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Objectives: The aim was to develop a gender-specific European job exposure matrix (EuroJEM) for occupational physical workload and study its predictive validity for musculoskeletal pain in four European cohorts., Methods: National, gender-specific JEM from Finland, France, Norway and Sweden, based on self-reported exposure information, were evaluated for similarities in exposures, exposure definitions, and occupational coding. The EuroJEM harmonized five exposures: heavy lifting, faster breathing due to heavy workload, kneeling/squatting, forward bent posture, and working with hands above shoulder level. Our expert panel addressed disagreements and missing information to reach consensus on exposure levels across occupations. To assess predictive validity of the EuroJEM, we examined associations between the harmonized exposure measures and self-reported musculoskeletal pain across the four cohorts., Results: The EuroJEM provides semi-quantitative exposure estimates for 374 ISCO-88 (COM) occupational codes. Five categories of exposure were defined by the proportion of workers exposed within each occupation. Comparable and statistically significant associations were found between EuroJEM exposures and low back, shoulder, and knee pain across all cohorts and genders, except for knee pain among women in the Finnish cohort. For instance, in both genders heavy lifting, faster breathing due to heavy workload, and forward bent posture were statistically significantly associated with low-back pain in all four cohorts, with OR ranging from 1.25-2.18 (men) and 1.23-2.04 (women)., Conclusions: Despite differences in study populations and outcome definitions, good predictive validity was observed in each national cohort, suggesting that EuroJEM can be an effective tool for exposure assessment in large-scale European epidemiological studies.

Objectives: This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors., Methods: The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for., Results: We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles., Conclusion: Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

Objective: Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD)., Methods: A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45-64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP., Results: Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32-1.46) and for those with high physical workload 1.48 (1.39-1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures., Conclusion: Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP)., (© 2023. The Author(s).)