Abstract

INTRODUCTION

The inability to work has a large impact on society, on the economy, labor and health¹1. Boer WE, Bruinvels DJ, Rijkenberg AM, Donceel P, Anema JR. Evidence-based guidelines in the evaluation of work disability: an international survey and a comparison of quality of development. BMC Public Health 2009; 9:349. and, among the most common causes, are synovitis and tenosynovitis, work-related or not²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003.

3. Morse T, Schenck P. Occupational Disease in Connecticut, 2010. Occupational and Environmental Health Center and Department of Community Medicine. University of Connecticut Health Center. Farmington, CT. 2010. Disponível em: http://www.oehc.uchc.edu/pubs/OD_2010.pdf. (Acessado em 12 de dezembro de 2012).
http://www.oehc.uchc.edu/pubs/OD_2010.pd... ^-44. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. .

Data on disability vary greatly between countries as a result of legislation, working conditions and insurance coverage⁵5. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.. The annual report on the causes of work-related chronic diseases by the Department of Labor of Connecticut, United States, showed that, in 2008, there was a prevalence of musculoskeletal disorders, and among these, 10% were due to tenosynovitis³3. Morse T, Schenck P. Occupational Disease in Connecticut, 2010. Occupational and Environmental Health Center and Department of Community Medicine. University of Connecticut Health Center. Farmington, CT. 2010. Disponível em: http://www.oehc.uchc.edu/pubs/OD_2010.pdf. (Acessado em 12 de dezembro de 2012).
http://www.oehc.uchc.edu/pubs/OD_2010.pd... . In Denmark, a study on musculoskeletal disorders conducted with workers in industry and services showed that shoulder tendonitis is common in repetitive and monotonous activities, such as in slaughterhouses and sewing workshops⁶6. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study on a cohort of Danish industrial and service workers. Occup Environ Med 2003; 60(9): e8. . In Brazil, research with social security data revealed that, in 2008, musculoskeletal disorders accounted for 22.0% of cases of sickness benefits (SB) granted to employees with a formal contract governed by the Brazilian Consolidation of Labor Laws (CLT). Among these, synovitis and tenosynovitis represented 11.6%²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. . When considering only sickness beneficiaries who had an accident and are female, synovitis and tenosynovitis were both the most prevalent² 2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. and more durable causes⁴4. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. , predominantly in manual occupations⁵5. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71..

The inability to work should not be considered only in terms of morbidity, but also behavior, because workers often avoid getting sick leaves, even when they are sick⁵5. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.. This approach may be convenient to the employer. However, it contributes to the worsening of their clinical picture and subsequent chronicity. Some studies have called attention to the presence of socioeconomic filters²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. ^,44. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. ^,55. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.^,77. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... , such as the lack of strong unions, fear of dismissal after returning to work in pension cases, the high unemployment rates in the industry and the lower value of wage replacement as a contributory factor in the decision by workers asking for SB.

Several studies have shown the influence of individual (gender, age and psychological profile)²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. ^,44. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207.

5. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.^-66. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study on a cohort of Danish industrial and service workers. Occup Environ Med 2003; 60(9): e8. and external factors (exposure to occupational hazards such as violence related or unrelated to work, physical and psychological occupational stressors)⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9.

9. Barham C, Begum N. Sickness absence from work in the UK. Office for National Statistic. Labour Market Trends 2005; 4: 149-58. ^-1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. in rates of incapacity for work. Work-related diseases that are similar to those unrelated present some difficulty in establishing a causal association between certain aspects of the job and the health problem, especially when it comes to chronic processes⁷7. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... . Several pieces of evidence have been presented in this sense, particularly related to problems of the upper limbs (UL)¹¹11. Punnett L, Gold J, Katz JN, Gore R, Wegman DH. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing: a one year follow up study. Occup Environ Med 2004; 61(8): 668-74.. In this context, the use of computers, tools and machines⁷7. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... , whether or not associated to psychosocial factors in the work environment⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9., can be highlighted as occupational risk factors. In some activities, such as automobile manufacturing¹¹11. Punnett L, Gold J, Katz JN, Gore R, Wegman DH. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing: a one year follow up study. Occup Environ Med 2004; 61(8): 668-74., food processing and clerical jobs⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9., physical exposure is evident, especially for the upper extremities¹¹11. Punnett L, Gold J, Katz JN, Gore R, Wegman DH. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing: a one year follow up study. Occup Environ Med 2004; 61(8): 668-74., reinforcing the importance of studying the association of the economic activity with sick leave due to synovitis and tenosynovitis.

