ismf’s Årsmøde 12. november 2004 eigtveds pakhus
DESCRIPTION
ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus. Hjertekarsygdomme - risikofaktorer i arbejdsmiljøet Tage Søndergård Kristensen Arbejdsmiljøinstituttet. General model for the relationship between work environment and cardiovascular diseases. WORK ENVIRON- MENT. CVD risk factors: - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/1.jpg)
ISMF’s Årsmøde12. november 2004
Eigtveds Pakhus
Hjertekarsygdomme - risikofaktorer i arbejdsmiljøet
Tage Søndergård Kristensen
Arbejdsmiljøinstituttet
![Page 2: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/2.jpg)
General model for the relationship between work environment and cardiovascular diseases
DK-2004-017The significance of work: 1 + 3
CVD risk factors:
Diet, obesity,
blood pressure,
smoking etc.
CARDIO-
VASCULAR
DISEASES.
WORK
ENVIRON-
MENT
1 2
3
![Page 3: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/3.jpg)
Causal network for CVD
DK-2004-010
Job strain
Social isolation
Uemploy-ment
Noise
Physical activity
Tobacco
Diet
Alcohol
Fitness
Obesity
Type A
Stress
Cholesterol
Blood pressure
Fibrinogen
Glucose
Athero-sclerosis
Thrombosis
Arrhythmia
ECG-changes
SES&
Occupa-tion
….
….
….
….
….
Upstream
Downstream
CVD
Social &Environmental
Factors Behavior
Individual
Characteristics Physiology Precursors
![Page 4: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/4.jpg)
The cardiovascular tradition fromFramingham and onwards
DK-2004-012
Cholesterol
Fibrinogen
Triglycerides
Glucose
Blood pressure
Heart rate
Obesity
Risk factors are individual
Smoking
Physical inactivity
Type A
Salt intake
Diet
Alcohol
Physiological: Behavioral:
![Page 5: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/5.jpg)
The occupational medicine tradition from Ramazzini and onwards
DK-2004-011
Physical
Chemical
Psychosocial
Ergonomic
Biological
Risk factors are environmental
![Page 6: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/6.jpg)
Arbejdsmiljøets betydning for hjertekarsygdomme
![Page 7: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/7.jpg)
Etiological fractions of work environment for cardiovascular diseases in Denmark
Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10 DK-2004-016
Proportion of CVD
Risk factor Men Women
“Sedentary” work 42% 42%
Job strain 6% 14%
Shift & night work 7% 7%
Noise 1% 1%
Chemical exposures 0-1% 0%
Passive smoking 2% 2%
All factors 51% 55%
All factors except sedentary work 16% 22%
![Page 8: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/8.jpg)
The significance of work environment for mortality
Estimates of etiologic fractions in Finland Men Women
Cardiovascular, total 14% 7%
IHD 19% 9%
Cerebrovascular 12% 8%
Cancer, total 13% 2%
Mental disorders 7% 2%
Respiratory diseases 7% 1%
Accidents 4% 0%
Total 10% 2%
Nurminen & Karjalainen. Scand J Work Environ Health 2001;27:161-213.
![Page 9: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/9.jpg)
The significance of work environment for hospitalisations
Estimates of etiologic fractions in Denmark Men Women
Circulatory 16% 18%
Cancer 8% 3%
Nervous system 17% 12%
Respiratory 16% 12%
Accidents 17% 6%
Musculoskeletal 21% 19%
Total 15% 11%
Tüchsen et al. Sci Total Environ 2004
![Page 10: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/10.jpg)
Etiologic fractions of psychosocial factors for acute myocardial infarctions: The INTERHEART STUDY
11,119 cases and 13,648 controls from 52 countriesEtiologic
fractions*
Work stress 9%
Home stress 8%
Financial stress 11%
Life events 10%
Locus of control 16%
Depressive mood 9%
All psychosocial factors 33%
Rosengren et al. www.thelancet.com Sept. 3,2004:1-10
* Adjusted for cardiovascular risk factors
![Page 11: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/11.jpg)
Risikofaktorer i arbejdet
![Page 12: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/12.jpg)
The pioneering studies
Coronary heart disease among London bus drivers and conductors
Morris et al. Lancet 1953;iii:1053-7.DK-2004-004
0
0,5
1
1,5
2
CHD Fatal CHD
Cases/1000 person-years
1.5
0.8 0.8
0.4
2
1.5
1
0.5
0
Bus driversConductors
![Page 13: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/13.jpg)
The effort-reward model in Whitehall II
*Fully adjusted
Bosma et al. Am J Public Health 1998;88:68-74 DK-2004-014
0
1
2
3
4
Ischemic heart disease5.3 years of follow-up
1.0
2.1
3.0
1.0
2.4
3.6
1.0
1.8
2.2
4.0
3.0
2.0
1.0
0.0L.E.H.R.
