Prevalence and Patterns of Multi-Site Musculoskeletal Disorders Among Occupational Populations in Key Chinese Industries — China, 2018–2023

Fengqiong Chen^1,&, Junyan Lei^2,&, Yiwei Song³, Ning Jia³, Zhongxu Wang³, Meibian Zhang³, Qing Xu³, Mimi Yang³, Xinwei Guo³, Huadong Zhang^1,#, Xin Sun^3,#

1. Chongqing Center for Disease Control and Prevention (Chongqing Academy of Preventive Medicine), Chongqing, China;

2. Fuling District Center for Disease Control and Prevention, Chongqing, China;

3. National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China.

^& Joint first authors.

^# Corresponding authors: Huadong Zhang, cdczhanghuadong@163.com; Xin Sun, sunxin@niohp.chinacdc.cn.

This study investigated the prevalence, patterns, and risk factors of multi-site work-related musculoskeletal disorders (WMSDs) among workers across 29 key industries in China. A total of 88,609 workers from 441 enterprises were surveyed using stratified cluster sampling during 2018–2023. Symptoms were assessed using the Chinese Musculoskeletal Disorders Questionnaire, and WMSDs were classified as single-site, dual-site, triple-site, and over-3-site; cross-classified multilevel generalized linear mixed models were employed to identify associated factors. The prevalence of multi-site WMSDs was 26.4%, exceeding that of single-site disorders (11.3%), and multi-site cases comprised 69.9% of all WMSDs. Packaging and printing (28.0%), healthcare (20.5%), and nonferrous metal smelting (20.5%) exhibited the highest prevalence of multi-site WMSDs. Female sex was an independent risk factor for all WMSD types. Higher education levels correlated with increased risk, with a master's degree or above showing the strongest association with triple-site WMSDs. Prolonged standing, sitting, and fixed postures demonstrated dose–response relationships with WMSD severity, and insufficient rest was associated with the highest risk of multi-site WMSDs. Multi-site WMSDs represented the predominant pattern among Chinese workers, and prevention strategies should prioritize high-risk industries and target modifiable factors, particularly insufficient rest and prolonged static postures.

重点行业职业人群多部位肌肉骨骼疾患患病率及患病特征分析 — 中国，2018–2023

陈凤琼^1,&, 雷钧艳^2,&, 宋奕玮³, 贾宁³, 王忠旭³, 张美辨³, 徐擎³, 杨咪咪³, 郭新苇³, 张华东^1,#, 孙新^3,#

1. 重庆市疾病预防控制中心（重庆市预防医学科学院），重庆，中国；

2. 重庆市涪陵区疾病预防控制中心，重庆，中国；

3. 职业卫生与中毒控制所，中国疾病预防控制中心（中国预防医学科学院）北京，中国。

^& 共同第一作者。

^# 通信作者：张华东，cdczhanghuadong@163.com；孙新，sunxin@niohp.chinacdc.cn。

该研究调查我国重点行业职业人群多部位工作相关肌肉骨骼疾患 （work-related musculoskeletal disorders, WMSDs）的患病率、分布特征及危险因素。2018—2023年采用分层整群抽样，对全国29个行业441家企业88,609名从业人员开展问卷调查，以中文版肌肉骨骼疾患调查表进行症状评估，将WMSDs分为单、双、三及>3部位，运用交叉分类多水平广义线性混合模型（cross-classified multilevel generalized linear mixed models, CCMM）分析影响因素。结果显示，多部位WMSDs患病率为26.4%，高于单部位（11.3%），占全部WMSDs病例的69.9%。包装印刷业（28.0%）、医疗卫生行业（20.5%）及有色金属冶炼业（20.5%）多部位WMSDs患病率位居前列。女性是各类WMSDs的独立危险因素；文化程度与患病风险正相关，硕士及以上学历人群与三部位WMSDs关联最强。长期站立、久坐及固定作业姿势与WMSDs严重程度呈剂量反应关系；休息不足者发生多部位WMSDs风险最高。多部位WMSDs是我国从业人员主要患病类型，防控需聚焦高风险行业，针对休息不足、长期静态作业姿势等可干预因素实施精准防控。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.091

Associations of Occupational Noise Exposure with Hearing-Related Functional Difficulty and Menstrual Abnormalities Among Female Workers — Selected Regions, China, 2024–2025

Peng Zhou^1,&, Wei Li^2,&, Changyan Yu³, Hengdong Zhang¹, Meibian Zhang^3,#, Lei Han^1,#

1. Occupational Disease Monitoring and Evaluation Institute, Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial Academy of Preventive Medicine), Nanjing City, Jiangsu Province, China;

2. Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing City, Jiangsu Province, China;

3. National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China.

^& Joint first authors.

