Siegrist J, Peter R, Junge A, Cremer P, Seidel D
Department of Medical Sociology, Medical School, University of Marburg, F.R.G.
Soc Sci Med. 1990;31(10):1127-34. doi: 10.1016/0277-9536(90)90234-j.
An inverse relation between socio-economic class and occurrence of ischemic heart disease (IHD) in advanced societies is an often replicated finding from empirical studies. Yet, the processes which produce these effects remain an open question. One promising explanation concerns the prevalence of stressful working life, especially of distinct 'job strain' occupations. Based on these considerations, we develop a refined concept of work-related socio-emotional distress which considers a mismatch between high workload and low control over occupational status (e.g. job insecurity, poor promotion prospects, status inconsistency) as crucial distress-provoking conditions. Moreover, we assume that the effect of this condition on IHD risk is substantially increased by the presence of a distinct individual pattern of coping with work demand ('need for control'). Based on data from a 6.5 years prospective study on IHD incidence (n = 21) in a cohort of 416 middle-aged blue-collar men this concept is tested using logistic regression analysis. Results indicate that status inconsistency [multivariate odds ratio (o.r.): 4.4], job insecurity (o.r. 3.4), work pressure (o.r. 3,4) and 'need for control' (o.r. 4,5) independently predict IHD occurrence after adjusting for major confounding somatic and behavioral coronary risk factors. In conclusion, a refined model of work-related socio-emotional distress substantially contributes to the explanation of high IHD incidence among blue-collar men.
在发达社会中，社会经济阶层与缺血性心脏病（IHD）的发生之间存在反比关系，这是实证研究中经常重复出现的发现。然而，产生这些影响的过程仍然是一个悬而未决的问题。一个有前景的解释涉及压力大的工作生活的普遍性，尤其是独特的“工作压力”职业。基于这些考虑，我们提出了一个与工作相关的社会情感困扰的精细概念，该概念将高工作量与对职业地位的低控制之间的不匹配（例如工作不安全感、晋升前景不佳、地位不一致）视为关键的困扰诱发条件。此外，我们假设这种状况对IHD风险的影响会因应对工作需求的独特个人模式（“控制需求”）的存在而大幅增加。基于对416名中年蓝领男性队列进行的为期6.5年的IHD发病率前瞻性研究（n = 21）的数据，使用逻辑回归分析对这一概念进行了检验。结果表明，在对主要的混杂躯体和行为性冠状动脉危险因素进行调整后，地位不一致[多变量优势比（o.r.）：4.4]、工作不安全感（o.r. 3.4）、工作压力（o.r. 3.4）和“控制需求”（o.r. 4.5）独立预测IHD的发生。总之，一个与工作相关的社会情感困扰的精细模型对解释蓝领男性中高IHD发病率有很大贡献。
