¹Washington University School of Medicine, St. Louis, United States
²Finnish Institute of Occupational Health, Helsinki, Finland
³University of Angers, Institut de recherche en santé, environnement et travail, INSERM, Angers, France
⁴Department of Public Health, University of Copenhagen, Copenhagen, Denmark
⁵Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
⁶National Institute of Occupational Health (STAMI), Oslo, Norway
⁷Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
⁸The Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
⁹Paris Cité University, “Population-based Cohorts Unit”, INSERM, Paris, France
¹⁰University of Angers, CHU Angers, University of Rennes, INSERM, Rennes, France
¹¹Department of Epidemiology, Local Health Unit ASL TO 3, Turin, Italy

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Objectives: Few studies have compared general population job exposure matrices across different countries; existing data suggest that some exposure estimates based on industry and job title are comparable, and can be applied to workers in different nations. The Exposome Project for Health and Occupational Research (EPHOR) seeks to construct a European JEM for use in pooled cohorts. In this context, we developed and tested a gender-specific European job exposure matrix (EuroJEM) for physical workload.

Methods: We created the EuroJEM based on existing gender-specific JEMs created from national surveys in Finland, France, Norway, and Sweden. Based on self-reported work exposure information combined at the job level, these national JEMs were evaluated for similarities in exposure definitions and occupational coding. An expert panel addressed disagreements and missing information to harmonize exposure levels across occupations for five exposures: heavy lifting, faster breathing due to heavy workload, kneeling/squatting, forward bent posture, and working with hands above shoulder level. We examined concordance and agreement between estimated exposures at the national level and those provided by the combined EuroJEM. We also assessed predictive validity through association between EuroJEM exposures and self-reported musculoskeletal pain.

Results: The four national validation cohorts varied in size. The French cohort was the largest (45,643 men and 59,267 women) and the Finnish cohort the smallest (1927 men and 2021 women). The harmonized EuroJEM provided semi-quantitative exposure estimates for 374 different ISCO-88 occupational codes. Gender differences in exposure were most common for heavy lifting (58 of 374 job codes) and least common for kneeling/squatting (9 codes). Measures of agreement between the different national JEMs assessed by kappa ranged from fair to good; AUC was good to excellent for all exposures except for faster breathing in women (0.62) and kneeling or squatting in men (0.76). All five exposures included in the EuroJEM showed good predictive validity for relevant site-specific musculoskeletal pain (low back, shoulder, and/or knee pain) among both men and women. For example, in both genders heavy lifting and forward bent posture were associated with statistically significant increases in low back pain (ORs ranged from 1.25-2.18 in men and 1.23-2.04 in women).

Conclusions: Despite differences in national study populations, these results suggest that the EuroJEM can be an effective exposure estimation tool for general populations. Using national health care and employment data, we are currently using the EuroJEM to study the association between cumulative work exposures and the outcomes of medical care for hip or shoulder disorders across four countries. Examples of the utility of the JEM for studying these work-related musculoskeletal disorders will be presented.