From the Department of Health Sciences (Gilbert-Ouimet), Université du Québec à Rimouski, Lévis; Population Health and Optimal Health Practices Department (Gilbert-Ouimet, Brisson), Research Center FRQS of the CHU of Quebec City, Quebec; Institute for Work and Health (Mustard, Smith, Gilbert-Ouimet); Dalla Lana School of Public Health (Glazier, Mustard, Smith), University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology and Preventive Medicine (Smith), Monash University, Melbourne, Victoria, Australia; Institute for Clinical Evaluative Sciences (Glazier); Department of Family and Community Medicine (Glazier), University of Toronto and St. Michael's Hospital; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Glazier), St. Michael's Hospital, Toronto, Ontario; and Social and Preventive Medicine Department (Brisson), Laval University, Quebec City, Quebec, Canada.
Psychosom Med. 2021;83(2):187-195. doi: 10.1097/PSY.0000000000000898.
The American Diabetes Association recently called for research on social and environmental determinants of diabetes to intensify primary prevention. Recent epidemiological evidence suggests that frequent and modifiable psychosocial stressors at work might contribute to the development of diabetes, but more prospective studies are needed. We evaluated the relationship between job strain and diabetes incidence in 12,896 workers followed up over a 13-year period in Ontario, Canada. We also examined the modifying effect of body mass index in this relationship.
Data from Ontario respondents (35-74 years of age) to the 2000-2001, 2002, and 2003 cycles of the Canadian Community Health Survey were prospectively linked to the Ontario Health Insurance Plan database for physician services and the Canadian Institute for Health Information Discharge Abstract Database for hospital admissions. The sample consisted of actively employed participants with no previous diagnosis for diabetes. Cox proportional hazard regression models were performed to evaluate the relationship between job strain, obesity, and the incidence of diabetes.
Overall, job strain was not associated with the incidence of diabetes (hazard ratio [HR] = 1.05; 95% confidence interval [CI] = 0.83-1.34). Among women, job strain was associated with an elevated risk of diabetes, although this finding did not reach statistical significance (HR = 1.36; 95% CI = 0.94-1.96). Among men, no association was observed (HR = 0.89; 95% CI = 0.65-1.22). Also, job strain increased the risk of diabetes among women with obesity (HR = 1.88; 95% CI = 1.14-3.08), whereas these stressors reduced the risk among men with obesity (HR = 0.58; 95% CI = 0.36-0.95).
The current study suggests that lowering job strain might be an effective strategy for preventing diabetes among women, especially the high-risk group comprising women with obesity.
美国糖尿病协会最近呼吁加强对糖尿病的社会和环境决定因素的研究，以加强一级预防。最近的流行病学证据表明，工作中频繁且可改变的心理社会压力源可能导致糖尿病的发生，但需要更多的前瞻性研究。我们评估了加拿大安大略省 12896 名工人在 13 年期间的工作压力与糖尿病发病之间的关系。我们还研究了在这种关系中体重指数的调节作用。
对 2000-2001 年、2002 年和 2003 年加拿大社区健康调查安大略省应答者的数据进行前瞻性链接，以获得安大略省医疗保险计划数据库的医生服务和加拿大卫生信息研究所出院摘要数据库的医院入院信息。样本由无糖尿病既往诊断的在职参与者组成。使用 Cox 比例风险回归模型评估工作压力、肥胖与糖尿病发病之间的关系。
总体而言，工作压力与糖尿病的发病率无关（风险比 [HR] = 1.05；95%置信区间 [CI] = 0.83-1.34）。在女性中，工作压力与糖尿病的风险增加有关，但这一发现没有达到统计学意义（HR = 1.36；95%CI = 0.94-1.96）。在男性中，没有观察到相关性（HR = 0.89；95%CI = 0.65-1.22）。此外，工作压力增加了肥胖女性患糖尿病的风险（HR = 1.88；95%CI = 1.14-3.08），而这些压力源降低了肥胖男性患糖尿病的风险（HR = 0.58；95%CI = 0.36-0.95）。
目前的研究表明，降低工作压力可能是预防女性，尤其是肥胖高危女性糖尿病的有效策略。
