Psychosocial predictors of hypertension in men and women
Psychosocial predictors of hypertension in men and women
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DOI：
10.1001/archinte.161.10.1341
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发表时间：
2001-05-28
影响因子：
--
通讯作者：
Kaplan, GA
中科院分区：
文献类型：
--
作者：
Levenstein, S;Smith, MW;Kaplan, GA
背景资料：在几项队列研究中，心理社会压力因素已被证明可预测高血压;重要性模式、性别差异以及与标准危险因素的相互作用尚未得到充分表征。在1974年无高血压的加州阿拉米达县的2357名成年人中，1994年报告的637人曾使用过抗高血压药物（男性27.9%，女性26.3%）。基线心理社会，行为和社会人口因素对治疗高血压的发病率的影响进行了检查，采用多元logistic regression.Results：低教育，非裔美国人的种族，低职业声望，担心工作稳定性，感觉不到很好的一个人的工作，社会疏远，抑郁症状，每个有显着的（P <0.05）年龄调整后与高血压事件的关联。通过调整身体质量指数、饮酒、吸烟状况和闲暇时间的体力活动，尤其是精神失常和抑郁的关联，这种关联在女性中持续存在，但在男性中不存在。在多变量模型中，（优势比，1.6），失业率（优势比，2.7），以及自我报告的工作绩效低（比值比，2.1）仍然是男性高血压的独立预测因子，而低地位工作（比值比，1.3）是女性高血压的独立预测因子。在一般人群中，低职业地位和表现以及失业的威胁或现实增加了患高血压的可能性，特别是在男性中，与人口统计学和行为风险因素无关。心理压力和社会疏离也可能增加高血压的发病率，尤其是在女性中，主要是通过与健康危险行为的关联。
Background: Psychosocial stressors have been shown to predict hypertension in several cohort studies; patterns of importance, sex differences, and interactions with standard risk factors have not been fully characterized.Methods: Among 2357 adults in a population sample of Alameda County, California, free of hypertension in 1974, 637 reported in 1994 having ever used antihypertensive medication (27.9% of the men and 26.3% of the women). The effects of baseline psychosocial, behavioral, and sociodemographic factors on the incidence of treated hypertension were examined using multiple logistic regression.Results: Low education, African American race, low occupational prestige, worry about job stability, feeling less than very good at one's job, social alienation, and depressive symptoms each had significant (P < .05) age-adjusted associations with incident hypertension. Associations were weakened by adjustment for body mass index, alcohol consumption, smoking status, and leisure time physical activity, especially the associations of anomy and depression, which persisted in women but not in men. In multivariate models, job insecurity (odds ratio, 1.6), unemployment (odds ratio, 2.7), and low self-reported job performance (odds ratio, 2.1) remained independent predictors of hypertension in men, whereas low-status work (odds ratio, 1.3) was an independent predictor of hypertension in women.Conclusions: In the general population, low occupational status and performance and the threat or reality of unemployment increase the likelihood of developing hypertension, especially among men, independent of demographic and behavioral risk factors. Psychological distress and social alienation may also increase hypertension incidence, especially in women, chiefly through an association with health risk behaviors.