Region-specific prevalence and associated factors of work-related musculoskeletal disorders among pilots of a commercial airline: a cross-sectional study.

OBJECTIVES: To estimate the prevalence and anatomical distribution of work-related musculoskeletal disorders (WMSDs) among pilots of a Chinese commercial airline and identify factors associated with neck, shoulder and lower-back WMSDs. DESIGN: Cross-sectional study. SETTING: A commercial airline in China; data were collected during routine periodic medical examinations from 17 November 2025 to 31 December 2025. PARTICIPANTS: A total of 1042 active commercial airline pilots (1030 men and 12 women) were included from 1200 invited pilots. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of WMSDs across nine anatomical regions and factors associated with WMSDs in the neck, shoulders and lower back. RESULTS: The overall prevalence of WMSDs was 21.50%; the most commonly affected regions were the lower back (11.52%), neck (11.32%) and shoulders (8.35%). Working in uncomfortable postures was associated with WMSDs across all three regions, particularly for 'often' exposure: neck (adjusted OR (aOR) 7.97, 95% CI 3.58 to 17.76), shoulders (aOR 5.48, 95% CI 2.35 to 12.80) and lower back (aOR 8.58, 95% CI 3.89 to 18.94). Neck WMSDs were associated with prolonged head-down posture and covering shifts for colleagues, whereas adequate rest time was inversely associated. Shoulder WMSDs were associated with prolonged static back posture. Lower-back WMSDs were positively associated with covering shifts and cold/temperature exposure and inversely associated with adequate rest, daily task variation and outdoor work. CONCLUSIONS: WMSDs most commonly affected the lower back, neck and shoulders. Working in uncomfortable postures was consistently associated with WMSDs across these regions, while work-organisation and environmental factors showed site-specific associations.