This study aims to analyze the association of variables such as gender, age, economic activity (class and division levels) and the type of benefit to the prevalence and duration of SB due to synovitis and tenosynovitis (ICD10 - M65), granted to workers employed in Brazil in 2008.

METHODS

This is a cross-sectional study of analytical nature, in which all SB were studied in the period from 01/01/2008 to 12/31/2008, granted by the Brazilian Institute of Social Security (INSS) to workers employed¹²12. Brasil. Decreto-Lei nº 5.492, de 01 de maio de 1943. Aprova a Consolidação das Leis do Trabalho. Brasília: Diário Oficial da União. 09 de outubro de 1943, Seção 1, p. 11937 in Brazil in 2008, whose clinical diagnosis of incapacity for work was the M65 code (ICD10), corresponding to synovitis and tenosynovitis and its derivations. For this study, the inability to work was regarded as the time during which the worker was granted the benefit; in this case, sickness benefit (temporary disability).

Data are from the Unified System of Benefits (SUB) of the Brazilian Social Security Institute and the National Social Information Database (CNIS), both managed by the Ministry of Social Security (MSS). Information concerning the type of benefit, gender, age, duration, diagnosis of disability (ICD10) were extracted from the SUB; and, from CNIS, the amount of employment relationships stratified according to the National Classification of Economic Activities (NCEA version 2.0, division and class)¹³13. Brasil. CNAE - Classificação Nacional de Atividades Econômicas - subclasses 2.0. Disponível em: http://www.receita.fazenda.gov.br/pessoajuridica/cnaefiscal/txtcnae.htm (Acessado 15 de julho de 2013).
http://www.receita.fazenda.gov.br/pessoa... , gender and age. The classification of the NCEA is an instrument of national standardization of economic activity codes and the criteria for eligibility used by the various tax administration bodies of the country¹³13. Brasil. CNAE - Classificação Nacional de Atividades Econômicas - subclasses 2.0. Disponível em: http://www.receita.fazenda.gov.br/pessoajuridica/cnaefiscal/txtcnae.htm (Acessado 15 de julho de 2013).
http://www.receita.fazenda.gov.br/pessoa... .

The study population was established by the average monthly employment relations declared to the Guarantee Fund for Time of Service²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. ^,44. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. ^,55. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71. in Brazil in 2008 (32,590,239 employment relations).

Employed worker is one who has an employment relationship with an employer agent, whether individuals with profit purposes or a legal person (company) with an employment contract governed by the Labor Code¹²12. Brasil. Decreto-Lei nº 5.492, de 01 de maio de 1943. Aprova a Consolidação das Leis do Trabalho. Brasília: Diário Oficial da União. 09 de outubro de 1943, Seção 1, p. 11937. The SB is granted to the insured who is incapacitated for work for more than 15 consecutive days, proven by medical examination by social security. This category can be subdivided into the pension sickness benefit (in which the health problem is not work-related) and work accident benefit (in which the relationship between the health problem and work is legally established)¹⁴14. Brasil. Ministério da Previdência Social. Disponível em: http://www.mpas.gov.br.
http://www.mpas.gov.br... .

All SB cases granted in the period from 01/01/2008 to 12/31/2008 as a salary replacement due to synovitis and tenosynovitis (M65) and its derivations (M65.0, M65.1, M65.2, M65.3, M65.4, M65.8, M65.9) were considered.

The inability to work due to synovitis and tenosynovitis was analyzed from the estimated prevalence, prevalence ratio (PR) and duration of the SB.

The analysis of the prevalence of incapacity for work was stratified by age group (< 40 and ≥ 40 years), gender (male and female), type of benefit (accident-B91 and pension-B31) and NCEA (division: classification with 2-digits code, and class: 4 digits). All prevalence rates were presented as benefits/10,000 employments. The PR was calculated by dividing the prevalence between genders, age groups and types of benefits.

The probability for the inability to work was estimated by PR. Analyses were conducted for each gender individually, aiming to detect specific associations between them in every field of activity.

The duration of incapacity for work in this context was considered as the duration in days of the SB. The duration was calculated according to NCEA division and class, and evaluated by measures of central tendency (median and 25% and 75% quartiles).

Depending on the specificity of cases, the NCEA with higher total prevalence rates were selected for individual analysis, and those with fewer than 100 benefits and total CNIS with less than 5,000 workers were excluded. Analyzes were performed using Microsoft Office Excel 2007 and PASW Statistics programs.

