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Open Access

Research

Work disability benefits due to
musculoskeletal disorders among
Brazilian private sector workers
E R Vieira,1 P R Albuquerque-Oliveira,2 A Barbosa-Branco3,4

To cite: Vieira ER,
Albuquerque-Oliveira PR,
Barbosa-Branco A. Work
disability benefits due to
musculoskeletal disorders
among Brazilian private
sector workers. BMJ Open
2011;1:e000003.
doi:10.1136/
bmjopen-2011-000003
< Prepublication history for

this paper is available online.
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visit the journal online (http://
bmjopen.bmj.com).
Received 23 September 2010
Accepted 23 January 2011
This final article is available
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http://bmjopen.bmj.com

1

Department of Physical
Therapy, Florida International
University, Miami, Florida,
USA
2
Ministry of Social Security
and Faculty of Mechanical
Engineering, University of
Brasilia, Brasilia, Brazil
3
Faculty of Health Sciences,
University of Brasilia,
Brasilia, Brazil
4
Institute for Work & Health,
Toronto, Canada
Correspondence to
Dr Edgar Ramos Vieira;
EVieira@fiu.edu

ABSTRACT
Objective: To evaluate the prevalence and
characteristics of disability benefits due to
musculoskeletal disorders (MSD) granted to Brazilian
private sector workers.
Methods: This was a population-based
epidemiological study of MSD-related benefits among
registered private sector workers (n¼32 959 329). The
prevalence (benefits/10 000 workers/year) of work
disability benefits was calculated by gender, age, state,
Human Development Index (HDI), economic activity,
MSD type and work-relatedness.
Results: The prevalence of MSD-related benefits in
Brazil among registered private sector workers in 2008
was 93.6/10 000 workers. The prevalence increased
with age, and was higher for women (112.2) than for
men (88.1), although the former had shorter benefit
duration. The gender-adjusted prevalence by state
varied from 16.6 to 90.3 for non-work-related, and
from 7.8 to 59.6 for work-related benefits. The
Brazilian states with a highevery high HDI had the
highest prevalence. The top four most common types
of MSD-related benefits were due to back pain,
intervertebral disc disorders, sinovitis/tenosynovitis
and shoulder disorders.
Conclusion: MSD is a frequent cause of work
disability in Brazil. There were differences in
prevalence among economic activities and between
states grouped by HDI. This study demonstrates that
further evaluation of the contributing factors
associated with MSD-related disability benefits is
required. Factors that should be considered include
production processes, political organisation,
socioeconomic and educational characteristics, the
compensation and recording systems, and
employeeeemployer power relationships. These
factors may play an important role in the prevalence of
MSD-related disability benefits, especially in countries
with large socioeconomic iniquities such as Brazil.

INTRODUCTION
Musculoskeletal disorders (MSD) affect
muscles, bones, nerves, tendons, ligaments,
joints, cartilage and spinal discs. MSD result
in malfunctioning of the musculoskeletal
system with or without diagnosable injuries1

ARTICLE SUMMARY
Article focus
-

Musculoskeletal disorders (MSD) are a major
cause of disability worldwide.
The prevalence and distribution of MSD among
Brazilian workers are not well known.
This article evaluates the prevalence and characteristics of disability benefits due to MSD granted to
Brazilian private sector workers.

Key messages
-

-

-

The prevalence of MSD-related benefits among
registered Brazilian private sector workers in
2008 was 93.6/10 000 workers, with the top four
most common benefits being due to back pain,
intervertebral disc disorders, sinovitis/tenosynovitis and shoulder disorders.
This study demonstrates that further evaluation
of the contributing factors associated with MSDrelated disability benefits is required and should
assess the production
processes, political
organisation, socioeconomic and educational
characteristics, the compensation and recording
systems, and employeeeemployer power relationships.
These factors may play an important role in the
prevalence of MSD-related disability benefits,
especially in countries with large socioeconomic
iniquities such as Brazil.

and are a major cause of disability and time
off work. For example, >600 000 American
workers (of a total workforce of approximately 140 million) spend time off work due
to MSD each year.2 In 2004, MSD accounted
for >57 million healthcare visits in the USA
(60% of all injury-related visits). Back pain
alone accounted for >53 million healthcare
visits, 313.5 million bed-days and 186.7
million days off work.3 Similarly, MSD are
one of the most common occupational
health issues in Brazil.4e6 In 2002, the
Brazilian National Social Security Institute
recorded 105 514 cases of MSD among
Brazilian workers insured for work-related
disability (n¼22 903 311). However, the
prevalence and distribution of MSD among

Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. BMJ Open 2011;1:e000003. doi:10.1136/bmjopen-2011-000003

