Влияние стресса на работе на риск возникновения сердечно-сосудистых заболеваний среди населения 25–64 лет в России/Сибири (программа ВОЗ «MONICA-психосоциальная»)
Влияние стресса на работе на риск возникновения сердечно-сосудистых заболеваний среди населения 25–64 лет в России/Сибири (программа ВОЗ «MONICA-психосоциальная»)
Гафаров В.В., Громова Е.А., Панов Д.О. и др. Влияние стресса на работе на риск возникновения сердечно-сосудистых заболеваний среди населения 25–64 лет в России/Сибири (программа ВОЗ «MONICA-психосоциальная»). Терапевтический архив. 2019; 91 (1): 8–18.DOI: 10.26442/00403660.2019.01.000022
DOI: 10.26442/00403660.2019.01.000022
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DOI: 10.26442/00403660.2019.01.000022
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Аннотация
Цель исследования – определить влияние стресса на работе на риск возникновения сердечно-сосудистых заболеваний за 16-летний период среди населения 25–64 лет в России/Сибири.
Материалы и методы. В рамках III скрининга программы ВОЗ «MONICA-психосоциальная» обследована случайная репрезентативная выборка населения обоего пола 25–64 лет Новосибирска в 1994 г. (мужчины: n=657, возраст 44,3±0,4 года, респонс – 82,1%; женщины: n=689, возраст 45,4±0,4 года, респонс – 72,5%). Программа скринирующего обследования включала регистрацию социально-демографических данных, определение стресса на работе (шкала Каразека). Срок проспективного наблюдения за участниками составил 16 лет. В исследовании выделены следующие «конечные точки»: впервые возникшие случаи инфаркта миокарда (ИМ), инсульта.
Результаты. Высокий уровень стресса на работе был у 29,5% мужчин и у 31,6% женщин, средний уровень – у 48,9% мужчин и у 50,7% женщин (χ2=2,574, υ=2, p=0,276). Риск развития ИМ за 16-летний период среди лиц, испытывающих стрессовые ситуации на работе, составил у мужчин относительный риск (ОР)=3,592, у женщин ОР=3,218 [95% доверительный интервал (ДИ) 1,146–9,042]; риск инсульта у мужчин – ОР=2,603 (95% ДИ 1,06–4,153), у женщин – ОР=1,956 (95% ДИ 1,008–3,795). В многофакторном анализе у лиц со стрессом на работе риск ИМ среди мужчин составил ОР=1,15 (95% ДИ 0,6–2,2), среди женщин – ОР=2,543 (95% ДИ 1,88–7,351); риск развития инсульта у мужчин – ОР=3,8 (95% ДИ 1,6–8,8), у женщин – ОР=1,95 (95% ДИ 0,984–3,887). Риск развития инсульта был выше среди одиноких, разведенных и овдовевших мужчин – ОР=4,2 (95% ДИ 1,5–13,2), и у женщин со средним или начальным образованием – ОР=3 (95% ДИ 0,852–11,039).
Заключение. Установлено, что высокий уровень стресса на работе гендерно не различается; риск развития ИМ за 16-летний период был выше у женщин, чем у мужчин, риск развития инсульта – выше у мужчин; на риск ИМ и инсульта у обоих полов влияет социальный градиент.
Ключевые слова: гендерные различия, инфаркт миокарда, инсульт, стресс на работе, риск развития.
Materials and methods. A random representative sample of the population of both sexes of 25–64 years old in Novosibirsk in 1994 (men: n=657, 44.3±0.4 years, response – 82.1%, women: n=689, 45.4±0.4 years, response – 72.5%). The screening survey program included: registration of socio-demographic data, determination of stress at work (Karazek scale). The period of prospective follow-up of participants was 16 years. The study identified the following "end points": the first cases of myocardial infarction (MI), stroke.
Results. A high level of stress at work was in 29.5% of men and 31.6% of women, the average level in 48.9% of men and 50.7% of women (χ2=2.574, υ=2, p=0.276). The risk of developing MI for a 16-year period, among people experiencing stressful situations at work, was: in men, HR=3.592, and women HR=3.218 (95% CI 1.146–9.042); stroke risk – among men, HR=2.603 (95% CI 1.06–4.153) in women HR=1.956 (95% CI 1.008–3.795). In multivariate analysis, in men with stress at work, the risk of MI among men was HR=1.15 (95% CI 0.6–2.2), among women – HR=2.543 (95% CI 1.88–7.351); risk of stroke, was in men, HR=3.8 (95% CI 1.6–8.8), in women – HR=1.95 (95% CI 0.984–3.887). The risk of stroke was higher among single, divorced and widowed men, HR=4.2 (95% CI 1.5–13.2), and in women with secondary or primary education, HR=3 (95% CI 0.852–11.039).
