Transcript 27th International Congress on Occupationall Health

L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage
27th International Congress on
Occupational Health
Iguassu Falls, Brazil
ICOH-Symposium on Psychosocial Factors
Tage S. Kristensen
Psychosocial Department
National Institute of Occupational Health
Copenhagen, Denmark
Cardiovascular mortality for Danish men.
SMR
Farmers
Architects
Military officers
Professors
Gardeners
Doctors
67
68
69
71
75
77
All employed men
100
Journalists
Sailors
Bus drivers
Cooks
Waiters
Salvage corps drivers
Restaurant owners
Taxi drivers
121
122
127
135
150
150
162
185
Heart disease and work
”Little is known about occupational risks
for coronary heart disease”
Kyle Steenland. NIOSH. Am J Ind Med 1996;30:495-9
The connection between
work and CVD
General model for the relationship between
work environment and cardiovascular
diseases
WORK
ENVIRONMENT
1
CVD risk factors:
Diet obesity,
blood pressure,
smoking etc.
3
THE SIGNIFICANCE OF WORK: 1+3
2
CARDIOVASCULAR
DISEASES
Work and death
How many deaths are due to working conditions?
Men
Women
Total
Death, all causes
10%
2%
7%
Heart disease
19%
9%
17%
Stroke
12%
8%
11%
Cancer
14%
2%
8%
Respiratory diseases
7%
1%
4%
Accidents, violence
4%
0.4%
3%
All proportions apply to Finland
Nurminen & Karjalainen. Scand J Work Environ Health 2001;27:161-213.
The impact of work on
cardiovascular diseases
Etiologic fraction
Men
16%
Women
22%
Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10
Etiologic fraction
IHD
17%
Stroke
11%
Nurminen & Karjalainen. Scand J Work Environ Helath 2001;27:161-213.
Empirical evidence
Etiological fractions of work environment for
cardiovascular diseases in Denmark
Risk factor
”Sedentary” work
Job Stressors
Shift & night work
Noise
Chemical exposures
Passive smoking
All factors
All factors except sedentary work
Proportion of CVD
Men
Women
42%
42%
6%
7%
1%
14%
7%
1%
0-1%
2%
51%
16%
0%
2%
55%
22%
(Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10)
Standardized Hospitalization Ratios (SHR’s) for IHD
among Danish men aged 20-59 years
(4 years of follow-up. N=407,000)
SHR
250
215
193
200
168
172
24 hour
rosters
Other
irregular
150
100
100
50
0
Day
Night
Late
evening
(Tüchsen. Int J Epidemiol 1993;22:215-21)
Relative risk of IHD among shift workers
15 years of follow-up
RR
33
2.8
2,5
2.5
2.2
2
2
1.5
1,5
1.5
1
1
0.4
0,5
0.5
00
0
2-5
6-10
11-15
16-20
Years of shift work
(Knutsson et al. Lancet 1986;II:89-92
21+
Work noise and AMI
A case control study of 395 cases and 2,148 controls from Berlin.
4
OR (adjusted)
3.8
3,5
3.5
3
2,5
2.5
2.0
2
1.4
1,5
1.5
11
1.0
0,5
0.5
0
Noise level:
Type writer
El. lawn mower
El. drill
Ising et al. Soz Präventivmed 1997;42:216-22.
Road drill
The two main psychosocial models on work
and CVD
The job strain model
– demands
– control
– support
The effort reward imbalance model
– effort (extrinsic)
– rewards (money, esteem, career opportunities)
– personality (instrincis effort – overcommitment)
Good – but not excellent – empirical support for the two models
Hospital admission for CVD in a group of
unemployed men compared with a control group
RR
1.6
1,6
1.60
1.4
1,4
1.2
1,2
1.04
1
0.8
0,8
0.80
0,6
0.6
0,4
0.4
0,2
0.2
0
Before
factory closure
(2 years)
During
factory closure
(3 years)
(Iversen et al. BMJ 1989;299:1073-6)
After
factory closure
(3 years)
Issues in research
and prevention
The cardiovascular tradition from
Framingham and onwards.
Risk factors are individual.
Physiological:
Behavioral:
• Cholesterol
• Smoking
• Fibrinogen
• Physical inactivity
• Triglycerides
• Type A
• Glucose
• Salt intake
• Blood pressure
• Diet
• Heart rate
• Alcohol
• Obesity
The individualistic bias of cardiovascular
epidemiology and prevention
Sampling:
Representative samples of individuals
Variables:
Physiological and behavioral factors
Risk factors: Individual characteristics (e.g. high
cholesterol) or behaviors (e.g. smoking)
Prevention
strategies:
Interventions aiming at the individual:
High risk intervention or mass intervention
The missing connection between
cardiovascular and occupational medicine
Occupational medicine
focuses on:
Preventive cardiology
focuses on:





–





–
Cancer
Lung diseases
Musculoskeletal disorders
Reproductive disorders
Allergies
but not CVD
Tobacco
Cholesterol
Blood pressure
Physical activity
Diet
but not work environment
The basic dimensions of stressors at work
The ”Copenhagen Stress Model”
• Influence
(with regard to the conditions of daily work)
• Meaning
(purpose and connection to the overall production)
• Predictability
(relevant information about future changes and events)
• Social support
(from supervisors and colleagues)
• Rewards
(salary, appreciation, and possibilities for a good and secure future)
• Demands
(quantitative and qualitative)
Kristensen. Scand J Work Environ Health 1999;25:550-557.
Topics for future research
Human service work:
Emotional demands
?
Burnout fatigue
?
CVD
New organisations:
Work without limits
?
Workaholism
?
CVD
Unstable labour markets:
Downsizing, unemployment, temporary work
?
Uncertainty, stress
?
CVD
Causal network for CVD
Individual
SES
&
Occupation
Social &
Environmental
Factors
Behavior
Job strain
Physical
activity
Fitness
Cholesterol
Atherosclerosis
Social
isolation
Tobacco
Obesity
Blood
pressure
Thrombosis
Unemployment
Diet
Type A
Fibrinogen
Arrhythmia
Noise
Alcohol
Stress
Glucose
ECGchanges
characteristics Physiology
Upstream
Downstream
Precursors
CVD
Integrated prevention at
the workplace
Health
promotion
Work
environment
improvements
Workplace
rehabilitation
This presentation can be found at:
www.ami.dk/presentations