Lynch J, Krause N, Kaplan G A, Salonen R, Salonen J T
Human Population Laboratory, Public Health Institute/California Department of Health Services, Berkeley 94704, USA.
Circulation. 1997 Jul 1;96(1):302-7. doi: 10.1161/01.cir.96.1.302.
Characteristics of the work environment have been associated with cardiovascular morbidity and mortality, but it is unclear whether these factors are associated with preclinical manifestations of disease.
We investigated the association between job demands, economic reward, and the 4-year progression of carotid atherosclerosis in a population-based sample of 940 Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in plaque height, maximum and mean intima-media thicknesses across combinations of job demands, and income. Associations were examined in relation to atherosclerotic risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. Men who had jobs with high demands and low economic rewards had significantly greater 4-year progression of plaque height (0.33 mm, P = .008) and maximum intima-media thickness (0.32, P = .03) than men with low-demand, high-income jobs. The magnitude of these differences was not greatly attenuated by risk factor adjustment and did not differ when examined by the level of workplace resources, social support, or employment status. Larger differences were observed in a subsample of men who had more advanced atherosclerosis at baseline.
These results show that men with demanding work that produces little economic reward have significantly greater progression of carotid atherosclerosis than more advantaged men. The relationship between job demands and health should be understood in a broad framework of interacting economic conditions, social circumstances, and behaviors that cascade over the life course and may ultimately contribute to socioeconomic inequalities in morbidity and mortality.
工作环境特征与心血管疾病的发病率和死亡率相关，但尚不清楚这些因素是否与疾病的临床前表现有关。
我们在940名芬兰男性的人群样本中，研究了工作要求、经济回报与颈动脉粥样硬化4年进展之间的关联。来自库奥皮奥缺血性心脏病危险因素研究的数据用于估计斑块高度、最大和平均内膜中层厚度在工作要求和收入组合中的变化。研究了与动脉粥样硬化危险因素相关的关联，并按动脉粥样硬化的基线水平和缺血性心脏病的患病率进行分层。与低要求、高收入工作的男性相比，从事高要求、低经济回报工作的男性在4年中斑块高度（0.33毫米，P = 0.008）和最大内膜中层厚度（0.32，P = 0.03）的进展明显更大。这些差异的幅度在进行危险因素调整后并没有大幅减弱，并且在按工作场所资源、社会支持或就业状况水平进行检查时也没有差异。在基线时动脉粥样硬化更严重的男性亚组中观察到了更大的差异。
这些结果表明，从事要求高但经济回报低的工作的男性，其颈动脉粥样硬化的进展明显大于条件更优越的男性。工作要求与健康之间的关系应在一个广泛的框架内理解，该框架包括相互作用的经济状况、社会环境和行为，这些因素在生命过程中层层递进，最终可能导致发病率和死亡率方面的社会经济不平等。
