Work-related illnesses and disorders have a significant impact on public health in France. Approximately 90% of recognized occupational diseases are musculoskeletal disorders. While they represent a significant burden, exposure to occupational risk factors and the associated musculoskeletal disorders and symptoms are partly preventable through appropriate preventive measures, which have evolved over time in response to changes in the characteristics of the working population and working conditions (longer working hours, aging, job insecurity, etc.).

High-quality epidemiological surveillance is necessary to identify priorities, quantify and monitor occupational exposures, work-related musculoskeletal disorders and their impact on employment, and the under-recognition of these conditions as occupational diseases. In particular, it helps to better tailor prevention efforts and target the sectors, occupations, and groups of workers most at risk. The goal is to better understand and describe occupational exposures that pose a risk of musculoskeletal disorders, and to reduce the occupational (illness, disability, impairment, social exclusion, etc.), socio-familial, psychological, and economic consequences of these disorders.

Santé publique France is committed to producing reliable and reproducible indicators tailored to current challenges in the world of work, covering both occupational exposures and the main work-related conditions. Santé publique France contributes in particular to the 2021–2025 Occupational Health Plan (PST4), whose two main pillars are prevention and job retention.

Epidemiological surveillance of musculoskeletal disorders

Until the launch in 2002 of an epidemiological surveillance program for MSDs by Santé publique France, through its EpiPrevTMS team in collaboration with the research team on occupational health epidemiology and ergonomics (Ester, Irset-Inserm UMR 1085) at the University of Angers, the epidemiological survey data available in France focused primarily on highly exposed workers. This program, which was initially based on an MSD surveillance network in the Pays de la Loire region, allows for a more precise description of the MSD epidemic across the entire population.

The Pays de la Loire region was initially chosen due to the presence of recognized local expertise in the field of MSD epidemiology and its representativeness of the French working population. Thanks to the use of new data sources—including medical-administrative data (PMSI, AT/MP), repeated surveys of salaried workers (MCP), cohorts of self-employed and agricultural workers (Coset), and cohorts in the general population (Constances)—surveillance is currently being expanded to other regions.

The objective of this surveillance program is to provide a description of MSDs and exposure to their risk factors by sector of activity and occupation to guide prevention policies. It thus consists of:

• estimating the incidence and prevalence of MSDs in the general population and among workers;

• assessing levels of exposure to occupational risk factors;

• estimating the proportion of cases attributable to work in France;

• studying the medical and occupational outcomes of workers with MSDs.

Focus on the Program for the Medicalization of Information Systems (PMSI)

The epidemiological surveillance of musculoskeletal disorders (MSDs) through the analysis of national PMSI data aims to produce incidence rates in the general population for hospitalized conditions that serve as indicators of MSDs. These incidence rates are reported at the national (metropolitan France), regional, and departmental levels (including the overseas departments).

In the Medical Information Systems Program, each hospital stay is assigned one or more diagnostic codes from the International Classification of Diseases, 10th Revision (ICD-10), and, where applicable, one or more codes for medical or surgical procedures from the Common Classification of Medical Procedures (or, previously, the Catalog of Medical Procedures).

Diagnostic codes and procedure codes make it possible to identify and count hospital stays (public/private) of patients treated for a specific condition, and to calculate the annual incidence rate of the indicator (hospitalization, surgical procedure) for that condition.
Data from the Medicalization of Information Systems Program were made available to Santé publique France by the Technical Agency for Hospitalization Information (accreditation No. 2015-111111-59-50), for data through 2014. They are now accessible via the National Health Data System (SNDS) portal.

Measures to prevent musculoskeletal disorders

Contributing to the development of public prevention policies

Epidemiological surveillance data on MSDs and exposure to their risk factors produced by Santé publique France help guide prevention policies and define and develop actions.

Support for the identification of MSDs

Santé publique France contributed to the French adaptation of the European SALTSA consensus on clinical examination protocols for the detection of upper limb MSDs.