건강근로자효과의 최소화 방안과 보정 방법

Abstract

Healthy worker effect (HWE) refers to the consistent tendency for actively employed individuals to have a more favorable mortality experience than the population at large. Although HWE has been well known since the 1970s, only a few studies in occupational epidemiology have attempted to fully define and evaluate HWE. HWE can be separated into effects on the initial hiring into the workforce (healthy worker hire effect) and those on continuing employment (healthy worker survival effect). In this review, we summarize the methods for minimizingor adjusting for the healthy worker effect available in occupational epidemiology. It is noteworthy that healthy worker survival effect appears complicated, considering that employment status plays simultaneous roles as a counfounding variable and intermediate variable, whereas healthy worker hire effect may be adjusted by incorporating health status at baseline into the statistical model. In addition, two retrospective cohort studies for workers in the semiconductor industry and Vietnam veterans in Korea, respectively, were introduced, and their results were explained in terms of healthy worker effect.