Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America.
Department of Public Health Sciences, Loyola University Medical Center, Maywood, IL, United States of America.
PLoS One. 2018 Nov 27;13(11):e0207652. doi: 10.1371/journal.pone.0207652. eCollection 2018.
The American Heart Association's 2020 Impact Goals propose to improve cardiovascular health (CVH) and reduce deaths from cardiovascular diseases and stroke in the US. Targeted health promotion efforts in workplaces and communities are needed to achieve these population-level changes. The present study examined the sex-specific cross-sectional associations between employment status and ideal CVH among Hispanics/Latinos, and whether these associations were modified by age (i.e., younger adults [aged 18-44] compared to middle-aged and older adults [aged 45-74]).
This study included 4,797 males and 7,043 females (aged 18-74) from the Hispanic Community Health Study / Study of Latinos. Employment status was categorized as employed full-time (FT), employed part-time (PT), employed (FT or PT) and homemakers, homemakers only, and unemployed. CVH metrics, operationalized as 'ideal' versus 'less than ideal,' included health factors (i.e., blood pressure, cholesterol, and fasting glucose) and health behaviors (i.e., body mass index, smoking, physical activity [PA], and diet). A total CVH score was derived based on the seven CVH metrics, and dichotomized as ideal vs. less than ideal (score of 11-14 vs. 0-10). Survey-based generalized linear regression models with Gaussian binomial distribution were used to estimate adjusted prevalence differences (APDs) and their 95% confidence intervals (CIs) for the associations between employment status (with employed FT as referent) and ideal CVH (total score and each metric), adjusting for socio-demographic characteristics. Effect modification by age was examined.
Among males, compared to their employed FT counterparts, those who were employed PT had a higher prevalence of ideal CVH score (APD = 6.8, 95% CI = 1.7, 11.8), ideal BMI (APD = 8.5, 95% CI = 3.0, 14.0), and ideal PA (APD = 4.8, 95% CI = 0.9, 8.7). Age modified the associations of employment type with ideal CVH score and ideal BMI, i.e., younger males who were employed PT had a higher prevalence of ideal CVH score and ideal BMI. Among females, employment status was not associated with ideal CVH score. Compared to females employed FT, females who were homemakers had a lower prevalence of ideal (non-) smoking (APD = -4.7, 95% CI = -8.5, -1.0) and ideal PA (APD = -7.9, 95% CI = -12.7, -3.0), and females who were unemployed had a lower prevalence of ideal PA (APD = -10.4, 95% CI = -16.7, -4.1). Age modified the associations of employment type with ideal fasting glucose and ideal PA, i.e., middle-aged and older females who were homemakers or unemployed had a lower prevalence of ideal fasting glucose and ideal PA.
Hispanic/Latino males who were employed PT had the most favorable CVH profiles but these associations were mostly driven by better CVH (total score and metrics) among younger males. Hispanic/Latino females who were homemakers or unemployed had lower rates of ideal CVH metrics.
美国心脏协会 2020 年的目标是改善美国的心血管健康状况并降低心血管疾病和中风的死亡率。需要在工作场所和社区开展有针对性的健康促进工作，以实现这些人口层面的变化。本研究调查了西班牙裔/拉丁裔人群中就业状况与理想心血管健康状况之间的横断面关联，以及这些关联是否因年龄而异（即，与中年和老年成年人[年龄 45-74 岁]相比，年轻成年人[年龄 18-44 岁]）。
这项研究包括来自西班牙裔社区健康研究/拉丁裔研究的 4797 名男性和 7043 名女性（年龄在 18-74 岁之间）。就业状况分为全职（FT）、兼职（PT）、就业（FT 或 PT）和家庭主妇、仅家庭主妇和失业。心血管健康指标的定义为“理想”与“不理想”，包括健康因素（即血压、胆固醇和空腹血糖）和健康行为（即体重指数、吸烟、身体活动[PA]和饮食）。根据七个心血管健康指标得出了一个总的心血管健康评分，并将其分为理想和不理想（评分 11-14 与 0-10）。采用基于问卷调查的广义线性回归模型和正态二项式分布来估计就业状况（以就业 FT 为参照）与理想心血管健康状况（总分和每个指标）之间的调整后的流行率差异（APD）及其 95%置信区间（CI），同时调整了社会人口统计学特征。检验了年龄的调节作用。
在男性中，与全职就业的男性相比，兼职就业的男性具有更高的理想心血管健康评分（APD = 6.8，95%CI = 1.7，11.8）、理想体重指数（APD = 8.5，95%CI = 3.0，14.0）和理想身体活动（APD = 4.8，95%CI = 0.9，8.7）。年龄改变了就业类型与理想心血管健康评分和理想体重指数之间的关联，即年轻男性兼职就业的比例越高，他们的理想心血管健康评分和理想体重指数就越高。在女性中，就业状况与理想心血管健康评分无关。与就业 FT 的女性相比，家庭主妇的女性具有较低的理想（非）吸烟（APD = -4.7，95%CI = -8.5，-1.0）和理想身体活动（APD = -7.9，95%CI = -12.7，-3.0）的比例，失业的女性具有较低的理想身体活动（APD = -10.4，95%CI = -16.7，-4.1）的比例。年龄改变了就业类型与理想空腹血糖和理想身体活动之间的关联，即中年和老年女性中，家庭主妇或失业的女性具有较低的理想空腹血糖和理想身体活动的比例。
西班牙裔/拉丁裔男性中兼职就业的男性具有最有利的心血管健康状况，但这些关联主要是由年轻男性更好的心血管健康（总分和指标）驱动的。西班牙裔/拉丁裔女性中家庭主妇或失业的女性具有较低的理想心血管健康指标。
