**3. Results**

also highly prevalent in manual‐intensive occupations, and back and lower limb disorders occur disproportionately among truck drivers, warehouse workers, construction trades,

The appropriate term is "work‐related" disorders, as distinguished from specifically " occupational" disorders where a single factor is both, necessary and sufficient, in order to

MSDs have multiple risk factors, both occupational and nonoccupational. In addition to work demands, other aspects of daily life can influence their appearance. Musculoskeletal tissues

Risk varies by age, gender, socioeconomic status and ethnicity. Other suspected risk factors may include obesity, smoking, muscle strength and other aspects of work capacity [1].

MSDs cause a huge socioeconomic burden to patients and their household, society and their country indeed. Yet, their relevance is often minimized, particularly in developing countries

MSDs have been extensively studied in several countries; however, few studies have been car‐

The main objective of this chapter is to describe the relationship between MSDs and ethnicity

A nonsystematic literature review of studies, with both quantitative and qualitative method‐ ology, was conducted. Methodological phases proposed by Greenhalgh et al. [10] were in the

**2.** Search phase: The search was conducted in the databases: MEDLINE, EMBASE, LILACS, SOCIAL SCIENCE INDEX and PSYCOINFO. The key words were as follows: work‐ related musculoskeletal disorders, ethnicity, vulnerable and indigenous populations. A hand search was carried out as well. Studies, in English and Spanish, were included in

**4.** Synthesis phase: Data relevant to the objectives of this study were synthesized using

**5.** Recommendation phase: The paper summarized all the aspects related to its objective,

**1.** Planning phase: It defines the research question for the development of the review.

**3.** Mapping phase: The key words of the selected studies were identified.

and since then, recommendations were developed.

ried out so as to investigate the relationship between MSDs and ethnicity [4–9].

among others. In most cases, it could cause chronic disability [1, 2].

can also be affected by systemic diseases [1, 2].

with fragmented healthcare system and poor nations.

cause the disease [3].

208 Occupational Health

in different parts of the world.

**2. Material and methods**

following (**Figure 1**):

the current search.

interpretive analysis.

Our findings fall into two categories: 1. Summary and analysis of quantitative studies and 2. Synthesis and interpretation of qualitative studies

1. Summary and analysis of quantitative studies (**Table 1**): The literature is mostly of European and American origin. They emphasize that certain population groups, especially immigrants and those belonging to lower socioeconomic status, have more MSDs.

In 1998, Urwin et al. [11] describes that people who live in socially deprived areas in United Kingdom (UK) have more musculoskeletal symptoms. Mergler [12] in Canada prioritizes the combination of qualitative and quantitative methods for this complex problem.



**Author, year [ref] Objectives and** 

210 Occupational Health

Urwin et al, 1998 [11] Estimate the

Mergler, 1999 [12] Identify work

Cole et al., 2001 [13] Describe the

Vindigni et al., 2004

Turner et al., 2004

Ahonen et al., 2007

[14]

[15]

[16]

**method**

frequency of musculoskeletal pain in the adult population. Population survey

conditions that affect human health and well‐being with a view to reducing or preventing MSDs Combining qualitative and quantitative methods

prevalence of MSDs in the Canadian working population The Canadian 1994 national population health survey (NPHS)

Describe the prevalence of MSK disorders in rural indigenous Australians areas A cross‐sectional research

Develop statistical models that accurately predict chronic work disability

This is a population‐ based, prospective

study

Review

workers Review

prevalence and incidence of neck pain and disability in

Côté et al., 2008 [17] Describe the

Summarizes the information on immigrant occupational health available from recent studies, incorporating varied study designs

**Country Group studied Conclusions**

UK Adults Musculoskeletal pain

Canada Adults Combining the results

Canada Adults household

Australia Indigenous members

US, Europe, Canada,

Asia

residents

of the community (Kempsey District, New South Wales)

US Worker interview The combination of

Canada Adult workers Neck pain is endemic in

Immigrant adults The immigrations

is common in the community. People who live in socially deprived areas have more musculoskeletal

allowed us to identify the behaviors and policies that resulted from workplace changes and improved health