Conclusion. It was established that a high level of stress at work is not gender-specific; the risk of developing MI over a 16-year period is higher in women than in men, stroke in men; the risk of myocardial infarction and stroke in both sexes is affected by the social gradient.
Keywords: gender, men, women, myocardial infarction, stroke, stress at work relative risk.
Материалы и методы. В рамках III скрининга программы ВОЗ «MONICA-психосоциальная» обследована случайная репрезентативная выборка населения обоего пола 25–64 лет Новосибирска в 1994 г. (мужчины: n=657, возраст 44,3±0,4 года, респонс – 82,1%; женщины: n=689, возраст 45,4±0,4 года, респонс – 72,5%). Программа скринирующего обследования включала регистрацию социально-демографических данных, определение стресса на работе (шкала Каразека). Срок проспективного наблюдения за участниками составил 16 лет. В исследовании выделены следующие «конечные точки»: впервые возникшие случаи инфаркта миокарда (ИМ), инсульта.
Результаты. Высокий уровень стресса на работе был у 29,5% мужчин и у 31,6% женщин, средний уровень – у 48,9% мужчин и у 50,7% женщин (χ2=2,574, υ=2, p=0,276). Риск развития ИМ за 16-летний период среди лиц, испытывающих стрессовые ситуации на работе, составил у мужчин относительный риск (ОР)=3,592, у женщин ОР=3,218 [95% доверительный интервал (ДИ) 1,146–9,042]; риск инсульта у мужчин – ОР=2,603 (95% ДИ 1,06–4,153), у женщин – ОР=1,956 (95% ДИ 1,008–3,795). В многофакторном анализе у лиц со стрессом на работе риск ИМ среди мужчин составил ОР=1,15 (95% ДИ 0,6–2,2), среди женщин – ОР=2,543 (95% ДИ 1,88–7,351); риск развития инсульта у мужчин – ОР=3,8 (95% ДИ 1,6–8,8), у женщин – ОР=1,95 (95% ДИ 0,984–3,887). Риск развития инсульта был выше среди одиноких, разведенных и овдовевших мужчин – ОР=4,2 (95% ДИ 1,5–13,2), и у женщин со средним или начальным образованием – ОР=3 (95% ДИ 0,852–11,039).
Заключение. Установлено, что высокий уровень стресса на работе гендерно не различается; риск развития ИМ за 16-летний период был выше у женщин, чем у мужчин, риск развития инсульта – выше у мужчин; на риск ИМ и инсульта у обоих полов влияет социальный градиент.
Ключевые слова: гендерные различия, инфаркт миокарда, инсульт, стресс на работе, риск развития.
________________________________________________
Materials and methods. A random representative sample of the population of both sexes of 25–64 years old in Novosibirsk in 1994 (men: n=657, 44.3±0.4 years, response – 82.1%, women: n=689, 45.4±0.4 years, response – 72.5%). The screening survey program included: registration of socio-demographic data, determination of stress at work (Karazek scale). The period of prospective follow-up of participants was 16 years. The study identified the following "end points": the first cases of myocardial infarction (MI), stroke.
Results. A high level of stress at work was in 29.5% of men and 31.6% of women, the average level in 48.9% of men and 50.7% of women (χ2=2.574, υ=2, p=0.276). The risk of developing MI for a 16-year period, among people experiencing stressful situations at work, was: in men, HR=3.592, and women HR=3.218 (95% CI 1.146–9.042); stroke risk – among men, HR=2.603 (95% CI 1.06–4.153) in women HR=1.956 (95% CI 1.008–3.795). In multivariate analysis, in men with stress at work, the risk of MI among men was HR=1.15 (95% CI 0.6–2.2), among women – HR=2.543 (95% CI 1.88–7.351); risk of stroke, was in men, HR=3.8 (95% CI 1.6–8.8), in women – HR=1.95 (95% CI 0.984–3.887). The risk of stroke was higher among single, divorced and widowed men, HR=4.2 (95% CI 1.5–13.2), and in women with secondary or primary education, HR=3 (95% CI 0.852–11.039).
Conclusion. It was established that a high level of stress at work is not gender-specific; the risk of developing MI over a 16-year period is higher in women than in men, stroke in men; the risk of myocardial infarction and stroke in both sexes is affected by the social gradient.
Keywords: gender, men, women, myocardial infarction, stroke, stress at work relative risk.
Список литературы
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11. Backe EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Archives of Occupational and Environmental Health. 2012;85:67-79. doi:10.1007/s00420-011-0643-6
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14. Glants С. Biomedical statistics. Transl From eng. М.: Practika; 1998; 459 p.
