From the Department of Social and Behavioral Sciences (Trudel-Fitzgerald, Kawachi, Kubzansky), Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine (Poole, Tworoger), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Clinical Sciences, Obstetrics and Gynecology (Idahl), Umeå University, Umeå, Sweden; Department of Medical Biosciences, Pathology (Lundin), Umeå University, Umeå, Sweden; Department of Gynecologic Oncology and Reproductive Medicine (Sood), Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Department of Epidemiology (Tworoger), Harvard T.H. Chan School of Public Health Boston, Massachusetts.
Psychosom Med. 2017 Nov/Dec;79(9):1059-1067. doi: 10.1097/PSY.0000000000000464.
Ovarian cancer (OvCA) is a leading cause of cancer death for women. Depression and social isolation have been associated with a higher OvCA risk and poorer survival, but other forms of chronic psychosocial stress, including work-related characteristics, remain understudied.
Women from three prospective cohorts (Nurses' Health Study: n = 31,754; Nurses' Health Study II: n = 74,260; Northern Sweden Health and Disease Study: nnested case-control study = 196) completed a job questionnaire, assessing demand and control at work, social support provided by coworkers and supervisor, and job security. Multivariate Cox and conditional logistic regression models estimated hazard ratios (Nurses' Health Study/Nurses' Health Study II) and odd ratios (Northern Sweden Health and Disease Study) of OvCA risk and mortality among cases. Random coefficient models were used for meta-analyses.
There were 396 OvCA cases and 186 deaths during follow-up. Overall, job strain, strain chronicity, social support, and job security were not significantly associated with OvCA risk (e.g., pooled relative risk [RR]high demand/low control = 1.06, confidence interval [CI] = 0.72-1.55) or mortality (e.g., pooled RRhigh demand/low control = 1.08, CI = 0.64-1.82). When considered individually, compared with low levels, only moderate levels of demand were associated with a reduced OvCA risk (pooled RR = 0.66, CI = 0.49-0.90). Social support provided by the coworker or the supervisor did not moderate the association of job strain with either OvCA risk or overall mortality.
We did not observe clear associations between work characteristics and OvCA incidence or mortality, but further research with diverse populations is warranted.
卵巢癌(OvCA)是导致女性癌症死亡的主要原因。抑郁和社会孤立与更高的 OvCA 风险和更差的生存相关,但其他形式的慢性心理社会压力,包括与工作相关的特征,仍研究不足。
来自三个前瞻性队列的女性(护士健康研究:n = 31754;护士健康研究 II:n = 74260;瑞典北部健康和疾病研究:巢式病例对照研究 = 196)完成了一份工作问卷,评估工作中的需求和控制、同事和主管提供的社会支持以及工作保障。多变量 Cox 和条件逻辑回归模型估计了病例 OvCA 风险和死亡率的风险比(护士健康研究/护士健康研究 II)和比值比(瑞典北部健康和疾病研究)。随机系数模型用于荟萃分析。
随访期间共有 396 例 OvCA 病例和 186 例死亡。总的来说,工作压力、压力持续性、社会支持和工作保障与 OvCA 风险(例如, pooled relative risk [RR]high demand/low control = 1.06,置信区间 [CI] = 0.72-1.55)或死亡率(例如, pooled RRhigh demand/low control = 1.08,CI = 0.64-1.82)无显著相关性。单独考虑时,与低水平相比,仅中等水平的需求与降低 OvCA 风险相关(pooled RR = 0.66,CI = 0.49-0.90)。同事或主管提供的社会支持并没有调节工作压力与 OvCA 风险或总死亡率之间的关系。
我们没有观察到工作特征与 OvCA 发病率或死亡率之间的明确关联,但需要进一步研究不同人群。