H.E.or
L.R.
H.E.L.R.
L.E.H.R.
H.E.or
L.R.
H.E.L.R.
L.E.H.R.
H.E.or
L.R.
H.E.L.R.
Men Women Total*
OR
![Page 14: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/14.jpg)
Job strain and effort-reward imbalance as predictors of CVD mortality
A 26 years’ follow-up of 812 Finnish employees
1
1,64
2,22
0
1
2
3
Low Medium High
RR*
1
1,91
2,42
0
1
2
3
Low Medium High
RR*Job strain Effort-reward imbalance
* Adjusted for smoking, physical activity, SBP, cholesterol, BMI, age and occupation. 73 cases.
Kivimäki et al. BMJ 2002;325:857-60
![Page 15: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/15.jpg)
1
1,38
2,14
1
1,52
2,12
11,19
1,33
11,23
1,48
0
1
2
3RR*
Psychosocial factors and acute myocardial infarction: The INTERHEART STUDY
11,119 cases and 13,648 controls from 52 countries
Work stress Home stress Financial stress Life events
Rosengren et al. www.the lancet.com Sept. 3,2004:1-10
![Page 16: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/16.jpg)
Is marraige worse than work?
(For women)
A follow-up study of 292 female heart patients in Stockholm
1
2,8 2,9
0
1
2
3
Low Moderate Severe
RR*
11,3
1,7
0
1
2
3
Low Moderate Severe
RR*
Marital stress Work stress
* Adjusted for age, diagnosis, SBT, DM, smoking, lipids and estrogen status.
Orth-Gomér et al. JAMA 2000;284:3008-14
For new events* For new events*
(NS)
(NS)
![Page 17: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/17.jpg)
Standardized Hospitalization Ratios (SHR’s) for IHD among Danish men aged 20 – 59 years
Tüchsen. Int J Epidemiol 1993;22:215-21. DK-2004-015
(4 years of follow-up. N = 407,000)
0
50
100
150
200
250
100
193215
168 172
250
200
150
100
50
0
SHR
Day Night Lateevening
24 hourrosters
Otherirregular
![Page 18: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/18.jpg)
Hospital admissions for CVD in a group of unemployed men compared with a control group
Iversen et al. BMJ 1989;299:1073-6. DK-2004-013
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
0.80
1.04
1.60
Before factoryclosure
(2 years)
During factoryclosure
(3 years)
After factoryclosure
(3 years)
0
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
![Page 19: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/19.jpg)
Passive smoking and IHDThe Nurses’ Health Study
Kawachi et al. Circulation 1997;95:2374-9. DK-2004-019
0
1
2
Never Occational Regular
1.0
1.6
1.9
Adjusted RR
N = 32,046 never smokers
Exposure to passive smoking (work or home)
![Page 20: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/20.jpg)
Carotid artery wall thickness and(passive) smoking
Diez-Roux et al. Prev med 1995;24:48-55.DK-2004-020
0
0,2
0,4
0,6
0,8
1
The ARIC Study
0.67 0.68 0.700.74 0.73
0.78
No P.S.
MenWomen
mm (adjusted)
0.820.90
P.S Ex S.
1.00
0.80
0.60
0.40
0.20
0No P.S. P.S Ex S.