Associations between work stressors and MSDs provide evidence for physical and psychosocial factors both affecting disability in a working population

The 57% people have learnt to live with chronic levels of pain affecting multiple anatomical sites

sociodemographic, biomedical, work‐related, administrative/legal and psychosocial risk factors for predicting chronic disability in workers

were associated with occupational risk factors, health consequences and the social, economic and cultural influences on worker health

workers throughout the industrialized world

symptoms



US, United States; UK, United Kingdom; MSK, rheumatic musculoskeletal disorders; MSDs, work‐related musculoskeletal disorders; COPCORD, Community‐Oriented Program for Control of Rheumatic Diseases; CTS, carpal tunnel syndrome; OA, osteoarthritis; SGIx, Social Gap Index; RRPS, rheumatic regional pain syndromes.

**Table 1.** Summary and analysis of quantitative studies.

**Author, year [ref] Objectives and** 

Cartwright et al., 2013 [9]

212 Occupational Health

Peláez‐Ballestas et al.,

Rodriguez‐Amado et al., 2016 [21]

Quintana et al., 2016

Loyola‐Sanchez et al.,

Julián‐Santiago et al.,

2016 [23]

2016 [24]

[22]

2015 [20]

**method**

workers

Estimate the prevalence of MSK disorders and rheumatic diseases in indigenous Maya‐Yucateco COPCORD methodology

Determine the incidence of CTS over 1 year in Latino poultry processing

Community‐based sampling.

Identify individual and contextual factors associated with the variation of prevalence of OA in the Mexican population Multilevel analysis SGIx was associated

with OA

Estimate the prevalence of MSK disorders and rheumatic diseases among the indigenous Qom (Toba) in Argentina COPCORD methodology

Evaluate the impact of arthritis on the physical function of people living in a Maya Yucateco rural community COPCORD methodology

Estimate the prevalence of MSK disorders and rheumatic diseases in the Chontal and Mixtec indigenous communities in Mexico COPCORD methodology

**Country Group studied Conclusions**

poultry and non‐ poultry manual labor occupations

indigenous resident in Chankom (state of

indigenous resident in Chankom who had symptomatic OA

indigenous resident in Rosario (Argentina)

indigenous resident in Chankom with arthritis

Mixtec and Chontal indigenous resident in rural areas of Oaxaca

Yucatan)

Latino poultry processing workers have an incidence of CTS that is possibly higher than Latinos in other manual labor positions

MSK pain and rheumatic diseases were highly prevalent, with high impact on daily activities

These factors were independently associated with the prevalence of OA: female, pain intensity, physical limitation and the use of pain treatments with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health

MSK pain and rheumatic diseases were highly prevalent, with high impact on daily activities

Arthritis is highly associated with disability. The prevalence of arthritis is associated with social factors, in addition to individual

The prevalence of MSK disorders was 45.5 %. The most common rheumatic diseases were back pain and osteoarthritis A high percentage of participants had not received medical care

factors

US Adult Latinos in

Mexico Adult identified as

Mexico Adult identified as

Argentina Adult identified as

Mexico Adult identified as

Mexico Adult identified as

In 2004, Vindigni et al. [14] describes the prevalence of musculoskeletal (MSK) disorders in rural Indigenous Australians areas, where the 57% of people have learnt to live with chronic levels of pain affecting multiple anatomical sites.

Ahonen et al. [16] summarize the information on immigrant occupational health avail‐ able from studies, incorporating varied study designs. The immigration was associated with occupational risk factors, health consequences, and the social, economic and cultural influences on worker health. Similarly, Jørgensen et al. [7] investigate differences in self‐ reported health measures between immigrant and Danish cleaners, where the immigrant cleaners generally had a poorer self‐reported health and work ability than the Danish cleaners.