^# Corresponding authors: Meibian Zhang, zhangmb@niohp.chinacdc.cn; Lei Han, hanlei@jscdc.cn.

This study examined the associations among occupational noise exposure, hearing-related functional difficulty, and menstrual abnormalities in female workers, and explored the potential role of noise annoyance. In this cross-sectional survey conducted in selected regions of China during 2024–2025, 3,283 female workers were screened, and 1,538 were included in the final analysis. Multivariate logistic regression and exploratory mediation analyses were conducted with bootstrap resampling. The prevalence rates of menstrual abnormalities and hearing-related functional difficulties were 22.82% and 17.88%, respectively. High occupational noise exposure was associated with higher odds of hearing-related functional difficulty [adjusted odds ratio (aOR)=1.79, 95% confidence interval (CI): 1.30, 2.46] and menstrual abnormalities (aOR=2.70, 95% CI: 1.96, 3.73). Sensitivity analyses for menstrual abnormalities yielded consistent results. In the exploratory mediation analyses, the indirect effect estimates were modest for hearing-related outcomes and not statistically significant for menstrual abnormalities. High occupational noise exposure is associated with higher odds of hearing-related functional difficulties and menstrual abnormalities in female workers. Noise annoyance may represent a potential explanatory pathway for hearing-related outcomes; however, the mediation findings should be interpreted cautiously.

职业噪声暴露与女性工人听力相关功能困难及月经异常的关联——中国部分地区，2024—2025年

周鹏^1,&, 李威^2,&, 于常艳³, 张恒东¹, 张美辨^3,#, 韩磊^1,#

1. 职业病监测与评价所，江苏省疾病预防控制中心（江苏省预防医学科学院），南京市，江苏省，中国；

2. 东南大学公共卫生学院，教育部环境医学工程重点实验室，南京市，江苏省，中国；

3. 职业卫生与中毒控制所，中国疾病预防控制中心（中国预防医学科学院），北京，中国。

^& 共同第一作者。

^# 通信作者：张美辨，zhangmb@niohp.chinacdc.cn；韩磊，hanlei@jscdc.cn。

该研究探讨女性工人职业噪声暴露与听力相关功能困难及月经异常的关联，并探索噪声烦恼的潜在作用。2024—2025年在中国部分地区采用横断面调查设计，共筛查3,283名女性工人，最终纳入1,538名。采用多因素logistic回归估计关联强度，并通过Bootstrap重复抽样进行探索性中介分析评估噪声烦恼的间接效应。月经异常与听力相关功能困难的患病率分别为22.82%和17.88%。与低噪声暴露相比，高噪声暴露与听力相关功能困难风险升高相关 [调整比值比 （aOR）=1.79，95% 置信区间 （CI）：1.30, 2.46]，亦与月经异常风险升高相关（aOR=2.70，95% CI：1.96, 3.73）；对月经异常的敏感性分析结果一致。探索性中介分析显示，噪声烦恼对听力相关结局的间接效应幅度较小，而对月经异常的中介效应未达统计学显著。高职业噪声暴露与女性工人听力相关功能困难和月经异常风险升高相关。噪声烦恼可能为听力相关结局的潜在解释路径，但中介结果需谨慎解读。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.093

Propensity Score Matching Analysis on Interaction Between Noise Exposure and Gestational Hypertension for Preterm Birth Among Female Workers — 4 PLADs, China, 2024−2025

Aihua Li¹, Meibian Zhang^2,#, Changyan Yu², Zhiqiang Cao³, Wenju Yuan⁴, Zhi Wang⁴, Haijiang Feng¹, Jinzhe Li¹, Hongyan Yang¹, Yan Ye^1,#

1. Institute for Occupational Health, Beijing Center for Disease Prevention and Control, Beijing, China;

2. National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China;

3. Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China;

4. Department of Occupational and Radiation Health, Pinggu District Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Meibian Zhang, zhangmb@niohp.chinacdc.cn; Yan Ye, bjzws@bjcdc.org.

