Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue-, white- collar workers and housewives of Tuscany, Italy

Running title: CTS in blue-collar workers and housewives ABSTRACT Objectives: We compared rates of surgically treated CTS among blue-/white-collar workers and housewives in the general population. Methods: We estimated numbers of surgically-treated cases of idiopathic CTS among 25–59-year-old residents of Tuscany, Italy, during 1997–2000 (when out-of-hospital CTS surgery was extremely rare), based on obligatory discharge records from all Italian public/private hospitals, archived according to residence on Tuscany's regional database. Population data were extracted from the 2001 census. Results: After excluding repeat admissions, we identified 8,801 eligible cases. Age-standardized rates (per 100,000 person-years) of surgical CTS were: " blue-collar women " , 367.8; " white-collar women " , 88.1; " housewives " , 334.5; " blue-collar men " , 73.5; " white-collar men " , 15.3. Compared with reference categories (same-sex white-collar workers), women blue-collar workers experienced a 4.2-fold higher standardized rate; housewives, 3.8-fold excess; men blue-collar workers, 4.8-fold excess (all P<0.001). Men and women blue-collar workers showed about 3-to 7-fold higher age-specific rates with respect to white-collar counterparts (all P<0.001). Housewives' rates appeared superimposable with those of blue-collar women workers up to 40–44 years of age, after which they were significantly lower (P<0.002). At all ages, housewives' rates were much higher (P<0.001) than those of white-collar women. Conclusions: Surgically-treated CTS appeared 3 to 7 times more common (depending on age/gender) in blue-collar than in white-collar workers—magnitudes difficult to attribute only to differences in body weight or other individual factors. Thus, occupational risk factors seem relevant throughout working life. The high rates recorded for full-time housewives suggest that domestic chores deserve more investigation as a possible risk factor for CTS. 3 MAIN MESSAGES In both women and men, manual work-related risk factors for surgical treatment of idiopathic CTS appear to be relevant throughout working life. As an occupational category, full-time housewives seem to have a raised risk of surgically treated CTS, possibly related to domestic work. POLICY IMPLICATIONS In aetiological studies of CTS, attention should be paid to domestic chores as a potentially relevant risk factor. INTRODUCTION Carpal tunnel syndrome (CTS) is a socially relevant disabling condition [1, 2] which accounts for many years of productivity loss.[3] Biomechanical overload associated with repetitive, forceful manual work is a major risk factor for CTS.[4] CTS affects women more frequently than men, with a peak incidence occurring at perimenopausal age (in contrast to a more gradual age-related increase in men).[5] Both overweight and biomechanical …