Jahn I, Becker U, Jöckel K H, Pohlabeln H
Bremen Institute for Prevention Research and Social Medicine (BIPS), Germany.
Soc Sci Med. 1995 Apr;40(7):961-75. doi: 10.1016/0277-9536(94)00151-i.
Psychosocial factors in general, and the social and psychological conditions of work and occupation in particular, have attracted little attention to the epidemiological investigation into the occupational-related causes of lung cancer. There is some evidence available concerning the impact of loss events--including job losses--on cancer development. During our research presented in this article, we examined job changes and job transitions in the occupational biography of men with regard to their circumstances in terms of (in-)voluntariness both as individual events and the job-changing histories of individuals. We expected the job-changing histories of lung cancer cases to be more involuntary than those of population controls, and vice versa. Our sample contains 391 male case-control pairs. Cases are defined as newly-diagnosed men of German nationality with a histologically- or cytologically-confirmed diagnosis of primary lung cancer. Population controls were drawn randomly from the municipality records of residents and individuals matched to cases 1:1 by age and region. Occupational histories were reconstructed, and information about other classical and suspected risk factors was collected during standardized interviews by trained interviewers. We categorized the reported reasons for job changes, and classified them with respect to voluntariness on a seven-stepped rating scale from -3 'very involuntary' to +3 'very voluntary', defining relations within the empirically established categories. The job-changing histories of individuals are described by using the average score of voluntariness. We measured the degree of voluntariness for the occupational history: (1) by the rounded average score; and (2) by the quintiles of the average score. On the basis of individuals matched odds ratios (OR) estimates are derived for the score of voluntariness unadjusted and adjusted for smoking, asbestos exposure and socio-economic group by conditional logistic regression. The investigation into job-changing histories using the average score of voluntariness lead to similar results for both measuring methods for the total study group. When the rounded score was used, job-changing histories which were assessed as 'very involuntary' and 'involuntary' (score -3 and -2) showed an elevated odds ratio of adjusted 1.41 (95%-CI: 0.57; 3.48), and when they were assessed as 'moderately involuntary' (score -1) the adjusted odds ratio was 1.59 (95%-CI: 1.02; 2.48), as compared with job-changing histories assessed as neutral (score 0). When the degree of voluntariness was measured by quintiles, the first quintile (score -3- < -0.6) showed an elevated risk of adjusted OR 1.36 (95%-CI: 0.79; 2.36) as compared to the third quintile (score -0.2- < -0.1).(ABSTRACT TRUNCATED AT 400 WORDS)
一般而言，社会心理因素，尤其是工作和职业的社会及心理状况，在肺癌职业相关病因的流行病学调查中很少受到关注。有一些证据表明，包括失业在内的丧失事件对癌症发展有影响。在本文所呈现的研究中，我们考察了男性职业经历中的工作变动和职业转换情况，从个体事件以及个人工作变动历史的角度，考量其变动的（非）自愿性。我们预计肺癌病例的工作变动历史比对照人群更具非自愿性，反之亦然。我们的样本包含391对男性病例对照。病例定义为新诊断出的德国籍男性，经组织学或细胞学确诊为原发性肺癌。对照人群从市政居民记录中随机抽取，与病例按年龄和地区1:1匹配。重建职业史，并由训练有素的访谈员在标准化访谈中收集其他经典和可疑风险因素的信息。我们对报告的工作变动原因进行分类，并根据自愿性在从-3“非常非自愿”到+3“非常自愿”的七级评分量表上进行分类，确定实证建立类别中的关系。个体的工作变动历史用自愿性平均得分来描述。我们通过以下方式衡量职业史的自愿程度：（1）取四舍五入后的平均得分；（2）取平均得分的五分位数。基于个体匹配比值比（OR），通过条件逻辑回归得出未调整及经吸烟、石棉暴露和社会经济群体调整后的自愿性得分估计值。对于整个研究组，使用自愿性平均得分对工作变动历史进行调查，两种测量方法得出了相似的结果。当使用四舍五入后的得分时，被评定为“非常非自愿”和“非自愿”（得分-3和-2）的工作变动历史，调整后的比值比为1.41（95%可信区间：0.57；3.48），而被评定为“中度非自愿”（得分-1）时，调整后的比值比为1.59（95%可信区间：1.02；2.48），与评定为中性（得分0）的工作变动历史相比。当通过五分位数衡量自愿程度时，与第三五分位数（得分-0.2 - < -0.1）相比，第一五分位数（得分-3 - < -0.6）调整后的OR风险升高，为1.36（95%可信区间：0.79；2.36）。（摘要截选至400字）