1

retirement age. and employers at least 12%. Study population The economically active Brazilian population in 2008 was estimated to be 99 500 202. Workers cannot be dismissed while in receipt of disability benefit.70) or underdeveloped (low HDI 0. BMJ Open 2011. In addition. of workers’ salaries to the National Insurer (NI) of the Ministry of Social Insurance. Barbosa-Branco A. the worker submits a claim to the NI. After 15 days of sickness absence. It has been estimated that in Sao Paulo city alone approximately 310 000 workers had MSD in 2001. diagnosis (International Classification of Diseases. Data sources The information used was obtained from two databases: (1) the Unique Benefit System of the National Social Security Institute.40e0. very low HDI <0. This database Vieira ER. Brazil accounts for approximately 65% of Central and South American trade.1136/bmjopen-2011-000003 .7 A cross-sectional study found that 56% of the Brazilian bank workers evaluated had MSD symptoms affecting the upper limbs.70e0. age and category of benefit (work-related or nonwork-related). gender. Brazilian workers are not as well described. In case of work-related disability. Claims filed for the same diagnosis within 60 days of return to work were considered a continuation of the previous claim. The first database includes all benefits granted and paid by the NI and contains information on age. and demonstrate the importance of determining whether or not workers’ disability is work related. Most Brazilian studies on MSD are limited to specific disorders/symptoms or occupations.1:e000003. Prevalence was adjusted by gender. all employees must be insured for work-related disability. we also grouped and compared the prevalence of MSD-related benefits among states according to their Human Development Index (HDI). Approximately 40% of the economically active population was insured by the NI (n¼39 652 510).Downloaded from bmjopen. Case definition Cases were defined as new MSD-related benefits granted by the NI from 1 January to 31 December 2008. benefit cost and geographical location of employment.8 Other cross-sectional studies found that 39% of Brazilian pottery workers and 71% of Brazilian hairdressers had MSD.9 10 These data demonstrate that MSD are significant problem among Brazilian workers even though their prevalence among the larger working population is not clearly established. economic activity. Another limitation is that this study depends on the quality of the data recorded by the National Insurer (NI) of the Brazilian Ministry of Social Insurance.55e0. 2011 .com on October 4. 10th revision (ICD-10) codes). The HDI is based on data on life expectancy. states and cities as developed (very high HDI >0. the objectives of this study were to evaluate and present data on the prevalence and characteristics of MSD-related benefits among private sector workers in Brazil. METHODS Brazilian policies on work absences due to health issues Registered private sector employees contribute at least 8%.Published by group. The NI contribution covers a wide range of 2 benefits. increasing awareness. and designing and evaluating prevention programs. and (2) the National Cadastre of Social Information. developing (medium HDI 0. Each worker received only one benefit regardless of the number of jobs he/she had. information presented by the employer or employee. because the socioeconomic development of the different Brazilian states varies greatly. and patient/ MSD history. The data may be used for future comparisons and to evaluate the effectiveness of prevention programs. high HDI 0. this additional NI insurance premium is paid by employers. For the first 15 days of leave.15 duration.11 Knowledge of the current MSD prevalence and distribution in Brazil is important for establishing the magnitude of the problem. the NI pays the benefits. Thus. including maternity leave. The study protocol was approved by the institutional research ethics board.bmj. category of benefit (work-related or non-workrelated). the worker cannot be dismissed for at least 1 year after return to work. One of the limitations is that it only includes data from registered workers although there are many non-registered workers in Brazil. benefits are paid by the employer regardless of work relatedness. This initial descriptive study provides some baseline data on the magnitude of the problem.com Work disability due to musculoskeletal disorders ARTICLE SUMMARY Strengths and limitations of this study - All employed workers with a registered job in the private sector were analysed (32 959 329 workers). all employed workers with a registered job in the private sector were analysed.or non-workrelated based on epidemiological evidence. Albuquerque-Oliveira PR. education and per capita gross domestic product. doi:10. resulting in a study population comprising w80% of the NI insured workers (n¼32 959 329). but they may be dismissed upon return to work if they received non-work-related benefits.12 13 The HDI is a composite index that classifies countries.40).85). The physician then classifies the MSD as work.55. In addition.bmj.85. time off work and non-work-related disability.14 Thereafter. The claim is reviewed by an auditor physician who determines if the worker has a work disability or not. These socio-economic and legal factors play a major role in the worker’s decision to claim or not claim benefits. The strength of this paper is that it supplies information which could be useful in the implementation of an occupational health policy to reduce MSD. All absences due to disabilities must be certified by a physician. Therefore. Self-employed workers (w20% of NI insured workers) were not included because reliable information on the denominator (exposed population) was not available.

