Piros S, Karlehagen S, Lappas G, Wilhelmsen L
Section of Preventive Cardiology, Heart and Lung Institute, Göteborg University, Göteborg, Sweden.
J Cardiovasc Risk. 2000 Oct;7(5):389-94. doi: 10.1177/204748730000700512.
Several earlier investigations have found an increased incidence of myocardial infarction among male drivers and, not least, among railway engine drivers. In a previous study we found that increased serum cholesterol, blood pressure or tobacco smoking did not explain this increased risk.
To investigate psychosocial factors and primarily work-related factors among male engine drivers.
Engine drivers were compared with random population samples in a cross-sectional study.
Two thousand three hundred and eighteen engine drivers aged 25-59 years were compared with 331 randomly selected men who were mainly from the Göteborg MONICA population study. Job demands and job decision latitude as well as social support were the main factors compared.
Job demands were reported as being significantly lower by both younger and older engine drivers compared to their referents (P = 0.002 and P = 0.0001, respectively). Decision latitude was reported as being lower by both younger and older engine drivers than among controls (P = 0.0001 for both groups). Engine drivers experienced deficient support from their superiors compared to the referents (P = 0.0001 for younger as well as older engine drivers). Low decision latitude was associated with significantly higher diastolic blood pressure (r = -0.11 and P = 0.0001), but otherwise there were no significant relationships between psychosocial work characteristics and somatic risk factors.
The combination of low decision latitude and low social support seems to be a key factor in the increased risk of myocardial infarction among railway engine drivers. They generally undertake shift work which may be an additional risk factor for myocardial infarction.
早期的几项调查发现，男性司机，尤其是铁路机车司机中心肌梗死的发病率有所上升。在之前的一项研究中，我们发现血清胆固醇升高、血压升高或吸烟并不能解释这种风险的增加。
调查男性机车司机的心理社会因素，主要是与工作相关的因素。
在一项横断面研究中，将机车司机与随机抽取的人群样本进行比较。
将2318名年龄在25至59岁之间的机车司机与331名主要来自哥德堡莫尼卡人群研究的随机抽取的男性进行比较。比较的主要因素包括工作要求、工作决策自由度以及社会支持。
与各自的对照人群相比，年轻和年长的机车司机报告的工作要求均显著更低（分别为P = 0.002和P = 0.0001）。年轻和年长的机车司机报告的决策自由度均低于对照组（两组均为P = 0.0001）。与对照人群相比，机车司机从上级那里得到的支持不足（年轻和年长的机车司机均为P = 0.0001）。低决策自由度与舒张压显著升高相关（r = -0.11，P = 0.0001），但除此之外，心理社会工作特征与躯体危险因素之间没有显著关系。
决策自由度低和社会支持低的组合似乎是铁路机车司机中心肌梗死风险增加的关键因素。他们通常从事轮班工作，这可能是心肌梗死的另一个危险因素。