Joshi and Chopra [18] and Davatchi et al. [19] investigate the prevalence of MSK diseases in India and Iran, respectively, through the implementation of the Community Orientated Program for the Control of Rheumatic Diseases (COPCORD). In the first case, people liv‐ ing in urban area had less prevalence of MSK diseases, in comparison to the people in rural area. In the second case, the musculoskeletal complaints were more frequent in Turks than in Caucasians, both living in identical environment.

In United States (US), several papers have been published on this topic, especially on immi‐ grant population. In this sense, Schulz et al. [5] describes that the back symptoms and wrist/ hand symptoms were reported by over 35% of Latino workers. In the same way, Rosenbaum et al. [6] identifies that upper body musculoskeletal and low back pain are common in immi‐ grant Latino workers and may negatively impact long‐term health and contribute to occupa‐ tional health disparities. Xiao et al. [8] and Cartwright et al. [9] describe the Latino population as a vulnerable group for MSDs.

In Latin American (LA), previous studies have shown that people belonging to an indig‐ enous group are associated with the prevalence of rheumatic disease as the rheumatoid arthritis (RA) [28]. Due to the presence in LA of indigenous groups, all countries and their condition of vulnerability, not only socioeconomic but also ethnic, were created the Latin American Group for the Study of Rheumatic Diseases in Original Populations (Grupo Latino Americano De estudio de Enfermedades Reumáticas en Pueblos Originarios; GLADERPO). The main objective was to carry out epidemiological, anthropological and genetic studies, thus fulfilling with intervention processes in the affected populations. Studies are currently being carried out in several indigenous populations of Argentina, Mexico and Venezuela [29]. In 2016, "The Clinical Rheumatology Journal" published a supplement with informa‐ tion about the Maya‐Yucateco, Mixtec, Chontal and Rarámuri populations from Mexico; Warao, Kari'ña and Chaima from Venezuela; and Qom from Argentina [29]. The design of the studies, including samplings, case definition and methodology, was the same. The methodology was that proposed by COPCORD. Overall, low back pain, osteoarthritis (OA) and rheumatic regional pain syndromes (RPPS) were the most prevalent rheumatic diseases across all populations. Among the inflammatory rheumatic diseases, RA was the most prevalent, especially in the Qom community (2.4%) [22]. There were variations in the prevalence of certain diseases among different populations. The low back pain was more prevalent in the Qom community (19.8%) [22] and the OA in the Chontal community (32.1%) [24]. Variations were not related to the design of the study but to the characteristics of the populations and environmental factors, that is to say, heavy loads in Chontales ver‐ sus Rarámuris or Maya‐Yucateco in people not exposed to the same environment [20–23, 26, 27]. These results give information on working and socioeconomic conditions in these populations.

2. Synthesis and interpretation of qualitative studies: Few researches have been conducted based on social impacts associated with MSDs so far. Most outcome studies in occupational health have been focused on workers' compensation (WC), insurance payments, provision of medical services, return‐to‐work time and other direct insurance and employment‐related measures [30]. Unfortunately, there has been little research studying the impact on the social and family environment of the workers affected, as well as the indirect economic conse‐ quences. These complex interactions create significant difficulties for researchers attempting to study the social consequences of MSDs.

The sociodemographic characteristics of affected individuals and groups such as age, gen‐ der, ethnicity, nationality, education and socioeconomic status can influence the social con‐ sequences of the injury. They could also influence the responses of employers, insurers and medical providers [30].

Studies suggest that work‐related injuries have significant long‐term physical, economic and psychological consequences, which were worse in those who had been out of work for longer periods of time [31].

Patients with more serious MSDs have higher rates of psychological problems, drug abuse, and marital difficulties and the quality of the affected worker's family relationships.

Contemporary studies suggest that significant disparities in the incidence of MSDs and deaths still exist among various racial and ethnic groups. For example, in California, workplace inju‐ ries were found to occur 32% more frequently among black workers than among whites, and the rate for Hispanics is 18% higher [32]. There is scattered evidence indicating that the social consequences of MSDs also fall most heavily on women, minorities, immigrants and other vulnerable populations [33, 34].