20 times.80) or mediumelow HDI (<0. and from 7.com Work disability due to musculoskeletal disorders was used to identify the cases (ie. All new jobs generated during the preceding month are recorded. gender. Finally.6 MSDrelated benefits/10 000 workers/year.Downloaded from bmjopen.and category of benefit-adjusted prevalence among the economic activities. The monthly reports include the total number of employees. 50e59 years. The prevalence of MSDrelated benefits was higher for women (112.8 to 59.70. The prevalence increased with age.80). There were differences between prevalence when the states were grouped by HDI. denominator) for our study. category of benefit (work.1136/bmjopen-2011-000003 3 . sinovitis/tenosynovitis and shoulder disorders. In general.12 13 We grouped states as having highevery high HDI (>0. doi:10. The four most common types of MSDrelated benefits were due to back pain. category XIII). 304 933 were MSD-related (ICD10.13 Data analysis The prevalence of MSD-related benefits was calculated and stratified by MSD type (ICD-10). MSD may occur when the musculoskeletal system is used beyond its physiological limits due to cumulative or single event exposures to one or multiple long lasting and/or excessive exertions. benefit category (non-work-related or work-related) and MSD type (ICD-10 classification). contains information on workers in all registered companies.1. beverages manufacturing).and non-work-related were calculated. and 60+ years. The denominator was the total number of registered private sector workers. 4 times. and w700 classes with four. 8 times. European NACE and United Nation’s ISIC.to five-digit codes. The differences between the highest and lowest prevalence of MSD-related benefits by age group were: <20 years. There were also differences in gender-adjusted. Albuquerque-Oliveira PR.6 for workrelated benefits. 20e29. 30e39. The overall PR was 1.com on October 4.3.15 The SIC-2007 is divided into 21 (A to U) sections (eg. 50e59 or $60 years of age) and state of employment. The PR for non-work-related to work-related MSD benefits was 2.1). we compared the prevalence of MSD-related benefits among the states according to their HDI. and non-work related benefits were more frequent. and was higher for women (112) than for men (88). Most benefits paid were due to back problems (45%). The most common types of MSD-related benefits were due to back pain. 2011 . The duration of the benefits increased with age. with sewage workers having the highest prevalence of benefits. the numerator) for prevalence calculations. DISCUSSION The prevalence of MSD-related benefits/10 000 registered Brazilian private sector workers in 2008 was 94.70). The prevalence was higher among females than among males. the Brazilian Social Security Institute granted 1 384 242 disability benefits to registered private sector workers. Barbosa-Branco A. and from 8 to 60 for work-related benefits. as well as new hires and layoffs. regardless of the benefit category and MSD type.2) than for men (88.17 Vieira ER. Table 4 shows the prevalence of MSD-related benefits for the most frequent types of MSD by gender and benefit category. Economic activities were classified according to the SIC-2007. BMJ Open 2011. The numerator was all MSD-related benefits paid by the NI during the study period. Among these. The prevalence figures were presented as benefits/10 000 workers/year. Table 1 presents the distribution and characteristics of MSD-related benefits by age group. 5 times. Most benefits were paid to 30e49-year-old workers (59%). age group (<20. We calculated the annual number of workers using the 2008 monthly average. women had more benefits. were calculated for comparison with economic activities using the total population as reference. followed by programming/ broadcasting activities and wood/products manufacturing (except furniture). age.bmj. The prevalences of MSD-related benefits that were work. resulting in a prevalence of 93. RESULTS In 2008. The genderadjusted prevalence by state varied from 17 to 90 for non-work-related. all of which are consistent in terminology. 30e39 years. meaning that women received 30% more MSD-related benefits than men. but the former had a shorter duration of benefit. standardised by gender and age.Published by group. economic activity (SIC-2007). manufacturing). The Brazilian SIC-2007 follows the UK.or non-workrelated).bmj. the HDI score of the different states was obtained from the Brazilian chapter of the United Nations Development Program. 20e29 years.1:e000003. The second database. Table 3 shows the prevalence and prevalence ratios for the 22 economic activities with the highest prevalence of MSD-related benefits. 88 divisions (eg. The demands of the work tasks within the industries are likely related to MSD among registered Brazilian private sector workers. mediumehigh HDI (>0. intervertebral disc disorders. and gender-.3 for nonwork-related benefits. Gender-adjusted prevalence by state varied from 16. 40e49 years. the National Cadastre of Social Information. payroll and other information. although the former had shorter benefit duration. Prevalence ratios (PR) were calculated by dividing the prevalence among females by the prevalence among males. Table 2 shows that there was a large variation in the prevalence of MSD-related benefits between Brazilian states and between age groups. 6 times. and the prevalence of nonwork-related benefits by the prevalence of work-related benefits. 40e49. gender (male or female). sinovitis/tenosynovitis and shoulder disorders. 4 times.12 States with highevery high HDI had the highest prevalence of MSD-related benefits. In addition. The prevalences of MSD-related benefits. <0.16 This database provided the total number of workers (ie.6 to 90. intervertebral disc disorders.