Preterm birth (PTB) remains a major public health concern. Noise exposure and gestational hypertension (GH) are recognized risk factors for PTB; however, few studies have examined their independent and combined effects on PTB among female workers. A cross-sectional survey was conducted among female manufacturing and mining workers in Gansu, Chongqing, Hebei, and Beijing during 2024−2025. Propensity score matching (PSM) at a 1:1 ratio balanced baseline characteristics between noise-exposed and non-exposed groups, yielding 7,886 matched participants (3,943 per group). Univariate logistic regression estimated the independent associations of noise exposure and GH with PTB, while multivariate logistic regression assessed their additive interaction, quantified by relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). After PSM, the overall PTB prevalence was 9.3%. Occupational noise [odds ratio (OR)=2.26, 95% confidence interval (CI): 1.93, 2.66] and GH (OR=1.83, 95% CI: 1.24, 2.68) independently elevated PTB risk. A significant positive additive interaction was detected, with the highest risk in the co-exposed group (adjusted OR=4.06, 95% CI: 2.14, 7.70; RERI=1.11, AP=27.34%, S=1.57). Occupational noise exposure and GH are independent risk factors for PTB among female workers, with a synergistic additive effect when co-present. Integrated interventions targeting both exposures may help reduce the PTB burden in this population.

基于倾向性评分匹配分析噪声暴露与妊娠期高血压对女工早产的交互作用 — 4省份，中国，2024−2025

李爱华¹, 张美辨^2,#, 于常艳², 曹志强³, 袁文菊⁴, 王智⁴, 冯海江¹, 李金哲¹, 杨红艳¹, 叶研^1,#

1. 职业卫生所，北京市疾病预防控制中心，北京，中国；

2. 职业卫生与中毒控制所，中国疾病预防控制中心（中国预防医学科学院），北京，中国；

3. 免疫预防所，北京市疾病预防控制中心，北京，中国；

4. 职业与放射卫生科，北京市平谷区疾病预防控制中心，北京，中国。

^# 通信作者：张美辨，zhangmb@niohp.chinacdc.cn；叶研，bjzws@bjcdc.org。

该研究于甘肃、重庆、河北和北京地区的女性制造业和采矿业工人中开展横断面调查，探索噪声暴露和妊娠期高血压（gestational hypertension, GH）对女性工人早产的独立及联合作用。采用1:1倾向得分匹配（propensity score matching, PSM）平衡噪声暴露组与非暴露组的基线特征，最终获得7,886名研究对象（每组3,943名）。以单因素logistic回归分析两者与早产的独立关联，多因素logistic回归结合相对超额风险（relative excess risk due to interaction, RERI）、归因百分比（attributable proportion, AP）、协同指数（synergy index, S）量化其相加交互作用。PSM后，早产总体患病率为9.3%，职业噪声 [比值比 （OR）=2.26，95%置信区间 （CI）：1.93, 2.66]和GH（OR=1.83，95% CI：1.24, 2.68）均独立增加早产风险，两者存在显著正相加交互作用，共暴露组风险最高（调整后OR=4.06，95% CI：2.14, 7.70；RERI=1.11，AP=27.34%，S=1.57）。职业噪声暴露和妊娠期高血压是女性工人早产的独立危险因素，共同暴露时具有协同相加作用，综合干预两者可降低该人群早产负担。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.094

Online Pairwise Comparisons Survey on Disability Weights for Chronic Cadmium Poisoning — Shenyang City, Liaoning Province, China, June–August, 2022

He Jiang^1,2,&, Fei Wang^1,3,&, Shuhao Nie^1,&, Qinyue Tan¹, Qihao Wang¹, Xing Yang¹, Le Yan¹, Ziqi Guo¹, Kun Song¹, Yuan Gao¹, Lingjun Yan^1,4,5, Haijiao Yu¹, Guowei Pan^1,4,5, Wei Sun^1,4,5,#

1. Universal Health Laboratory, School of Public Health, China Medical University, Shenyang City, Liaoning Province, China;

2. Quality Management and Accreditation Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen City, Guangdong Province, China;

3. Public Health Center, Gumei Community Health Service Center, Minhang District, Shanghai, China;

4. Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education (China Medical University), Shenyang City, Liaoning Province, China;

5. Liaoning Provincial Key Laboratory of Early Warning and Intervention Technology and Countermeasures for Major Public Health Events (China Medical University), Shenyang City, Liaoning Province, China.

