1 Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA.
2 Department of Public Health Graduate School of Medicine The University of Tokyo Japan.
J Am Heart Assoc. 2019 Mar 19;8(6):e011350. doi: 10.1161/JAHA.118.011350.
Background In contemporary Western settings, higher occupational class is associated with lower risk for cardiovascular disease ( CVD ) incidence, including coronary heart disease ( CHD ) and stroke. However, in non-Western settings (including Japan), the occupational class gradient for cardiovascular disease risk has not been characterized. Methods and Results Using a nationwide, multicenter hospital inpatient data set (1984-2016) in Japan, we conducted a matched hospital case-control study with ≈1.1 million study subjects. Based on a standard national classification, we coded patients according to their longest-held occupational class (blue-collar, service, professional, manager) within each industrial sector (blue-collar, service, white-collar). Using blue-collar workers in blue-collar industries as the referent group, odds ratios and 95% CI s were estimated by conditional logistic regression with multiple imputation, matched for sex, age, admission date, and admitting hospital. Smoking and drinking were additionally controlled. Higher occupational class (professionals and managers) was associated with excess risk for CHD . Even after controlling for smoking and drinking, the excess odds across all industries remained significantly associated with CHD , being most pronounced among managers employed in service industries (odds ratio, 1.19; 95% CI , 1.08-1.31). On the other hand, the excess CHD risk in higher occupational class was offset by their lower risk for stroke (eg, odds ratio for professionals in blue-collar industries, 0.77; 95% CI , 0.70-0.85). Conclusions The occupational "gradient" in cardiovascular disease (with lower risk observed in higher status occupations) may not be a universal phenomenon. In contemporary Japanese society, managers and professionals may experience higher risk for CHD .
在当代西方环境中，较高的职业阶层与较低的心血管疾病（CVD）发病风险相关，包括冠心病（CHD）和中风。然而，在非西方环境（包括日本）中，心血管疾病风险的职业阶层梯度尚未得到描述。
我们使用日本全国性多中心医院住院患者数据集（1984-2016 年）进行了一项匹配的医院病例对照研究，研究对象约为 110 万例。根据标准的国家分类，我们根据每位患者在每个工业部门（蓝领、服务业、专业人员、管理人员）中从事的最长职业类别（蓝领、服务业、白领）对其进行编码。以蓝领工人从事蓝领行业为参照组，采用条件逻辑回归和多重插补法，按性别、年龄、入院日期和入院医院进行匹配，估计比值比（OR）及其 95%置信区间（CI）。另外还控制了吸烟和饮酒情况。较高的职业阶层（专业人员和管理人员）与 CHD 风险增加相关。即使在控制了吸烟和饮酒情况后，各行业的超额 OR 与 CHD 仍存在显著相关性，在服务业从业的管理人员中最为显著（OR，1.19；95%CI，1.08-1.31）。另一方面，较高职业阶层患中风的风险较低，抵消了他们患 CHD 的风险增加（例如，蓝领行业的专业人员 OR，0.77；95%CI，0.70-0.85）。
心血管疾病的职业“梯度”（高地位职业的风险较低）可能不是普遍现象。在当代日本社会，管理人员和专业人员可能面临更高的 CHD 风险。