The protocol was approved by the Research Ethics Committee of the School of Health Sciences, Universidade de Brasilia, Federal District.

RESULTS

In Brazil, in 2008, INSS recorded a monthly average of 32,590,239 employees in the private sector, of which 35,601 were granted SB with clinical diagnosis of synovitis and tenosynovitis (ICD10 - M65). Overall, the prevalence of this condition was 10.9/10,000 employments, with a predominance of accident SB (B91 with PR = 1.2 among benefit types), provided mainly to women (PR = 3.3 among the genders) and workers aged ≥ 40 years (PR = 1.4 among the expanded age groups).

The prevalence and the RP for incapacity for work due to synovitis and tenosynovitis are presented according to the economic activity (NCEA-division), the type of benefit and age in Table 1.

The highest prevalence rate for incapacity for work for synovitis and tenosynovitis was presented by NCEA 37-Sewage (55.4) and 60-Activities related to radio and TV (47.1) compared with the number of workers in Brazil. As for the type of benefit, the accident SB prevailed (B91) in most of the NCEA. The NCEA 64-Activities of financial services registered 3.2 times more accident benefits than pension benefits, followed by NCEA-division 10-Manufacture of food products (PR = 2.1).

When analyzing the influence of age on the inability to work by synovitis and tenosynovitis, there was a predominance of workers over 39, regardless of the type of benefit. The NCEA 64-Financial services activity (PR = 2.2) presented more accidents in this age group. The high prevalence of benefits granted to workers under 40 years in NCEA-60 Activities related to radio and TV in both types (Pension benefits-B31 = 27.9 and Accident benefits-B91 = 33.4) is noteworthy. As for the potential influence of gender on incapacity for work due to synovitis and tenosynovitis (Table 2), a higher rate of females is observed in all NCEA, regardless of the type of benefit. Among female workers, the highest prevalence and PR was observed in NCEA 60-Activities related to radio and TV (122.5), in which women were granted 8.1 times more SB when compared to men.

The distribution of the duration according to the quartiles (Table 2) shows that, overall, 50% of workers returned to work within 56 days, and the benefits that were 25% smaller lasted less than 36 days, whereas 25% larger benefits lasted over 85 days. The NCEA 64-Financial services division had the highest median duration (70 days).

For the individual analysis of NCEA-class, 16 economic activities (Table 3) were selected, with the prevalence and PR of SB due to synovitis and tenosynovitis according to the type of benefit and age. The NCEA, 4757-Retailer specialized in parts and accessories for household electronics, except computers and communication devices (186.8) and 4222-Construction of water supply and sewage networks (175.2) had the higher rates of prevalence and likelihood for incapacity to work due to synovitis and tenosynovitis when compared to the group of workers in Brazil. The accident benefit type predominated in most industries. The NCEA-class 6422-Multiple banks with commercial portfolio (PR = 3.8) and 1011-Slaughtering and manufacturing of meat products (PR = 3.3) had the highest rates of workplace accidents.

As for age groups, workers aged 40 or more years had the highest rates of inability for synovitis and tenosynovitis in most of the NCEA. In this context, the NCEA 4757-Retailer specialized in parts and accessories had the highest probability in the age group ≥ 40 years (PR = 3.4), in contrast with the NCEA 6010-Activities related to radio, which had the lowest probability (0.3).

The analysis of the influence of gender on the prevalence of SB for synovitis and tenosynovitis (Table 4) in NCEA-class was similar to the NCEA-division, in which a high rate of females was observed throughout the NCEA; however, with great variability among types of benefits. The NCEA-class 6422-Multiple banks with commercial portfolio had the highest median duration (73 days).

DISCUSSION

This study showed that the prevalence SB for synovitis and tenosynovitis in Brazil was 10.9/10,000 employments, with a median duration of 56 days. These rates represented 2.6% of all cases of SB, with 11.7% of those resulting from musculoskeletal and ligamentous disorders recorded in Brazil in 2008²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. . In relation to Brazil in 2008, synovitis and tenosynovitis was the second most common type among all musculoskeletal disorders (second only to back problems)²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. , with median duration period of 62 days. Comparisons of these rates with those presented by the various countries becomes a challenge, since the studies found treated generically occupational chronic diseases⁷ 7. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... or musculoskeletal disorders of the upper limbs⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9., or those related to specific activities such as industry and services, such as sewing, clerical work⁶6. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study on a cohort of Danish industrial and service workers. Occup Environ Med 2003; 60(9): e8. and manufacturing of automobiles¹¹11. Punnett L, Gold J, Katz JN, Gore R, Wegman DH. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing: a one year follow up study. Occup Environ Med 2004; 61(8): 668-74..

