Hadrevi Jenny, Lu Sai San Moon, Järvholm Lisbeth Slunga, Palmqvist Richard, Olsson Tommy, Harlid Sophia, Van Guelpen Bethany
Section of Sustainable Health, Department of Global Health and Epidemiology, Umeå University, Umeå, Sweden.
Section of Oncology, Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden.
Cancer Med. 2025 Apr;14(8):e70888. doi: 10.1002/cam4.70888.
This study examined whether sick leave due to severe stress (stress leave) and duration of leave are associated with future cancer risk.
We conducted a matched case-control study using complete-population data from Swedish national registers (2005 to 2018), including 516,678 primary cancer cases and 2,357,433 matched controls. Odds ratios (OR) were calculated by conditional logistic regression and adjusted for pre-specified confounders.
Stress leave of any duration, reported to the Swedish Social Insurance Register, was associated with a slightly increased cancer risk, with the highest risk estimate for 1-30 versus 0 days (adjusted OR 1.05, 95% CI 1.02-1.09). In men, a clear exposure-response trend was present. We observed increased risks of prostate cancer (adjusted OR for > 90 days: 1.10, 95% CI 1.01-1.20) and cervical cancer (adjusted OR for > 90 days: 1.11, 95% CI 1.05-1.17, including cancer in situ). In etiology-based analyses, a positive association was found for smoking-related cancers, and the risk relationship for non-cervical HPV-related cancers was similar to that for cervical cancer. Risk estimates were above one for several types of stress in relation to overall cancer risk, including an exposure-response trend for acute stress reactions (p-trend 4.0 × 10) but a null association for post-traumatic stress disorder.
Stress leave was associated with a modestly higher risk of cancer overall and prostate and cervical cancers specifically. Regardless of whether the link is biological or reflective of lifestyle mediators or for cervical cancer, lower participation in screening, these findings suggest a potential relevance of severe stress for cancer prevention.
本研究调查了因严重压力导致的病假（应激性病假）及其时长与未来患癌风险之间是否存在关联。
我们利用瑞典国家登记处的全人群数据（2005年至2018年）开展了一项匹配病例对照研究，包括516,678例原发性癌症病例和2,357,433例匹配对照。通过条件逻辑回归计算比值比（OR），并对预先设定的混杂因素进行调整。
向瑞典社会保险登记处报告的任何时长的应激性病假都与患癌风险略有增加相关，1 - 30天与0天相比风险估计最高（调整后的OR为1.05，95%置信区间为1.02 - 1.09）。在男性中，存在明显的暴露 - 反应趋势。我们观察到前列腺癌风险增加（超过90天的调整后OR：1.10，95%置信区间为1.01 - 1.20）以及宫颈癌风险增加（超过90天的调整后OR：1.11，95%置信区间为1.05 - 1.17，包括原位癌）。在基于病因的分析中，发现与吸烟相关的癌症存在正相关，非宫颈癌HPV相关癌症的风险关系与宫颈癌相似。与总体癌症风险相关的几种压力类型的风险估计值均高于1，包括急性应激反应的暴露 - 反应趋势（p趋势为4.0×10），但创伤后应激障碍无关联。
应激性病假总体上与患癌风险适度增加相关，尤其与前列腺癌和宫颈癌相关。无论这种关联是生物学上的，还是反映生活方式介导因素，或者对于宫颈癌来说是筛查参与度较低，这些发现都表明严重压力对癌症预防可能具有潜在相关性。
