THE EVOLVING CONCEPT OF THE HEALTHY WORKER SURVIVOR EFFECT

被引：394

作者：

ARRIGHI, HM

HERTZPICCIOTTO, I

机构：

[1] Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC

来源：

EPIDEMIOLOGY | 1994年 / 5卷 / 02期

关键词：

HEALTHY WORKER EFFECT; BIAS; CONFOUNDING FACTORS; EPIDEMIOLOGIC METHODS; STUDY DESIGN; ATA ANALYSIS; OCCUPATIONAL EXPOSURES;

D O I：

10.1097/00001648-199403000-00009

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

The ''healthy worker survivor effect'' describes a continuing selection process such that those who remain employed tend to be healthier than those who leave employment. In an analysis of exposure response patterns in an occupational study, the healthy worker survivor effect generally attenuates an adverse effect of exposure. In practical terms, such attenuation will be more problematic when evaluating subtle rather than strong associations. The use of an internal referent does not guarantee elimination of this effect, since by definition, it manifests within an occupational cohort. Although documented over 100 years ago, there is little consensus regarding the most appropriate method to control for: the healthy worker survivor effect. Four methods have been Proposed for its control: (1) restriction of the cohort to survivors of a fixed number Of years of follow-up, (2) lagging the exposure to exclude recent exposure incurred by those who remained on the job, (3) adjusting for employment status as as a confounder, and (4) treating the healthy worker survivor effect simultaneously as an intermediate and confounding variable by means of the G-null test or its extension, G-estimation analysis, using structurally nested failure time models. This paper reviews the concept of the healthy worker survivor effect and the four methods to control for it.

引用

页码：189 / 196

页数：8

共 30 条

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