A review of the healthy worker effect in occupational epidemiology
Abstract
This review article aims to anatomize sources of the healthy worker effect (HWE) and to summarize advantages and limitations of several approaches frequently proposed to eliminate the HWE. Although the HWE is frequently addressed in the context of selection bias, our review suggests that the selection of occupational cohorts with advantageous health status would preferably be addressed as a source of confounding biases. The authors also conclude that the exclusion of unhealthy workers at employment and the study of active workers are the two main sources of HWE, and that the use of the general population as a comparison group in occupational epidemiology should be avoided if possible. The authors encourage investigators to make distinctions between the underlying factors related to the use of the general population as the comparison group in occupational epidemiology.
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The theory of the healthy worker effect suggests that healthier individuals are more likely to remain in the workforce.
“The theory of the healthy worker effect suggests that healthier individuals are more likely to remain in the workforce [42].”
From Which aspects of health differ between working and nonworking women with fibromyalgia? A cross-sectional study of work status and health (2012) · cites this paper as [42]
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- Authors
- Li, C.-Y., & Sung, F.-C.
- Affiliations
- Fu Jen Catholic University (TW)
- National Taiwan University (TW)
- Corresponding author
- Li, C.-Y.
- ORCID
- Li, C.-Y.
- Venue
- Occupational Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1999
- Volume
- 49
- Issue
- 4
- Pages
- 225-229
- ISSN
- 0962-7480 (ISSN-L)
- 1471-8405
- OpenAlex
- W2158364693
- Cited by
- 829
- References
- 23
- Citations by year
- 2026: 32 · 2025: 36 · 2024: 25 · 2023: 31 · 2022: 42 · 2021: 61 · 2020: 50 · 2019: 60 · 2018: 40 · 2017: 43 · 2016: 40 · 2015: 49 · 2014: 57 · 2013: 42 · 2012: 52
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Occupational Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- healthy worker effect, selection bias, confounding, occupational cohort, active workers
- MeSH terms
- Humans, Occupational Medicine, Time Factors, Reproducibility of Results, Cohort Studies, Bias, Selection Bias, Confounding Factors, Epidemiologic, Cohort Effect, Healthy Worker Effect, Occupational Health
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