体因素、工作组织、工作姿势、工作类型、肌肉疲劳和下背痛6个因子,对其进行结构方程分析,并建立结构方程模型.结果 调整后的下背痛及其不良工效学因素结构方程模型的主要结构信效度指标基本达标[拟合优度指数(goodness offit index,GFI)为 0.956,调整拟合优度指数(adjusted goodness of fit index,AGFI)为 0.944,近似均方根误差(root mean square error of approximation,RMSEA)为 0.043,规范拟合指数(normed fit index,NFI)为 0.922,比较拟合指数(comparative fit index,CFI)为 0.923,塔克-刘易斯指数(Tucker-Lewis index,TLI)为0.908],模型拟合度较好.个体因素、工作组织、工作姿势和工作类型4个外生潜变量间具有相关性.其中,个体因素与工作组织、工作姿势、工作类型3个外生潜变量存在较弱的负相关(r=-0.30、-0.11、-0.18),工作组织与工作姿势、工作类型均存在中等程度的正相关(r=0.49、0.55),工作类型与工作姿势存在较强的正相关(r=0.72).除工作组织外,其他外生潜变量与下背痛均存在直接路径,个体因素、工作姿势和肌肉疲劳的直接路径系数分别为0.07、0.11和0.40,工作类型的直接路径系数为-0.07;工作类型、工作姿势和工作组织与下背痛存在经肌肉疲劳中介的间接路径,其间接路径系数:工作类型-肌肉疲劳-下背痛(0.15)、工作姿势-肌肉疲劳-下背痛(-0.04)和工作组织-肌肉疲劳-下背痛(0.27).结论 开展下背痛防控工作时,应综合考虑工作组织、工作姿势和工作类型因素导致劳动者肌肉疲劳进而诱发下背痛的发生路径,为提高此类疾患的防控水平提供理论参考.
Objective To establish a structural equation model of lower back pain and its risk factors in occupational population in China based on a large-sample occupational epidemiological survey and structural equation analysis,so as to lay the foundation for the prevention of this disease.Methods A total of 73497 occupational epidemiological cases were selected from June 2018 to December 2023 using the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire.The results were analyzed using ergonomic hazard factors and their risk source classification criteria.Confirmatory factor analysis was then applied to extract individual factors,work organization,working postures,work types,muscle fatigue,and lower back pain.These factors were subsequently classified into six categories and structural equation model was established.Results The main structural reliability and validity indexes of the structural equation model of lower back pain and its adverse ergonomic factors after adjustment were basically up to standard[goodness of fit index(GFI)was 0.956,the adjusted goodness of fit index(AGFI)was 0.944,the root mean square error of approximation(RMSEA)was 0.043,the normed fit index(NFI)was 0.922,the comparative fit index(CFI)was 0.923,and the Tucker-Lewis index(TLI)was 0.908],and the model fit was good.There were correlations among four exogenous latent variables:individual factors,work organization,working postures and work types.Among them,individual factors had a weak negative correlation with the three exogenous potential variables of work organization,working postures and work types(r=-0.30,-0.11,-0.18),and work organization had a moderate positive correlation with working postures and work types(r=0.49,0.55).There was a strong positive correlation between work types and working postures(r=0.72).The direct path coefficients of individual factors,working postures and muscle fatigue were 0.07,0.11 and 0.40,respectively.The direct path coefficients of work types were-0.07.There was an indirect path mediated by muscle fatigue between work types,working postures and work organization and lower back pain,and the indirect path coefficients were:work types-muscle fatigue-lower back pain(0.15),working postures-muscle fatigue-lower back pain(-0.04)and work organization-muscle fatigue-lower back pain(0.27).Conclusion When carrying out the prevention and control of lower back pain,the pathogenesis of lower back pain induced by workers'muscle fatigue caused by work organization,working postures,and work types factors should be comprehensively considered,so as to provide a theoretical reference for improving the prevention and control level of lower back pain.

Musculoskeletal systemLower back painWork-related musculoskeletal disordersRisk factorsStructural equation model

徐擎、贾宁、孙新、张美辨、郭新苇、张华东、凌瑞杰、刘移民、王致、李刚、尹艳、邵华、李珏、张恒东、邱兵、王大宇、曾强、王如刚、叶研、肖斌、邹华、陈建超、黎东霞、刘永泉、时庆华、刘吉祥、蒋恩霏、漆骏、梅良英、赵显锋、杨咪咪、王忠旭

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中国疾病预防控制中心职业卫生与中毒控制所职业防护与工效学研究室,北京 100050

中国疾病预防控制中心职业卫生与中毒控制所,北京 100050

重庆市疾病预防控制中心主任办公室,重庆 400042

湖北省职业病与中毒临床医学研究中心办公室,武汉 430024

广州市职业病防治院职业卫生管理科,广州 510620

广州市职业病防治院职业环境与健康重点实验室,广州 510620

辽宁省疾病预防控制中心职业病防治所,沈阳 110399

上海市疾病预防控制中心职业健康科,上海 200051

山东省职业卫生与职业病防治研究院检测评价中心,济南 255030

北京市化工职业病防治院院办公室,北京 100195

江苏省疾病预防控制中心职业病防治所,南京 210009

中国民用航空局民用航空医学中心民航公共卫生应急管理办公室,北京 100010

天津市职业病防治院体检科,天津 300011

天津市疾病预防控制中心职业健康所,天津 300011

北京市疾病预防控制中心职业卫生所,北京 100013

广东省职业病防治院物理因素监测所,广州 510300

浙江省疾病预防控制中心职业健康与辐射防护所,杭州 310051

福建省职业病与化学中毒预防控制中心医务科,福州 350025

贵州省职业病防治院院办公室,贵阳 610599

江西省职业病防治研究院职业病医院,南昌 330006

宁夏疾病预防控制中心办公室,银川 750003

四川省疾病预防控制中心职业与辐射卫生所,成都 610044

云南省疾病预防控制中心职业健康与放射卫生所,昆明 650118

湖北省疾病预防控制中心卫生监测所,武汉 430070

陕西省疾病预防控制中心职业与放射卫生所,西安 710054

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肌肉骨骼系统 下背痛 工作相关肌肉骨骼疾患 危险因素 结构方程模型

2024

10.3760/cma.j.cn121094-20240422-00177

中华劳动卫生职业病杂志
中华医学会

中华劳动卫生职业病杂志

CSTPCD北大核心
影响因子：0.787
ISSN：1001-9391
年,卷(期)：2024.42(12)