Department of Civil, Constructional and Environmental Engineering, Sapienza University of Rome, Roma, Italy
Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy.
BMJ Open. 2020 Jun 3;10(6):e033776. doi: 10.1136/bmjopen-2019-033776.
Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study.
Cohort study.
Rome, capital of Italy.
We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15-65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition.
We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women.
We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively).
This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.
社会经济不平等对全球人口健康有很大影响。在富裕社会中，职业地位是健康的重要决定因素。我们旨在通过一项大型都市研究调查职业与死亡率之间的关系。
队列研究。
意大利罗马。
我们使用了罗马纵向研究，这是 2001 年总人口普查时罗马居民的行政队列，一直随访到 2015 年。我们选择了基线时年龄在 15-65 岁之间的居民。对于每个受试者，我们根据意大利普查的分类标准，获得了有关性别、年龄和职业（职业状况和工作类型）的信息。
我们研究了全因、癌症、心血管和意外死亡率，这是工作年龄人群的主要死因。我们使用 Cox 比例风险模型调查了职业与全因和特定原因死亡率之间的关系，分别在男性和女性中进行分析。
我们选择了 1466726 名受试者（52.1%为女性）。42715 名男性和 29915 名女性在随访期间死亡。在男性中，47.8%的死亡归因于癌症，26.7%归因于心血管原因，6.4%归因于意外事故，而在女性中，57.8%的死亡归因于癌症，19.3%归因于心血管原因，3.5%归因于意外事故。我们发现职业变量与死亡率之间存在关联，这种关联在男性中比女性中更为明显。与就业者相比，失业者的全因死亡率更高，男性的风险比（HR）为 1.99（95%CI 1.92 至 2.06），女性的 HR 为 1.49（95%CI 1.39 至 1.60）。与高技能非体力劳动者相比，非专业体力劳动者的死亡率风险更高（男性的 HR 分别为 1.68（95%CI 1.59 至 1.77）和 1.30（95%CI 1.20 至 1.40），女性的 HR 分别为 1.68（95%CI 1.59 至 1.77）和 1.30（95%CI 1.20 至 1.40）。
本研究表明职业变量作为社会健康决定因素的重要性，并为决策者提供了证据，证明有必要制定综合和预防性政策，以改善生活和工作环境的安全性。
