Hemström Orjan
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden.
Scand J Public Health. 2005;33(2):131-7. doi: 10.1080/14034940410028389.
A study was undertaken to analyse the possible interaction between work environment and income for the probability of self-rated health being less than good.
Data from the Swedish Survey of Living Conditions for the years 1998 and 1999 were analysed. Employed 20- to 64-year-olds with a registered wage were included (n=5982). The synergy index (SI) was applied, using odds ratios from logistic regressions for men, women, and all. Low and high levels of physical demands, decision authority, skill discretion and psychological demands were separately combined with low- and high-wage income (median split). Full-time work and four sociodemographic factors were controlled for.
Significant synergy was found for women when they were exposed to low income and a low level of skill discretion (SI=1.46 [1.01-2.13]), although this was attenuated by education level (SI=1.47 [0.96-2.25]). In general (both sexes), poor health caused by low income and unfavourable work is additive rather than multiplicatively exaggerating the risk among the jointly exposed.
Work exposures in the form of high physical load, low levels of decision authority and skill discretion, or a high level of psychological demands were significantly related to poor health also when income was high, suggesting that high income does not seem to buffer the detrimental effects of adverse working conditions. As nearly half of employed women were found to be in circumstances marked by synergy, it seems a relevant public health issue to improve these women's conditions at work, by simultaneously increasing, for example, job variety and wages.
开展一项研究，分析工作环境与收入之间可能的相互作用对自我评定健康状况不佳可能性的影响。
对1998年和1999年瑞典生活条件调查的数据进行分析。纳入有登记工资的20至64岁就业人员（n = 5982）。应用协同指数（SI），使用男性、女性及全体人员逻辑回归的比值比。分别将低水平和高水平的体力需求、决策自主权、技能裁量权和心理需求与低工资和高工资收入（中位数分割）相结合。对全职工作和四个社会人口学因素进行了控制。
女性在面临低收入和低技能裁量权水平时发现有显著协同作用（SI = 1.46 [1.01 - 2.13]），不过这一作用因教育水平而减弱（SI = 1.47 [0.96 - 2.25]）。总体而言（男女皆是），低收入和不良工作导致的健康不佳是累加性的，而非在共同暴露人群中以相乘方式夸大风险。
即使收入较高，以高体力负荷、低决策自主权和技能裁量权水平或高心理需求形式存在的工作暴露也与健康不佳显著相关，这表明高收入似乎无法缓冲不良工作条件的有害影响。由于发现近一半的就业女性处于存在协同作用的环境中，通过同时增加例如工作多样性和工资等方式来改善这些女性的工作条件似乎是一个相关的公共卫生问题。