^& Joint first authors.

^# Corresponding authors: Wei Sun, wsun@cmu.edu.cn.

Currently, the disease burden of chronic cadmium poisoning remains unquantifiable due to the absence of disability weights (DWs). This study aimed to derive DWs for both mild and severe chronic cadmium poisoning. Adopting the pairwise comparison (PC) method from the Global Burden of Disease (GBD) study, health state descriptions for mild and severe chronic cadmium poisoning were developed, and a severity spectrum of 13 health states was constructed based on GBD 2023. Questionnaires pertaining to demographic information and PC task questionnaires were distributed to the general population (n=552) and medical professionals (n=488). Heatmaps confirmed response consistency. Probit regression and Loess modeling revealed that DWs for mild and severe chronic cadmium poisoning were 0.099 and 0.363, respectively, in the general population, and 0.102 and 0.397, respectively, among medical professionals. Spearman correlation coefficients for DW values with reference studies (GBD 2023 study and a Chinese national study) ranged from 0.64 to 0.95. To our knowledge, this is the first study to successfully establish DW parameters for chronic cadmium poisoning. No significant differences were observed between DWs derived from the general population and those from medical professionals. This study provides a methodological reference for establishing DWs of environmental pollutants to assess their indirect disease burden.

线上配对比较法调查慢性镉中毒的伤残权重研究 — 沈阳市，辽宁省，中国，2022年6月–8月

姜鹤^1,2,&, 王菲^1,3,&, 聂书豪^1,&, 谭沁月¹, 王琦淏¹, 杨星¹, 闫乐¹, 郭子琪¹, 宋坤¹, 高原¹, 闫灵均^1,4,5, 于海娇¹, 潘国伟^1,4,5, 孙炜^1,4,5,#

1. 全民健康研究室，公共卫生学院，中国医科大学，沈阳市，辽宁省，中国；

2. 质量管理与认证科室，香港大学深圳医院，深圳市，广东省，中国；

3. 公共卫生中心，古美社区卫生服务中心，闵行区，上海，中国；

4. 环境应激与慢病防控教育部重点实验室（中国医科大学），沈阳市，辽宁省，中国；

5. 辽宁省重大公共卫生事件预警与干预技术和对策研究重点实验室（中国医科大学），沈阳市，辽宁省，中国。

^& 共同第一作者。

^# 通信作者：孙炜，wsun@cmu.edu.cn。

目前，由于缺乏慢性镉中毒的伤残权重（disability weights, DWs），其造成的间接疾病负担尚无法量化评估。本研究明确了轻度和重度慢性镉中毒的健康状态描述，基于全球疾病负担（Global Burden of Disease, GBD）2023研究构建了包含13种健康状态在内的健康损害严重程度谱，采用GBD研究中的配对比较（pairwise comparison, PC）法，于普通社区人群（n=552）和医疗专业人群（n=488）中开展了在线问卷调查，旨在明确轻度和重度慢性镉中毒的DWs参数。调查问卷涵盖了人口统计学信息及PC问题。热图分析结果表明本研究中PC问题的应答具有良好的内部一致性。经Probit回归和Loess模型计算，于普通社区人群中获得的轻度和重度慢性镉中毒的DWs参数分别为0.099和0.363，于医疗专业人群中获得的参数分别为0.102和0.397。本研究中获得的DWs参数与GBD 2023研究和中国本土化DWs研究中相应参数的斯皮尔曼相关系数在0.64至0.95之间。本研究率先明确了慢性镉中毒的DWs参数，且阐明了两人群获得的DWs参数无显著差异，为明确环境污染物伤残权重进而实现其间接疾病负担评估提供了方法学依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.095