20 21 Sewage workers had 7.22 Working in small. MSD are multifactorial in nature. those affecting muscles and tendons) had the shortest duration. shift work and fatigue. these workers are exposed to several established biomechanical and psychosocial risks including highly repetitive precision tasks.19 Systemic connective tissue disorders (eg. Soft tissue disorders (eg.com Work disability due to musculoskeletal disorders Table 1 Frequency.1:e000003.10 137 350 95 973 3541 42 38 34 64 60 79 1587. Lund found that municipal workers from Sweden and Denmark contributed disproportionally to disability absence longer than 7 days.25 The factors affecting disability benefits for programming and broadcasting workers may be different.Downloaded from bmjopen.58 1199.27 Other factors Vieira ER.83 2061.87 695.1 17 26 In one study.00 463.11 690. however.31 1784.15 64 059 1576 40 35 68 81 1718.52 170 849 134 084 40 40 66 61 1909. In addition. and home and parenthood activities.17 722.54 1881. confined spaces and the heavy workload of sewage industry employees may contribute to the higher prevalence of MSD-related benefits among these workers than among most other economic activities. Albuquerque-Oliveira PR. in addition to biomechanical factors act together to precipitate these disorders.25 1480.9 times. Other studies also found higher prevalence of MSD among women.bmj. equipment.13 205 772 99161 41 39 64 62 1601.com on October 4.57 612.18 The higher prevalence of MSD among women may be related to differences in work characteristics.23 24 Despite the fact that sewage workers are employed under the same regulations as the private sector.56 1246.01 678. No studies on the risks affecting this economic activity were found.93 1852. BMJ Open 2011.94 579. median age.17 Women received more MSD-related benefits than men. International Classification of Diseases. 2011 .16 718.4 times more MSD-related benefits than the general population of registered Brazilian private sector workers. temporal pressure and stress. musculoskeletal disorders. doi:10.36 852. but these benefits were of shorter duration.14 579. maximisation of minor mistakes. computer work. as employees of mixed public/private companies they enjoy higher job security than private sector employees. and workers involved in the manufacture of wood and wood products had 3. sewage workers had 9. cost of benefits and income replacement for Brazilian private sector workers receiving MSD-related benefits in 2008 Characteristic Age group (years) <20 20e29 30e39 40e49 50e59 $60 Gender Male Female Benefit category Non-work-related Work-related MSD type (ICD-10) Arthropathies Systemic connective tissue disorders Dorsopathies Soft tissue disorders Osteopathies/ chondropathies Other MSD and connective tissue disorders Median age Median no. morphology and psychosocial characteristics.47 722. 10th revision. MSD.49 684.19 728.48 827.63 768. This difference in duration is due to the fact that systemic connective tissues disorders take longer to heal than more localised muscle and/or tendon injuries.82 1531.1 times higher prevalence than the total population. Barbosa-Branco A. duration. being municipal employees and having low socioeconomic status could also have contributed to the high prevalence of MSD found among sewage workers.24 1082. These six activities employ predominantly male workers. Men had a higher prevalence of MSD-related benefits than women in only six of the top 22 economic activities.bmj. For work-related benefits. those affecting the skin and blood vessels) had longer duration. However. Job characteristics and occupational ergo4 nomic stressors are important aetiological factors for MSD of the lower back and upper extremities. work environment and workstation design.Published by group.5 times.17 725.42 2434 34 64 1588. awkward postures. of days off work Median benefit cost (R$) Median income replacement (R$) 1653 56 951 87 890 93 296 56 423 8720 19 26 35 44 53 62 46 53 62 67 71 76 743. and programming and broadcasting workers had 2. gender and level of worker participation. of claims ICD-10.75 1778. independent of gender and benefit category. it was found that Brazilian systems analysts’ mental and physical health were affected by working conditions including workload.1136/bmjopen-2011-000003 .05 No. genetics.