15. Cox DR. Regression Models and Life Tables. J Royal Statistical Society Series B. 1972;34:187-220.
16. Li J, Loerbroks A, Bosma H, Angerer P. Work stress and cardiovascular disease: a life course perspective. J Occup Health. 2016;58(2):216-9. doi:10.1539/joh.15-0326-OP
17. Schnall PL, Dobson M, Landsbergis P. Globalization, Work, and Cardiovascular Disease. Int J Health Serv. 2016;46(4):656-92. doi:10.1177/0020731416664687
18. Sabbath EL, Mejía-Guevara I, Noelke C, et al. The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers. Soc Sci Med. 2015;146:111-9. doi:10.1016/j.socscimed.2015.10.024
19. Slopen N, Glynn RJ, Buring JE, Lewis TT, Williams DR, Albert MA. Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women’s Health Study: Results from a 10-Year Prospective Study. PLoS One. 2012;7(7): e40512. doi:10.1371/journal.pone.0040512
20. Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002;325(7369):857. PMCID: PMC129630. PMID: 12386034
21. Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H, Hu Y, Liu T.The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med. 2015;47(6):512-8. doi:10.3109/07853890.2015.1075658
22. Potocka A. What do we know about psychosocial risk factors at work? Part I. Theoretical considerations. Med Pr. 2010;61(3):341-52.
2. Gazlano TA. Reducing the growing burden of cardiovascular disease in the developing world. Health Affairs. 2007;26:13-24. doi:10.1377/hlthaff.26.1.13
3. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469-500. doi:10.1146/annurev.publhealth.26.021304.144542
4. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237-46. doi:10.1016/j.jacc.2007.12.024
5. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953-62. doi:10.1016/S0140-6736(04)17019-0
6. Aboderin I, Kalache A, Ben Shlomo Y, et al. Life Course Perspectives on Coronary Heart Disease, Stroke and Diabetes: Key issues and implications for policy and research. Geneva: World Health Organisation. [Online]. 2002 [cited 2015 Dec. 2]; Available from: URL: http://apps.who.int/iris/bitstream/10665/67174/1/WHO_NMH_NPH_02.1.pdf
7. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med. 2002;2:267-314. doi:10.1055/s-2002-35401
8. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192-217.
9. Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health. 1994;15:381-411. doi:10.1146/ annurev.pu.15.050194.002121
10. Eller NH, Netterstrom B, Gyntelberg F, Kristensen TS, Nielsen F, et al. Work-related psychosocial factors and the development of ischemic heart disease: a systematic review. Cardiol Rev. 2009;17:83-97. doi:10.1097/CRD.0b013e318198c8e9
11. Backe EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Archives of Occupational and Environmental Health. 2012;85:67-79. doi:10.1007/s00420-011-0643-6
12. MONICA Monograph and Multimedia Sourcebook. Helsinki, 2003; 237 p.
13. Byuyul A, TsYofel P. SPSS: iskusstvo obrabotki informatsii. Analiz statisticheskih dannyih i vosstanovlenie skryityih zakonomernostey. SPb.: OOO “DiaSoftYuP”. 2015; p. 608 (In Russ.)
14. Glants С. Biomedical statistics. Transl From eng. М.: Practika; 1998; 459 p.
15. Cox DR. Regression Models and Life Tables. J Royal Statistical Society Series B. 1972;34:187-220.
16. Li J, Loerbroks A, Bosma H, Angerer P. Work stress and cardiovascular disease: a life course perspective. J Occup Health. 2016;58(2):216-9. doi:10.1539/joh.15-0326-OP
17. Schnall PL, Dobson M, Landsbergis P. Globalization, Work, and Cardiovascular Disease. Int J Health Serv. 2016;46(4):656-92. doi:10.1177/0020731416664687
18. Sabbath EL, Mejía-Guevara I, Noelke C, et al. The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers. Soc Sci Med. 2015;146:111-9. doi:10.1016/j.socscimed.2015.10.024
19. Slopen N, Glynn RJ, Buring JE, Lewis TT, Williams DR, Albert MA. Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women’s Health Study: Results from a 10-Year Prospective Study. PLoS One. 2012;7(7): e40512. doi:10.1371/journal.pone.0040512
20. Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002;325(7369):857. PMCID: PMC129630. PMID: 12386034
21. Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H, Hu Y, Liu T.The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med. 2015;47(6):512-8. doi:10.3109/07853890.2015.1075658
22. Potocka A. What do we know about psychosocial risk factors at work? Part I. Theoretical considerations. Med Pr. 2010;61(3):341-52.
2. Gazlano TA. Reducing the growing burden of cardiovascular disease in the developing world. Health Affairs. 2007;26:13-24. doi:10.1377/hlthaff.26.1.13
3. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469-500. doi:10.1146/annurev.publhealth.26.021304.144542
4. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237-46. doi:10.1016/j.jacc.2007.12.024
5. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953-62. doi:10.1016/S0140-6736(04)17019-0
6. Aboderin I, Kalache A, Ben Shlomo Y, et al. Life Course Perspectives on Coronary Heart Disease, Stroke and Diabetes: Key issues and implications for policy and research. Geneva: World Health Organisation. [Online]. 2002 [cited 2015 Dec. 2]; Available from: URL: http://apps.who.int/iris/bitstream/10665/67174/1/WHO_NMH_NPH_02.1.pdf
7. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med. 2002;2:267-314. doi:10.1055/s-2002-35401
8. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192-217.
9. Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health. 1994;15:381-411. doi:10.1146/ annurev.pu.15.050194.002121
10. Eller NH, Netterstrom B, Gyntelberg F, Kristensen TS, Nielsen F, et al. Work-related psychosocial factors and the development of ischemic heart disease: a systematic review. Cardiol Rev. 2009;17:83-97. doi:10.1097/CRD.0b013e318198c8e9
11. Backe EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Archives of Occupational and Environmental Health. 2012;85:67-79. doi:10.1007/s00420-011-0643-6
12. MONICA Monograph and Multimedia Sourcebook. Helsinki, 2003; 237 p.
13. Бююль А, Цёфель П. SPSS: искусство обработки информации. Анализ статистических данных и восстановление скрытых закономерностей. СПб.: ООО «DiaSoftЮП». 2015; c. 608 [Byuyul A, TsYofel P. SPSS: iskusstvo obrabotki informatsii. Analiz statisticheskih dannyih i vosstanovlenie skryityih zakonomernostey. SPb.: OOO “DiaSoftYuP”. 2015; p. 608 (In Russ.)].
14. Glants С. Biomedical statistics. Transl From eng. М.: Practika; 1998; 459 p.
15. Cox DR. Regression Models and Life Tables. J Royal Statistical Society Series B. 1972;34:187-220.
16. Li J, Loerbroks A, Bosma H, Angerer P. Work stress and cardiovascular disease: a life course perspective. J Occup Health. 2016;58(2):216-9. doi:10.1539/joh.15-0326-OP
17. Schnall PL, Dobson M, Landsbergis P. Globalization, Work, and Cardiovascular Disease. Int J Health Serv. 2016;46(4):656-92. doi:10.1177/0020731416664687
18. Sabbath EL, Mejía-Guevara I, Noelke C, et al. The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers. Soc Sci Med. 2015;146:111-9. doi:10.1016/j.socscimed.2015.10.024
19. Slopen N, Glynn RJ, Buring JE, Lewis TT, Williams DR, Albert MA. Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women’s Health Study: Results from a 10-Year Prospective Study. PLoS One. 2012;7(7): e40512. doi:10.1371/journal.pone.0040512
20. Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002;325(7369):857. PMCID: PMC129630. PMID: 12386034
21. Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H, Hu Y, Liu T.The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med. 2015;47(6):512-8. doi:10.3109/07853890.2015.1075658
22. Potocka A. What do we know about psychosocial risk factors at work? Part I. Theoretical considerations. Med Pr. 2010;61(3):341-52.
________________________________________________
2. Gazlano TA. Reducing the growing burden of cardiovascular disease in the developing world. Health Affairs. 2007;26:13-24. doi:10.1377/hlthaff.26.1.13
3. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469-500. doi:10.1146/annurev.publhealth.26.021304.144542
4. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237-46. doi:10.1016/j.jacc.2007.12.024
5. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953-62. doi:10.1016/S0140-6736(04)17019-0
6. Aboderin I, Kalache A, Ben Shlomo Y, et al. Life Course Perspectives on Coronary Heart Disease, Stroke and Diabetes: Key issues and implications for policy and research. Geneva: World Health Organisation. [Online]. 2002 [cited 2015 Dec. 2]; Available from: URL: http://apps.who.int/iris/bitstream/10665/67174/1/WHO_NMH_NPH_02.1.pdf
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Авторы
В.В. Гафаров1,2, Е.А. Громова1,2, Д.О. Панов1,2, И.В. Гагулин1,2, А.В. Гафарова1,2
1 Научно-исследовательский институт терапии и профилактической медицины – филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук» (НИИТПМ – филиал ИЦиГ СО РАН), Новосибирск, Россия;
2 Межведомственная лаборатория эпидемиологии сердечно-сосудистых заболеваний, Новосибирск, Россия
1 Research Institute of Therapy and Preventive Medicine – a Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (IIPM – Branch of IC&GSB RAS), Novosibirsk, Russia;
2 Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
1 Научно-исследовательский институт терапии и профилактической медицины – филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук» (НИИТПМ – филиал ИЦиГ СО РАН), Новосибирск, Россия;
2 Межведомственная лаборатория эпидемиологии сердечно-сосудистых заболеваний, Новосибирск, Россия
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1 Research Institute of Therapy and Preventive Medicine – a Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences (IIPM – Branch of IC&GSB RAS), Novosibirsk, Russia;
2 Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
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