Considering the area of capital-labor relations, some studies pointed to the occurrence of underreporting of worker health problems²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003.

3. Morse T, Schenck P. Occupational Disease in Connecticut, 2010. Occupational and Environmental Health Center and Department of Community Medicine. University of Connecticut Health Center. Farmington, CT. 2010. Disponível em: http://www.oehc.uchc.edu/pubs/OD_2010.pdf. (Acessado em 12 de dezembro de 2012).
http://www.oehc.uchc.edu/pubs/OD_2010.pd...

4. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. ^-55. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.^,77. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... ^,1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. , especially those related to work⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9.^,1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. . Report by the American Congress reveals that, in the period 1995-2001, the number of cases of musculoskeletal disorders was six times greater than reported to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII)³3. Morse T, Schenck P. Occupational Disease in Connecticut, 2010. Occupational and Environmental Health Center and Department of Community Medicine. University of Connecticut Health Center. Farmington, CT. 2010. Disponível em: http://www.oehc.uchc.edu/pubs/OD_2010.pdf. (Acessado em 12 de dezembro de 2012).
http://www.oehc.uchc.edu/pubs/OD_2010.pd... . Despite the differences of existing social security coverage systems between the United States and Brazil, several factors associated with underreporting in that country can be extended to the Brazilian context, such as socioeconomic filters²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. ^,44. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. ^,55. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.^,77. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... ^,1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. .

The establishment of the Technical Epidemiological Social Security Technical Nexus (NTEP) in Brazil in 2007¹⁷17. Brasil. Ministério da Previdência Social. Menu: Saúde e Segurança Ocupacional: Nexo Técnico Epidemiológico Previdenciário - NTEP. Disponível em: www.mpas.gov.br/conteudoDinamico.php?id=463 (Acessado em 15 de julho de 2013).
www.mpas.gov.br/conteudoDinamico.php?id=... helped to correct, on a large scale, the issue of underreporting of work-disease relationship. However, companies have observed indicatives of establishment of measures to contribute to the pension underuse, and so companies would get a more favorable relaxation of occupational accident insurance, regulated by the Accident Prevention Factor (FAP)⁴4. Almeida PCA, Barbosa-Branco A. Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença. Rev Bras Saúde Ocup 2011; 36(124): 195-207. ^,55. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.. Even in a context of possible underreporting, in 2008, the majority of SB due to synovitis and tenosynovitis were due to work accidents.

To better understand the possible causes and determinants of prevalence and duration of synovitis and tenosynovitis, one needs to consider the occupational, personal (gender, age and psychological profile) and socioeconomic factors⁸8. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9.

9. Barham C, Begum N. Sickness absence from work in the UK. Office for National Statistic. Labour Market Trends 2005; 4: 149-58. ^-1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. . In relation to occupational factors, it is likely that the economic activities analyzed in this study exhibit elevated risks related to work organization, inadequate furniture for the tasks undertaken by the employee or the relationship between co-workers or supervisors.

The higher prevalence of incapacity for work presented in NCEA-division 37-Sewage can stem from both occupational and socioeconomic factors. Due to this NCEA-division consisting mostly of mixed enterprises, the workers feel more freedom to request SB when sick without fear of dismissal after their return to work⁵5. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Am J Ind Med 2011; 54(11): 858-71.. On the other hand, in the more specific context (NCEA-class), in essentially private activities, such as NCEA-class 4757-Retailer specialized in parts, accessories and electronic devices, the higher prevalence occurs predominantly due to occupational factors. In these cases, it is common, due to limitations imposed by the health problem, for the employee to be away from work, because it is impossible not to do so.

The high prevalence of accident SB in NCEA-division 64-Activity of financial services and 10-Manufacture of food products, as well as the NCEA-class 6422-Multiple banks with commercial portfolio and 1011-Slaughtering and manufacturing of meat products can be justified by the recognition of the high physical and psychological demands in the labor environment. The structural and technological changes in banking in recent decades have increased the physical (local) and cognitive demands, as well as the pressure to fulfill goals. These factors may contribute to the development/worsening of specific clinical conditions²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. ^,1010. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28(10): 1854-66. .