8 132. However.1136/bmjopen-2011-000003 5 .Published by group.7 68.3 134.7 88.9 53.8 51.4 97.9 35.1 88. over time. age and category of benefit (g/a/cb) Age group (years) HDI classification: index State: index <20 20e29 30e39 40e49 50e59 ‡60 Crude g/a/cb Adj Mediumelow: 0.2 113. only workers who are genetically and/or physically less prone to develop MSD remain in their jobs.2% of the working population. 2011 .3 4.1 32.74 Ceara´: 0. adjusted.4 45.7 148.8 3. Barbosa-Branco A.8 227.1 1. The lower prevalence for the 60+ age group versus the 50e59 age group may be related to the fact that female workers are eligible to retire at 60 and male workers at 65.com on October 4.8 148.8 46.1 69.6 75.4 50. men represent 67.5 68.6 104.6 30.5 2.9 2.28 However.1 62.17 Also.9 109.9 71.9 212.4 40.4 67.0 165.1 76.72 Piauı´: 0.83 Brazil: 0.5 85.7 42.8 67.9 51.3 260.1 16.6 133.5 67.4 97.0 72.3% of the workforce.9 20.0 155.5 80.75 Acre: 0.1 144.68 Alagoas: 0.2 127.8 200.0 90.3 16.6 29.7 17.5 10.4 40.5 63.7 167.1 177.3 78.0 162.72 Pernambuco: 0. with young workers (<20 years old) having the highest variation.0 18.75 Mato Grosso: 0.5 132.7 180.7 84.3 5.5 105.4 137.1 70.8 318. HDI.5 87.1 110.3 68. MSD.1 53. for the 50e59 age group.6 89. more and more workers develop MSD due to the cumulative effects of prolonged exposure to the risk factors for MSD.5 52.71 Highevery high: 0. their easier access to healthcare due to their higher wages.3 161.0 17. and may be related to slower healing and changes in the characteristics of collagen and elastin with age. men represent 76. and possibly their increased ability to claim disability because of their educational level and workereemployer relationships.5 119.5 73.1 25.0 53.5 89.80 Rio Grande do Sul: 0.2 89.9 148.1:e000003.3 37.5 1.0 154.2 52. reaching the eligible retirement age does not mean that workers actually retire.Downloaded from bmjopen.87 Santa Catarina: 0.0 105.7 24.8 59.1 27.3 152. Thus.8 204.4 12.78 Bahia: 0.5 62.83 Rio de Janeiro: 0.1 42.3 94.7 120. BMJ Open 2011.0 64.9 88.6 82.2 285.4 120.1 61.3 10.3 176.1 75.7 1. For example.3 76.3 99. The decreased income upon retirement and the increased life expectancy lead workers to remain in the workforce after reaching retirement age.0 107.3 65.5 147.7 66.76 Para´: 0.8 219.1 195.0 26.74 Sergipe: 0. as was reported in previous studies and reviews.2 172. In addition.9 5.7 30.4 93.com Work disability due to musculoskeletal disorders Table 2 Prevalence of MSD-related benefits/10 000 registered Brazilian private sector workers in 2008.83 Minas Gerais: 0.1 46.0 147.3 196.79 Amapa´: 0.9 106.0 83.3 91.3 0.75 Rio Grande do Norte: 0.82 Mato Grosso do Sul: 0.3 35.4 119.9 253.3 112.3 7. In most Brazilian states.1 34.9 210.0 130.5 84.2 97.7 121.4 53.3 36.3 108.2 107.6 32.2 173.7 99.3 136.8 9.8 50.29 30 Some states had up to 60% higher gender-adjusted.7 8.6 253.6 95. the duration of the benefits increased with age.1 201.2 47.4 121. This may be explained by the healthy worker effect.5 111.78 Amazonas: 0.7 147.0 53.4 8.4 261.2 45.7 17.7 47.3 170.0 151.2 144. the differences between states may be related to differences in economic activity and job categories.84 Sa˜o Paulo: 0.3 59.78 Roraima: 0.2 0.5 37.0 156.5 65.1 236.5 182.5 186.8 11. musculoskeletal disorders.9 54. and up to 70% higher age-adjusted MSD-related benefits Vieira ER.8 83.3 84.1 97.80 Goia´s: 0.3 117.75 4.8 93.bmj.3 112.8 42. the prevalence of MSD-related benefits increased with age up to the 50e59 age group and then decreased for the 60+ age group.9 115.9 29.8 8.7 59.4 36.8 37.0 10.68 Mediumehigh: 0. This is further illustrated by the fact that in six states the prevalence of MSD-related benefits continued to increase in the 60+ age group. likely associated with the high prevalence of MSD-related benefits among programming and broadcasting workers are their higher level of education in comparison to most other occupational groups evaluated.9 40.1 101.72 Rondoˆnia: 0.6 69.76 Paraı´ba: 0.6 155.1 11.0 175.8 241.1 109.2 206.4 68.0 115.0 75.6 66.7 109. while for the 60+ age group.8 61.5 74.8 228.7 139.3 11.8 6.1 54.2 43.6 75. some workers return to the work force soon after retiring.5 57.5 67.2 93.0 150.4 4.bmj.1 41.9 38.6 Adj.0 61.7 168. Albuquerque-Oliveira PR.7 91. doi:10.8 33.8 28.80 Parana´: 0.3 84.7 32.6 99. Also.5 12.1 10.7 29.1 42.68 Maranha˜o: 0. by state and HDI per age group: crude and adjusted prevalence by gender. Human Development Index.0 373.6 102.1 156.4 77.0 154.82 Espı´rito Santo: 0.74 Tocantins: 0. Differences between the state prevalence of MSDrelated benefits were observed for all age groups.2 150.0 156.0 64.80 Distrito Federal: 0.9 76. where exposed individuals who developed MSD may have left employment earlier in their careers.7 91.7 127.4 76.

