M. Bovenzi, EXPOSURE-RESPONSE RELATIONSHIP IN THE HAND-ARM VIBRATION SYNDROME - AN OVERVIEW OF CURRENT EPIDEMIOLOGY RESEARCH, International archives of occupational and environmental health, 71(8), 1998, pp. 509-519
The complex of vascular, neurologic, and osteoarticular disorders occu
rring in the upper limbs of vibration-exposed workers is called hand-a
rm vibration syndrome. There is epidemiologic evidence for an increase
d occurrence of peripheral sensorineural disorders in occupational gro
ups working with vibrating tools. An excess risk for wrist osteoarthro
sis and for elbow arthrosis and osteophytosis has been reported in wor
kers exposed to shocks and low-frequency vibration of high magnitude f
rom percussive tools. However, there are too few epidemiology data to
enable reliable conclusions to be drawn about exposure-response relati
onships for both sensorineural disturbances and bone and joint disorde
rs caused by hand-transmitted vibration. Cross-sectional and longitudi
nal epidemiology studies have shown that occupational exposure to hand
-transmitted vibration from a great variety of hand-held tools is sign
ificantly associated with an increased occurrence of digital vasospast
ic disorders called vibration-induced white finger (VWF). The proposal
of an exposure-response relationship for VWF has been included in an
annex to the international standard ISO 5349. The findings of several
epidemiology studies have shown a poor agreement between the risk for
VWF observed in various occupational groups and that predicted by the
ISO 5349 model. Both overestimation and underestimation of the occurre
nce of VWF have been reported by investigators. It has been argued tha
t the current ISO frequency-weighting curve for hand-transmitted vibra
tion may be inappropriate for the assessment of vibration-induced adve
rse vascular effects. Alternative exposure-response relationships for
VWF have been suggested in recent epidemiology studies. The epidemiolo
gy data used to construct current exposure-response relationships for
vibration-induced injuries are primarily derived from cross-sectional
studies. Future epidemiology research should be based on prospective c
ohort studies because the design characteristics of such studies permi
t the study of cause-effect relationships and the formulation of etiol
ogic hypotheses.