Bohley Stefanie, Kluttig Alexander, Werdan Karl, Nuding Sebastian, Greiser Karin Halina, Kuss Oliver, Markus Marcello Ricardo Paulista, Schmidt Carsten Oliver, Völzke Henry, Krabbe Christine, Haerting Johannes
Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
BMJ Open. 2016 Jan 4;6(1):e008703. doi: 10.1136/bmjopen-2015-008703.
Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German reunification were associated with an increase in cardiovascular risk factors and cardiovascular diseases (CVDs).
Cross-sectional data from 2 cohort studies in East Germany were used: Cardiovascular Disease, Living and Ageing in Halle Study (CARLA), and Study of Health in Pomerania (SHIP).
2 populations in East Germany.
CARLA study: 1779 participants, aged 45-83 years at baseline (812 women), SHIP study: 4308 participants, aged 20-79 years at baseline (2193 women).
Psychosocial stressors related to reunification were operationalised by the Reunification Stress Index (RSI; scale from 0 to 10). This index was composed of questions that were related to individually perceived changes in psychosocial stressors (occupational, financial and personal) after reunification. To examine the associations between the RSI and each stressor separately with cardiovascular risk factors and CVD, regression models were used.
RSI was associated with CVD in women (RR=1.15, 95% CI 1.00 to 1.33). Cardiovascular risk factors were associated with RSI for both men and women, with strongest associations between RSI and diabetes in women (RR=1.10, 95% CI 1.01 to 1.20) and depressive disorders in men (RR=1.15, 95% CI 1.07 to 2.77). The change in occupational situation related to reunification was the major contributing psychosocial stressor. We observed a strong association with CVD in women who experienced occupational deterioration after reunification (RR=4.04, 95% CI 1.21 to 13.43).
Individually perceived deterioration of psychosocial stressors (occupational, financial and personal) related to German reunification was associated with cardiovascular risk factors and CVD. The associations were stronger for women than for men. An explanation for these findings could be that women were more often affected by unemployment after reunification. Morbidity and mortality follow-up of both cohorts could enhance the results.
旨在研究与德国统一相关的个体感知到的心理社会压力源变化与心血管影响之间的关系。我们假设，与德国统一相关的较高水平心理社会压力与心血管危险因素及心血管疾病（CVD）的增加有关。
使用了东德两项队列研究的横断面数据：哈雷心血管疾病、生活与衰老研究（CARLA）以及波美拉尼亚健康研究（SHIP）。
东德的两个人口群体。
CARLA研究：1779名参与者，基线年龄为45 - 83岁（812名女性）；SHIP研究：4308名参与者，基线年龄为20 - 79岁（2193名女性）。
与统一相关的心理社会压力源通过统一压力指数（RSI；范围从0到10）来衡量。该指数由与统一后个体感知到的心理社会压力源（职业、财务和个人方面）变化相关的问题组成。为了分别研究RSI与每个压力源与心血管危险因素及CVD之间的关联，使用了回归模型。
RSI与女性的CVD相关（风险比[RR]=1.15，95%置信区间[CI]为1.00至1.33）。心血管危险因素在男性和女性中均与RSI相关，其中RSI与女性糖尿病之间的关联最强（RR=1.10，95%CI为1.01至1.20），与男性抑郁症之间的关联最强（RR=1.15，95%CI为1.07至2.77）。与统一相关的职业状况变化是主要的心理社会压力源。我们观察到统一后经历职业恶化的女性与CVD之间存在强烈关联（RR=4.04，95%CI为1.21至13.43）。
与德国统一相关的个体感知到的心理社会压力源（职业、财务和个人方面）恶化与心血管危险因素及CVD相关。这些关联在女性中比在男性中更强。对这些发现的一种解释可能是，统一后女性更常受到失业影响。对两个队列的发病率和死亡率进行随访可能会增强研究结果。