8 50.9 0.9 1.3 178.0 67.5 112.9 243.1:e000003.2 69.9 1.4 0.5 103.6 2.9 175.4 101 109.8 116.8 382. Albuquerque-Oliveira PR.7 250.8 80.7 50.5 1.4 47.8 139. 145.7 112.5 4.2 2 3.6 301.2 74.8 0.5 Male 1.9 2.4 46.7 30.1 89.6 244.6 111.7 145.0 95.2 30.8 2.2 0.6 72.4 208.0 51.5 139.3 88.2 45.0 45.9 156.4 84.6 84.2 45.0 1.3 161.6 56.0 g/a/cb adj Table 3 Prevalence of MSD-related benefits/10 000 registered Brazilian private sector workers in 2008 per economic activity.7 628.7 0.6 41. MSD.6 0.4 148.4 49.9 68.8 26.9 58.5 111.9 139.6 86.3 143.3 51.4 81.7 95.8 0.4 89.5 0 127.3 72.1 30.3 554.7 1.2 112.3 334. prevalence ratio.8 69.7 93.6 83.8 433 129 The population prevalence was the standard.4 74.0 g/a adj 99.2 47.8 2.5 1.5 177.bmj.0 139.4 68.3 1.2 113. age (a) and cb (g/a/cb) Downloaded from bmjopen.1 1.6 Crude 76.2 20.6 102.5 63.6 36.7 149.3 154.2 119.5 62.9 253.6 253.6 112.1 71. adj.1 85.9 66.7 80.4 39.6 151.5 37.0 112.3 1 1 2.3 43.2 218. gender (g) and category of benefit (cb): crude and adjusted prevalence by g.0 56.9 88.6 81.8 73.9 383.7 147.1 111.8 132.5 242.8 132.6 PR 79.8 77.9 50.6 50.9 1.5 126.0 91.8 2.6 138.1 135.5 146.com Work disability due to musculoskeletal disorders Vieira ER.8 72.4 40.3 120.4 2.3 47.6 233.3 130.4 132.com on October 4.1 37.5 146.5 145.6 228.4 1.6 98.4 2.8 90.4 113.4 96.6 97.1 62.2 96.7 1.4 97.5 131.8 115.9 1.2 1.1 113.3 2 2.6 28.8 30.3 68.6 165. doi:10.9 70.4 137.8 2.9 76 77.5 59 50.5 202.1 611.7 1.1 122.1 131.2 106.9 151.7 93.2 34.5 139.1 57.3 1.1 0.5 1.2 0.9 254.1 50.1 205.3 1.2 0.2 49 38.9 114.9 1.5 124.2 69. 2011 .7 219.1 56. IRR.2 1.0 Crude 24.6 183.7 69.5 171.7 2.1 186.6 138.6 84.7 220.3 104. Barbosa-Branco A.5 210.4 92.6 2 2 2.2 95.7 80.3 Female Both 70.8 59.6 48. musculoskeletal disorders.9 1.1 107.1 1.3 0.8 124.2 94.7 132.8 108.4 44. adjusted. incidence risk ratio.7 105.6 151.6 125.2 0.2 157.1 130.0 161.3 103.1 121.4 67.8 IRR 23.8 1103.1 90.3 104. BMJ Open 2011.Published by group.2 264.5 1.3 59.9 54.9 0.7 1.6 91.8 93.5 70.6 369.7 176.6 198.5 177.0 72.4 69.0 63.6 154 2.6 205.7 140.5 1.7 206.7 213.7 53.1 77.6 169.2 150.0 51.5 31.4 1.3 g/a adj Sewage Programming/broadcasting activities Wood/products manufacturing (not furniture) Other transport equipment manufacturing Building construction Residential care activities Motor vehicles/trailers/semitrailers manufacturing Forestry/logging Coal mining/lignite Food products manufacturing Computer/electronic/optical products manufacturing Furniture manufacturing Postal/courier activities Water transport Coke/refined petroleum products manufacturing Textiles manufacturing Electrical equipment manufacturing Rubber/plastic products manufacturing Land/pipeline transport Beverages manufacturing Crop/animal production/ hunting/related services Others Brazil Crude Work-related PR Female Male Non-work-related Female Economic activity 1.7 141.5 90.6 66.9 164.8 65.5 108.5 176.9 70.6 56.3 49.0 78.6 52.9 132 36.3 129.5 51.1 35.7 160. PR.7 147.4 100.5 92.6 78.6 101.9 198.3 Male 670.8 130.5 80.1 85.0 2.5 154.8 83.2 70.8 87.0 163.3 1.9 0.8 87.5 91.4 134.5 47.3 76.1136/bmjopen-2011-000003 .1 74.bmj.5 1.2 63.6 0.2 132.4 1.6 188.3 60.5 90.8 0 2.5 102.5 53.6 134.9 242.

