건강 노동자 효과

건강 노동자 효과(healthy worker effect)라는 용어는, 지금은 기후 변화와 건강이라는 주제에 천착하고 있는 Tony McMichael이 쓴 1974년도 J Occup Med 논문에서 최초로 보고되었고, 75년도 논문에서 용어화되었다.

McMichael AJ. Standardized mortality ratios and the "healthy worker effect": Scratching beneath the surface. J Occup Med. 1976 Mar;18(3):165-8. 

Abstract:

The age-standardized mortality ratio (SMR) is a relative index of mortality, expressing the mortality experience of the study population relative to that of a comparison ("standard") population. With the general population as the "standard", the SMR for an occupational population will underestimate the mortality experience of that latter population (since it comprises individuals necessarily healthy enough to be employable --and whose mortality risk is therefore initially lower than the general population average). However, this "healthy worker effect" does not equally to all groups within the study population. Therefore, if one attempts to adjust for this effect, the summary nature of the SMR must be recognized, and allowance must be made for variation in the healthy worker effect between different age groups, different races, different work-status groups, different causes of death, and different elapsed-time periods of observation.

역학사전(Dictionary of Epidemiology) 5판 정의. 

HEALTHY WORKER EFFECT A phenomenon observed initially in studies of occupational diseases: workers often exhibit lower overall death rates than the general population,because persons who are severely ill and chronically disabled are ordinarily excluded from employment or leave employment early [230]. Death rates in the general population may be inappropriate for comparison if this effect is not taken into account. Similar effects are known for military personnel, migrants, and other groups.

건강 노동자 효과 직업성 질환 연구에서 최초로 관찰된 현상으로 종종 노동자들은 일반 인구보다 전체 사망률이 더 낮게 제시되는데, 그 까닭은 심각하게 아프거나 계속 장애가 있는 사람이 고용에서 배제되거나 일찍 퇴직하기 때문이다[230]. 만약 이 효과가 고려되지 않는다면 일반 인구 사망률로 비교하는 것은 부적절할 것이다. 비슷한 효과가 군인, 이민자, 기타 집단 등에서 알려져 있다.

[230] McMichael AJ, Spirtas R, Kupper LL. An epidemiologic study of mortality within a cohort of rubber workers, 1964.72. J Occup Med 1974; 16:458.464.