Objectives. The major objectives of this dissertation were to: (1) identify predictors of occupational musculoskeletal disability, with a focus on knee-related outcomes; (2) demonstrate that a series of related case-control comparisons can be used to identify differences in the determinants of causally related outcomes (knee injury and knee-related disability); and (3) demonstrate that data collected for administrative purposes represent a cost-effective resource for analytical epidemiological studies. Methods. Using data from the U.S. Army, we adapted Haddon's Matrix to the study of occupational disability by conducting separate case-control comparisons of occupational knee injury and knee-related disability discharge from active duty service. Each case-control comparison was nested within the population of Army personnel on active duty between 1980 and 1997. We developed multiple logistic regression models to analyze the independent contributions of sociodemographic and occupational characteristics to the risk of knee-related injury and disability. All models were stratified by gender. Results. Among men and women, non-whites were at about 30% lower risk than whites for both knee injury and disability. There was increasing risk of both injury and disability with increasing age for women, and for disability among men. Duration of service (positive) and pay grade (negative) were also associated with both outcomes for men and women. Other risk factors differed for men and women by outcome, and the final models predicting injury and disability included different parameters for each gender. Exploratory analyses of possible effect modification suggested interactions between demographic and occupational factors. Conclusions. These analyses were possible because of the availability of a large database containing occupational, demographic and health information for a cohort of Army personnel. The wide range of data elements and the large, relatively diverse population enabled the evaluation of the separate and combined influence of sociodemographic and occupational characteristics on the risk of occupational injury and disability. This is among the first analytical epidemiological studies of its kind. The differences between the final injury and disability models suggests that the use of separate case-control comparisons to identify risk factors for related outcomes is a viable research method.
| Identifer | oai:union.ndltd.org:UMASS/oai:scholarworks.umass.edu:dissertations-3388 |
| Date | 01 January 2000 |
| Creators | Sulsky, Sandra Ilene |
| Publisher | ScholarWorks@UMass Amherst |
| Source Sets | University of Massachusetts, Amherst |
| Language | English |
| Detected Language | English |
| Type | text |
| Source | Doctoral Dissertations Available from Proquest |
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