8 1.1 0.1 0.9 1.6 0.1 9. Men had a higher prevalence of work-related back pain benefits.2 0.5 0.9 0.4 2.8 1. awkward postures.9 0. Another point to consider is that some states have a larger geographical area and greater socioeconomic variability.2 74. and the lowest prevalence was found among the states with mediumehigh HDI.6 5.5 2.2 0.5 7. and more work.9 2.bmj.9 1. However.1136/bmjopen-2011-000003 7 . gender and category of benefit Non-work-related Work-related Both MSD type F M PR Total F M PR Total F M PR Total Back pain (dorsalgia) Intervertebral disc disorders Sinovitis/tenosynovitis Shoulder disorders Knee disorders Other joint disorders Other enthesopathies Knee arthrosis Other soft tissue disorders Other arthrosis Cervical disc disorders Hip arthrosis Other bursopathies Other back problems Patellar disorders Soft tissue disorders Spondylosis Others All MSD 20.9 0.4 1.3 16.1 1.4 1.9 1.2 2.3 11.7 1.com on October 4. International Classification of Diseases. These issues are common to all studies with secondary analysis of previously recorded data. some states have higher industrial concentration in and around their capital cities.7 0.1 1.1 1.6 0.4 2.7 2.1 0.4 0.5 0.0 3. female gender.4 2. increased weight and co-morbidities. the direction of these potential influences cannot be ascertained.4 3. Another issue to be considered is that the quality of the data including issues related to reporting and recording in different states and the databases in general may have affected the presented results.5 0.5 0.2 0. However.6 8.6 63.9 1.8 0.1 59.8 9.2 3.6 0.3 1.6 2.4 1.4 0.5 2. smoking. M.3 3.2 0.5 2.9 1.9 10.3 0.0 0.7 2.0 2.0 0. distress.0 0. while women had a higher prevalence of non-work-related back pain benefits.3 0.2 2.4 0.2 0.6 1.2 88.5 0.3 0.1 Risk factors for wrist/hand MSD (including sinovitis/tenosynovitis) include heavy physical work.3 12.6 93. The analyses of the states grouped by HDI may indicate under-reporting and consequently lack of access to social security benefits by workers in states with lower HDI.2 0.0 8.9 0. BMJ Open 2011. Risk factors for back pain include heavy physical work.3 1.2 4. In addition. male. repetitive work.1 Complex interactions between work and home activities result in different exposures between men and women. The highest prevalence was found among the states with highevery high HDI.1 4.4 2. female.3 0.7 1.1 1.1 0.2 0.8 3.3 2.5 0.31 Back pain.7 0.5 0.9 2.5 1.7 0. City level HDI comparisons may help to clarify these issues in future studies.4 29.9 1.9 5.1 1. by type of MSD (ICD-10).8 0.1 0.5 5.2 2.3 0.1:e000003.Published by group.0 8. intervertebral disc disorders.6 9.1 0.1 1.0 0.2 0.4 0.3 27.2 0. These differences may help explain our findings.9 0. and more family based small agricultural enterprises in the countryside.1 1.2 3.0 1.3 0. awkward postures.7 5.com Work disability due to musculoskeletal disorders Table 4 Prevalence of MSD-related benefits/10 000 registered Brazilian private sector workers in 2008.9 2.3 1.3 1. musculoskeletal disorders. than the general population of Brazilian workers.bmj.1 9. sinovitis/ tenosynovitis and shoulder disorders were responsible for approximately 64% of all MSD-related benefits.5 1.9 1. such as the migration of industrial enterprises from traditional industrial areas to less developed states because of tax benefits and lower labour costs.0 0.6 0.8 37. 10th revision.1 0.1 28.6 2. Back pain-related benefits were the most common for both genders and categories of benefit.5 0.Downloaded from bmjopen. smoking.1 0. Barbosa-Branco A.1 1. This is an interesting finding indicating higher prevalence among the most productive and populous areas and is supported by the facts that productivity and gross domestic product (which is part of the HDI calculation) are closely related. prolonged computer work.2 1.4 3. possibly resulting in an unrepresentative mean HDI for these states.1 2. race.9 2.5 7.5 1.5 0. Despite significant economic advances during the last decade.1 1.7 8.6 0.4 1.8 3.1 0.2 0. 57% of all non-work-related benefits and 80% of all workrelated benefits.3 0. The reasons for and implications of these findings need to be further explored and are likely related to socio-politicoeconomical issues found in Brazil and other developing countries.5 9.6 0.1 1.5 2.5 7.1 0.7 6.7 0.2 1.5 0.6 0.8 1.9 2.1 1.1 0.8 12.5 1.9 3.9 2.6 F.8 1.2 0.1 1.2 3.9 0.and non-work-related sinovitis/tenosynovitis benefits.9 0.7 0.4 20. lifting.2 0.7 0.2 0.1 112.4 0.7 1.9 30.9 0. increased weight and co-morbidities. older age.5 3. MSD. but is likely also related to under-reporting in less developed environments with fewer jobs available.4 1.2 0.0 8.1 10.9 11.5 1. female gender.1 0.2 3. This finding may be related to the more repetitive nature of tasks in more industrialised environments.3 0.1 0.9 15.0 0.7 1.1 0. Albuquerque-Oliveira PR.9 1.0 4.9 10.1 0.1 1.2 0.0 2.9 11. and that 78% of registered Brazilian private sector workers live in states with highevery high HDI.7 2.6 0.7 3.5 0.0 1.5 0. ICD-10.6 10.2 28. doi:10. other factors should be considered.4 1. younger age.3 2.6 8.0 6. Brazil still lacks efficient occupational health Vieira ER.8 6.0 15. 2011 .5 9.1 1.2 0. negative affectivity.9 3. low level of job control. high psychological demands and work dissatisfaction.

