Section of Epidemiology, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark.
Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden.
Eur Heart J. 2019 Apr 7;40(14):1124-1134. doi: 10.1093/eurheartj/ehy683.
To assess the associations between bullying and violence at work and cardiovascular disease (CVD).
Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates.
Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.
评估工作场所欺凌和暴力与心血管疾病（CVD）之间的关联。
参与者为 79201 名年龄在 18-65 岁之间、无 CVD 的瑞典和丹麦三队列研究中的在职男性和女性。使用自我报告在基线时测量工作场所欺凌和暴力的暴露情况。参与者与全国性健康和死亡登记处相关联，以确定包括冠心病和脑血管病在内的新发 CVD。使用边缘结构 Cox 回归估计特定研究的结果，并使用固定效应荟萃分析进行合并。9%的人报告在工作中受到欺凌，13%的人报告在过去一年中遭受过工作场所暴力。我们记录了 3229 例新发 CVD 病例，平均随访时间为 12.4 年（前 4 年中有 765 例）。在校正年龄、性别、出生地、婚姻状况和教育水平后，与未受欺凌相比，在职场中受欺凌与 CVD 的风险比（HR）为 1.59（95%置信区间[CI]为 1.28-1.98）。与未遭受工作场所暴力相比，遭受工作场所暴力与 CVD 的 HR 为 1.25（95%CI 为 1.12-1.40）。工作场所欺凌的人群归因风险为 5.0%，工作场所暴力为 3.1%。在不同随访时间、心血管风险分层以及进一步调整后的分析中，超额风险仍然相似。对工作场所欺凌和暴力都观察到了剂量-反应关系（Ptrend <0.001）。特定研究的估计值之间几乎没有异质性。
工作场所欺凌和暴力很常见，暴露于这些压力源的人患 CVD 的风险更高。
