Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies
Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies
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DOI：
10.1136/oem.2004.013417
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发表时间：
2004-11-01
影响因子：
4.9
通讯作者：
Diderichsen, F
中科院分区：
文献类型：
--
作者：
Andersen, I;Burr, H;Diderichsen, F
目的：调查社会经济地位对心肌梗死（MI）风险的影响是否是由不同的暴露程度或对心理社会工作环境的不同易感性介导的。方法：数据来自于哥本哈根进行的三项前瞻性人口研究。共有 16214 名员工，其中 44% 为女性，年龄在 20-75 岁之间，在 1974 年至 1992 年期间进行了初步检查，并对其进行跟踪直至 1996 年是否发生 MI 事件（入院或死亡）。使用了基于登记册的工作类别信息。心理社会工作暴露是通过基于 1990 年丹麦工作环境队列研究的工作暴露矩阵来间接测量的。结果：在随访期间，731 名受试者被诊断患有 MI：610 名男性和 121 名女性（35% 死亡）。与执行经理相比，非熟练工人的社会经济地位的危害表现出分级效应，其风险比 (HR) 为 1.57（95% CI 1.23 至 2.03）。尽管 MI 风险与决策权威和技能自由裁量权之间存在强烈且分级的关联，但只有技能自由裁量权介导了社会经济地位的影响。调整决策权和其他心血管危险因素后，非技术工人的 HR 降至 1.47（0.93 至 2.31），调整技能裁量权和心血管危险因素后，HR 降至 1.07（0.72 至 1.60）。没有发现协同作用的迹象。结论：决策权威和技能自由裁量权与社会经济地位密切相关；对心肌梗死风险的影响部分是由技能判断力调节的。社会心理工作环境的改善，尤其是技能自由裁量权的可能性，可能有助于减少心肌梗死的发生率和心肌梗死中的社会不平等。
Aim: To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment.Methods: Data were used from three prospective population studies conducted in Copenhagen. A total of 16214 employees, 44% women, aged 20-75 years, with initial examination between 1974 and 1992 were followed until 1996 for incident (hospital admission or death) MI. Register based information on job categories was used. Psychosocial job exposures were measured indirectly by means of a job exposure matrix based on the Danish Work Environment Cohort Study 1990.Results: During follow up, 731 subjects were diagnosed with an MI: 610 men and 121 women (35% fatal). The hazards by socioeconomic position showed a graded effect with a hazard ratio (HR) of 1.57 (95% CI 1.23 to 2.03) for unskilled workers compared to executive managers. Despite a strong and graded association in risk of MI related to decision authority and skill discretion, only skill discretion mediated the effect of socioeconomic position. The HR for unskilled workers was reduced to 1.47 (0.93 to 2.31) after adjustment for decision authority and other cardiovascular risk factors, and to 1.07 (0.72 to 1.60) after adjustment for skill discretion and cardiovascular risk factors. No sign of synergy was found.Conclusions: Decision authority and skill discretion were strongly related to socioeconomic position; and the effect on risk of MI was partially mediated by skill discretion. Improvements in psychosocial work environment, especially possibilities for skill discretion, might contribute to reducing the incidence of MI and social inequality in MI.