Peter R, Siegrist J, Hallqvist J, Reuterwall C, Theorell T
Department of Medical Sociology, University of Ulm, Am Hochstraess 8, D-89081 Ukm, Germany.
J Epidemiol Community Health. 2002 Apr;56(4):294-300. doi: 10.1136/jech.56.4.294.
Associations between two alternative formulations of job stress derived from the effort-reward imbalance and the job strain model and first non-fatal acute myocardial infarction were studied. Whereas the job strain model concentrates on situational (extrinsic) characteristics the effort-reward imbalance model analyses distinct person (intrinsic) characteristics in addition to situational ones. In view of these conceptual differences the hypothesis was tested that combining information from the two models improves the risk estimation of acute myocardial infarction.
951 male and female myocardial infarction cases and 1147 referents aged 45-64 years of The Stockholm Heart Epidemiology (SHEEP) case-control study underwent a clinical examination. Information on job stress and health adverse behaviours was derived from standardised questionnaires.
Multivariate analysis showed moderately increased odds ratios for either model. Yet, with respect to the effort-reward imbalance model gender specific effects were found: in men the extrinsic component contributed to risk estimation, whereas this was the case with the intrinsic component in women. Controlling each job stress model for the other in order to test the independent effect of either approach did not show systematically increased odds ratios. An improved estimation of acute myocardial infarction risk resulted from combining information from the two models by defining groups characterised by simultaneous exposure to effort-reward imbalance and job strain (men: odds ratio 2.02 (95% confidence intervals (CI) 1.34 to 3.07); women odds ratio 2.19 (95% CI 1.11 to 4.28)).
Findings show an improved risk estimation of acute myocardial infarction by combining information from the two job stress models under study. Moreover, gender specific effects of the two components of the effort-reward imbalance model were observed.
研究从努力-回报失衡和工作压力模型得出的两种不同形式的工作压力与首次非致命性急性心肌梗死之间的关联。工作压力模型关注情境（外在）特征，而努力-回报失衡模型除情境特征外，还分析个体（内在）特征。鉴于这些概念差异，对以下假设进行了检验：结合两个模型的信息可改善急性心肌梗死的风险估计。
斯德哥尔摩心脏流行病学（SHEEP）病例对照研究中的951例男性和女性心肌梗死病例以及1147名年龄在45 - 64岁的对照者接受了临床检查。工作压力和健康不良行为信息来自标准化问卷。
多变量分析显示，两种模型的优势比均适度增加。然而，关于努力-回报失衡模型，发现了性别特异性影响：在男性中，外在因素有助于风险估计，而在女性中，内在因素起作用。为检验任一方法的独立作用，对另一个工作压力模型进行控制时，未显示优势比有系统性增加。通过定义同时暴露于努力-回报失衡和工作压力的组，结合两个模型的信息，可改善急性心肌梗死风险估计（男性：优势比2.02（95%置信区间（CI）1.34至3.07）；女性：优势比2.19（95%CI 1.11至4.28））。
研究结果表明，结合所研究的两种工作压力模型的信息可改善急性心肌梗死的风险估计。此外，还观察到努力-回报失衡模型两个组成部分的性别特异性影响。