Data Sources: National Confederation for Industries. Lacerda EM. National Center for Health Statistics. and mental health among systems analysts in Sa˜o Paulo. et al. Wijnhoven HA. Wolfhagen C. human development and decent work: the recent Brazilian experience. 3.com Work disability due to musculoskeletal disorders and safety surveillance systems and effective prevention programs. Women. United Electrical Radio and Machine Workers of America. 16. The Human Development Index (HDI). Picavet HS. Brazil. Martikainen P.5:107. CESAT / SUS Bahia. 7. Bammer G. Understanding the scale and distribution of MSD among Brazilian workers is a first step towards more effective data recording and better design of prevention programs. Strazdins L. Maeland JG. Berzoini R.30 This initial descriptive study will help to establish baseline data on the magnitude of the problem. MSD Affects 310. 26. Maricq HR.ba. Consent was not obtained but the data are anonymised. United Nations Development Programme.bmj. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate.undp. no. Augusto LGS. BMJ Open 2011. et al. Occup Environ Med 2004.zip (accessed 15 Sep 2010). 29. Veja.saude. http://www. Official Press. doi:10. van der Velde G. Agency for Healthcare Research and Quality. 2001. Kumar S. Coˆte´ P. United Nations Development Program. 23.uk/statbase/product. Factors that should be considered include the production processes.seade. 27. http://www. There were differences in the prevalence between economic activities and between the states grouped by HDI. visual fatigue. Eur J Public Health 2008. 31. 4. Acknowledgements The authors would like to thank Daniel Holt for helping to format and edit the paper. and employeeeemployer power relationships. Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies.php? id01¼3039&lay¼pde (accessed 15 Sep 2010). Version 2007. Iguti AM. but they clearly demonstrate the need for such initiatives. repetitive strain injuries (RSI) and ’RSI-like condition’. Economic Commission for Latin America and the Caribbean. Spine (Phil Pa 1976) 2008.pnud. Standard Industrial Classification of Economic Activities.br/pobreza_desigualdade/reportagens/index. Interrelationships between education. MSD is a frequent cause of work disability in Brazil.gov/data/hcup (accessed 15 Sep 2010). 18. 6. http://hdrstats. Franklin G. ahrq. Vaez M. income and sickness absence. Contributors ERV. Clin J Pain 2006.19:343e9.38:707e22. 13.60:244e53. Database of the Statistical Yearbook of Social Security 2003. Ergonomics 2001. Health and Safety: Two Cheers for Half an Ergo Standard 1999. Employment. 2004.14:13e23. Bratberg E. Working conditions. the compensation and recording systems. political organisation. et al. Profile. Hogg-Johnson S.34:1519e25.html (accessed 15 Sep 2010). Na´cul LC. the researchers had no access to the names of the subjects and risk of identification is low. This study demonstrates that further evaluation of the factors associated with MSD-related disability benefits is required. Ethics approval The study protocol was approved by the University of Brasilia research ethics board. 2. 14. 21. 2009:15.20:276e80. 10.gov.9:9.statistics. and Dr Denis Brunt for reviewing the manuscript before submission. socioeconomic and educational characteristics. 17. et al. 2009. Costa H. PRAO and ABB were responsible for the study conception and design and drafting of the manuscript. Situation of Workers’ Health in Brazil and in Bahiadthe Epidemiologic 25. Juca´ R. Gouveia N. Franklin G. Cassidy JD.org/h&s1299. Washington. 22. Am J Med 1982. PRAO and ABB performed the data analysis.xls (accessed 15 Sep 2010). http://www. 9. 28. Musculoskeletal impairments in the Norwegian working population: the prognostic role of diagnoses and socioeconomic status. Veja. 11. Brazilian Centre for Studies and Analysis in Occupational Health. Basic Text of the National Policy on Occupational Health and safety. Early prognostic factors for duration on temporary total benefits in the first year among workers with compensated occupational soft tissue injuries. Barbosa-Branco A. National Institute of Musculoskeletal Disorders Prevention.1136/bmjopen-2011-000003 . Prevalence of musculoskeletal disorders is systematically higher in women than in men. Nationwide Inpatient Sample. 4239-09-1). J Electromyogr Kinesiol 2004.000 Workers in Sa˜o Paulo. Theories of musculoskeletal injury causation. 20. Provenance and peer review Not commissioned.br/ cesat/Informacoes/SituacaoST_2007. PRAO and ABB made critical revisions to the paper and approved the final manuscript. Christensen KB. DC: National Academy Press. http://www. Brazilian Ministry of Social Welfare. Harper FE.br/imprimir. et al.gov. Rocha LE.br/produtos/ anuario/2003/tudo_2003. ABB obtained funding.mps. The burden and determinants of neck pain in workers: results of the bone and joint decade 2000e2010: task force on neck pain and its associated disorders. A prospective study of raynaud phenomenon and early connective tissue disease: a fiveyear report. Turk DC. Spine (Phil Pa 1976) 2009. These factors may play an important role in the prevalence of MSD-related disability benefits. Social Security Statistical Bulletin.Published by group. 15.pdf (accessed 15 Sep 2010). ERV. Musculoskeletal Disorders and the Workplace: Low Back Pain and Upper Extremities. Cad Sau´de Pu´blica 2010. Eur J Public Health 2010.22:717e24. Laaksonen M. de Vet HC.com. 2005:85. http://www. 2002:96e7.61:24e32. Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study. Albuquerque-Oliveira PR.org/en/indicators/49806. Weekly Magazine. A cross sectional study of bank workers in Northeast Brazil. REFERENCES 1. and National Ambulatory Medical Care Survey. http://www. 2001. Institute of Medicine. International Labour Organization. Competing interests None. occupational class. Melzer AC. Brazil has done More with Less. Brasilia: 2008. Brazilian Ministry of Social Welfare. 19. 24. Occup Med (Lond) 2008.php?id¼39 (accessed 15 Sep 2010). 2011 . Our findings may not be detailed enough to promote specific prevention programs. Wegman DH. 30.1:e000003. Brazil.58:997e1005. National Hospital Ambulatory Medical Care Survey. Brazilian Ministry of Social Welfare. PAGE fraction trail=8 Vieira ER. Healthcare Cost and Utilization Project.33(4 Suppl):S60e74.44:17e47.gov.html (accessed 15 Sep 2010).84:190e6. 12. ranknfile-ue. ERV. work and musculoskeletal health. http://www. PRAO and ABB performed the data collection. Turner RE.58:367e9. 8 da Costa BR.72:883e8. Debert-Ribeiro M. Working conditions and musculoskeletal pain among Brazilian pottery workers.Downloaded from bmjopen.gov. Mussi G. 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