Validation of JEM Soignances Job-Exposure Matrix Through Comparison with Self-Reported Exposures Among Healthcare Workers in CONSTANCES.

Abstract

Purpose: A healthcare-specific job-exposure matrix, JEM Soignances, was recently developed to assess the occupational exposome of healthcare workers. This study aimed to compare estimates of known associations between occupational exposures and health outcomes obtained using JEM Soignances and self-reported data.

Methods: Healthcare professionals from the CONSTANCES cohort with linked data from the French National Healthcare Database (SNDS) were included (n = 12219). Exposures were estimated using JEM Soignances (occupations and sectors of activity) and its alternative version (+ establishment size and status), as binary exposure at inclusion or as lifetime cumulative exposure (< 10y/ ≥ 10y). Association with relevant health outcomes (i.e., pain, depressive symptoms, hypertension, cancer, use of psychoactive drugs) were evaluated using logistic regression and compared to estimates obtained from self-reported exposure data in terms of direction, magnitude, and significance.

Results: For organizational exposures, 10/16 associations for JEM Soignances and 12/16 for the alternative version aligned with self-reported data in direction and magnitude. For biomechanical exposures, confidence intervals overlapped in 11/15 associations for JEM Soignances and in 9/15 for the alternative version. For the others, discrepancies generally lean toward underestimation. For psychosocial exposure, JEM Soignances revealed significant limitations: While self-reported effort-reward imbalance was strongly associated with depressive symptoms (aOR = 3.18[2.81;3.59]), JEM Soignances underestimated this association (aOR = 1.37[1.23;1.54]), and the alternative version failed to detect it (aOR = 0.99[0.87;1.13]).

Conclusion: JEM Soignances demonstrated good agreement with self-reported data for organizational and biomechanical exposures but failed for psychosocial exposure, often underestimating or missing associations. Further research is needed to evaluate JEM Soignances validity for biological, chemical, and physical exposures.