Macleod J, Smith G D, Heslop P, Metcalfe C, Carroll D, Hart C
Department of Primary Care and General Practice, University of Birmingham, UK.
J Epidemiol Community Health. 2001 Dec;55(12):878-84. doi: 10.1136/jech.55.12.878.
To examine the association between perceived psychological stress and cause specific mortality in a population where perceived stress was not associated with material disadvantage.
Prospective observational study with follow up of 21 years and repeat screening of half the cohort five years from baseline. Measures included perceived psychological stress, coronary risk factors, and indices of lifecourse socioeconomic position.
27 workplaces in Scotland.
5388 men (mean age 48 years) at first screening and 2595 men at second screening who had complete data on all measures.
Hazard ratios for all cause mortality and mortality from cardiovascular disease (ICD9 390-459), coronary heart disease (ICD9 410-414), smoking related cancers (ICD9 140, 141, 143-9, 150, 157, 160-163, 188 and 189), other cancers (ICD9 140-208 other than smoking related), stroke (ICD9 430-438), respiratory diseases (ICD9 460-519) and alcohol related causes (ICD9 141, 143-6, 148-9, 150, 155, 161, 291, 303, 571 and 800-998).
At first screening behavioural risk (higher smoking and alcohol consumption, lower exercise) was positively associated with stress. This relation was less apparent at second screening. Higher stress at first screening showed an apparent protective relation with all cause mortality and with most categories of cause specific mortality. In general, these estimates were attenuated on adjustment for social position. This pattern was also seen in relation to cumulative stress at first and second screening and with stress that increased between first and second screening. The pattern was most striking with regard to smoking related cancers: relative risk high compared with low stress at first screening, age adjusted 0.64 (95% CI 0.42, 0.96), p for trend 0.016, fully adjusted 0.69 (95% CI 0.45, 1.06), p for trend 0.10; high compared with low cumulative stress, age adjusted 0.69 (95% CI 0.44, 1.09), p for trend 0.12, fully adjusted 0.76 (95% CI 0.48, 1.21), p for trend 0.25; increased compared with decreased stress, age adjusted 0.65 (95% CI 0.40, 1.06), p for trend 0.09, fully adjusted 0.65 (95% CI 0.40, 1.06), p for trend 0.08.
This implausible protective relation between higher levels of stress, which were associated with increased smoking, and mortality from smoking related cancers, was probably a product of confounding. Plausible reported associations between psychosocial exposures and disease, in populations where such exposures are associated with material disadvantage, may be similarly produced by confounding, and of no causal significance.
在一个感知压力与物质匮乏无关的人群中，研究感知到的心理压力与特定病因死亡率之间的关联。
前瞻性观察性研究，随访21年，并在基线后5年对一半队列进行重复筛查。测量指标包括感知到的心理压力、冠心病风险因素以及生命历程社会经济地位指数。
苏格兰的27个工作场所。
首次筛查时有5388名男性（平均年龄48岁），第二次筛查时有2595名男性，他们在所有测量指标上均有完整数据。
全因死亡率以及心血管疾病（国际疾病分类第九版390 - 459）、冠心病（国际疾病分类第九版410 - 414）、吸烟相关癌症（国际疾病分类第九版140、141、143 - 9、150、157、160 - 163、188和189）、其他癌症（国际疾病分类第九版140 - 208中除吸烟相关以外的）、中风（国际疾病分类第九版430 - 438）、呼吸系统疾病（国际疾病分类第九版460 - 519）和酒精相关病因（国际疾病分类第九版141、143 - 6、148 - 9、150、155、161、291、303、571和800 - 998）导致的死亡率的风险比。
在首次筛查时，行为风险（较高的吸烟和饮酒量、较低的运动量）与压力呈正相关。这种关系在第二次筛查时不太明显。首次筛查时较高的压力与全因死亡率以及大多数特定病因死亡率呈现出明显的保护关系。一般来说，在对社会地位进行调整后，这些估计值有所减弱。在首次和第二次筛查时的累积压力以及首次和第二次筛查之间压力增加的情况中也观察到了这种模式。在吸烟相关癌症方面这种模式最为显著：与首次筛查时低压力相比，高压力的相对风险较高，年龄调整后为0.64（95%可信区间0.42，0.96），趋势p值为0.016，完全调整后为0.69（95%可信区间0.45，1.06），趋势p值为0.10；与低累积压力相比，高累积压力的相对风险较高，年龄调整后为0.69（95%可信区间0.44，1.09），趋势p值为0.12，完全调整后为0.76（95%可信区间0.48，1.21），趋势p值为0.25；与压力降低相比，压力增加的相对风险较高，年龄调整后为0.65（95%可信区间0.40，1.06），趋势p值为0.09，完全调整后为0.65（95%可信区间0.40，1.06），趋势p值为0.08。
较高水平的压力与吸烟增加相关，但与吸烟相关癌症死亡率之间这种看似不合理的保护关系可能是混杂因素导致的。在心理社会暴露与物质匮乏相关的人群中，心理社会暴露与疾病之间看似合理的报道关联可能同样是由混杂因素导致的，并无因果意义。