The high PR of accidents in NCEA-division 10-Manufacture of food products and class 1011-Slaughtering and manufacturing of meat products derives largely from the recognition of overloading of the muscles and tendons imposed by the need to stabilize the upper limbs while hands exert force and repetitiveness¹⁸18. Leclerc A, Chastang JF, Niedhammer I, Landre MF, Roquelaure Y. Incidence of shoulder pain in repetitive work. Occup Environ Med 2004; 61(1): 39-44. .

The high prevalence of SB identified among workers with more than 40 years can be explained in part by decreased muscle strength and the loss of flexibility and agility common in people with increasing age, as in certain health problems, especially chronic ones¹⁵15. Prasnsky GS, Benjamim KL, Savageau JA, Currivan D, Fletcher K. Outcomes in work-related injuries: a comparison of older and younger workers. Am J Ind Med 2005; 47(2): 104-12.. Some studies show that age delays the recovery of an injury⁶6. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study on a cohort of Danish industrial and service workers. Occup Environ Med 2003; 60(9): e8. ^,77. US House of Representatives. Hidden tragedy: underreporting of workplace injuries and illnesses. US House of Representatives; 2008. Disponível em: http://workerscomphub.org/resources/hidden-tragedy-underreporting-workplace-injuries-and-illnesses (Acessado em 12 de dezembro de 2012).
http://workerscomphub.org/resources/hidd... ^,1515. Prasnsky GS, Benjamim KL, Savageau JA, Currivan D, Fletcher K. Outcomes in work-related injuries: a comparison of older and younger workers. Am J Ind Med 2005; 47(2): 104-12.^,1616. Vlasveld MC, van der Feltz-Cornelis CM, Bültmann U, Beekman AT, van Mechelen W, Hoedeman R, et al. Predicting return to work in workers with all-cause sickness absence greater than 4 weeks: a prospective cohort study. J Occup Rehabil 2012; 22(1): 118-26.. Data from this study suggest an association between age and the duration of SB. The longer duration found in older workers, both in NCEA-division 64-Activities of financial services and in NCEA-class 6422-Multiple banks with commercial portfolio, which also presented a higher prevalence of SB in older workers, strengthen the contribution of age to these results, since these NCEA classes divisions also had the highest prevalence of SB in this age group.

The high ratio of females found in this study may be related to several factors, such as double shifts, differences in biological and subjective responses and characteristics of repetitive and monotonous work⁶6. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study on a cohort of Danish industrial and service workers. Occup Environ Med 2003; 60(9): e8. ^,88. Morse T, Dillon C, Kenta-Bibi E, Weber J, Diva U, Warren N, et al. Trends in work-related musculoskeletal disorders reports by year, type, and industrial sector: a capture-recapture analysis. Am J Ind Med 2005; 48(1): 40-9.^,1919. Taiwo OA, Cantley LF, Slade MD, Pollack KM, Vegso S, Fiellin MG, et al. Sex differences in injury patterns among workers in heavy manufacturing. Am J Epidemiol 2009; 169(2): 161-6.^,2020. Gjesdal S, Bratberg E, Mæland JG. Gender differences in disability after sickness absence with musculoskeletal disorders: five-year prospective study of 37.942 women and 26.307 men. BMC Musculoskelet Disord 2011; 12: 37.. The greater occurrence of SB in young women in NCEA 60-Activities related to radio and TV and 6010-Activities related to radio may be associated with the presence of risks arising from the execution of highly repetitive precision tasks, requiring minimization of errors and work in shifts that favor working on stereotyped postures²2. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1(1): e000003. . Moreover, the workers in this activity receive better wages than the average worker, which allows greater access to health services.

This study presents particularities and limitations that must be considered for proper understanding of its results. The ICD-10 M65, used as the study parameter, can refer both to synovitis and tenosynovitis of upper and lower limbs. Therefore, there might have been an excess in estimations when compared to studies limited to upper limbs.

Data from this study refer to SB granted to workers employed, excluding individual taxpayers, domestic workers, special insured workers, optional, public servants and informal workers. One has to consider the age of the study population, workers employed over 16 years old. Thus, these results should not be extrapolated to the general population.

One of the strengths of the study is the representativeness of the study population, considering that SUB is one of the largest databases of social security in the world under a single administration. This factor brings advantages to the homogeneity of the information, since the granting of benefits follows standardized procedures and protocols that enhance the consistency and reliability of the information.

CONCLUSION

In short, the prevalence and duration of SB due to synovitis and tenosynovitis are associated with the branch of economic activity, with females, advancing age and the type of benefit. These data suggest the need to further investigate the relationship of the branch of economic activity in the inability to work process.

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