The evolving concept of the healthy worker survivor effect

摘要: The "healthy worker survivor effect" describes a continuing selection process such that those who remain employed tend to be healthier than leave employment. In an analysis of exposure-response patterns in occupational study, the healthy effect generally attenuates adverse exposure. practical terms, attenuation will more problematic when evaluating subtle rather strong associations. use internal referent does not guarantee elimination this effect, since by definition, it manifests within cohort. Although documented over 100 years ago, there is little consensus regarding most appropriate method control for effect. Four methods have been proposed its control: (1) restriction cohort survivors fixed number follow-up, (2) lagging exposure exclude recent incurred remained on job, (3) adjusting employment status as confounder, and (4) treating simultaneously intermediate confounding variable means G-null test or extension, G-estimation analysis, using structurally nested failure time models. This paper reviews concept four it.