Smoking status
![Page 21: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/21.jpg)
The Seaton – Sjögren hypothesis
Seaton et al. Lancet 1995;345:176-8Sjögren. Occup Environ Med 1997;54:466-9
Air pollution(dust)
Alveolarinflammation(low grade)
Release of mediators
IHD
Increased level of plasma fibrinogen
![Page 22: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/22.jpg)
Den nye træthed
![Page 23: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/23.jpg)
Burnout as predictor of ischaemic heart diseas
A 4.2 years’ follow-up study of 3,877 Dutch male employees from Rotterdam
”Have you ever been burned out?” No 74%Yes 26%
1
2,13
0
1
2
3
No Yes
RR* for IHD*
Burnout
* Controlled for age, BP, smoking, cholesterol. 59 cases.
Appels & Schouten. Behav Med 1991;Summer:53-59
![Page 24: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/24.jpg)
Vital exhaustion, IHD and death
6 years of follow-up of 9,563 adults from Copenhagen
RR*
Vital exhaustion
* Adjusted for 13 biological, behavioural and social factors
Prescott et al. Int J Epidemiol 2003;32:990-7
1 1,1 1,21,6
1
1,61,8
2,2
0
1
2
3
0 1-4 5-9 10+
IHD
Mortality
![Page 25: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/25.jpg)
0
5
10
15
20
25
30
35
40
45
50
Work-relatedburnout
Work-related burnout and sleeping problems two years later
Results from the PUMA baseline and 2 years’ follow-up
N = 1014 DK-2004-007
25.1
32.6 34.4
44.6
Low HighQuartiles
Karolinska sleepquestionnaire (scale)
![Page 26: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/26.jpg)
1
2,82
1,22
3,16
1
0
1
2
3
4
Good Poor Low Medium High
RR
CVD, sleep quality and ”need for recovery” after work
Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue
N=7,944 workers. 18-65 years. 42 cases.
Van Amelsvoort et al. Occup Environ Med 2003;60:83-87
Sleep quality Need for recovery
![Page 27: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/27.jpg)
Sleep and risk of IHD
A study of 71,617 American nurses followed for 10 years
Ayas et al. Arch Intern Med 2003;163:205-9 DK-2004-008
0,0
0,5
1,0
1,5
2,0
2,5
1.8
1.31.1
1.0
5
RR
1.61.4
1.21.1
1.0
1.4
6 7 8 9 5 6 7 8 9
Adjusted for 14 factorsAge-adjusted
The Nurses’ Health Study
![Page 28: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/28.jpg)
1
1,3
1,8
1 1,1
2,1
0
1
2
3
Under40
41-60 61+ 0 1 2+
RR*
Long working hours and short sleep as risk factors for AMI
*Adjusted for smoking, alcohol, BMI, BP, DM, cholesterol, heart disease in family, job type and sedentary job
Lin er al. Occup Environ Med 2002;59:447-51
Working hours/week past year
Days/week within <5 hours of sleep
A case control study of working Japanese men 40-79 years of age
260 cases and 445 matched healthy controls
![Page 29: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/29.jpg)
1
0,72
2,31
0
1
2
3
At neither time At one time At both times
Bullying at work and CVD
*Adjusted for gender and incomeBullying was associated with obsesity and depression
Kivimäki et al. Occup Environ Med 2003;6:779-83
RR for CVD*
Subjected to bullying
A 2-year follow-up study of 5,432 hospital employees in Finland
![Page 30: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/30.jpg)
The new fatigue
Long workinghours
Shift work,24 h society
High emotionaldemands
Conflicts,bullying
High workpace
Family/work conflict
Fatigue
Burnout
Stress
Withdrawal
Sleep problems
Depression
Need for recovery
Cardiovasculardisease
![Page 31: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/31.jpg)
Danske forskernetværker om arbejde og hjertekarsygdom
Glostrup/Østerbro/HCPB: Eva Prescott, John Barefoot,Bo Netterstrøm, Nanna Eller,Naja Rod Nielsen, Ingelise Andersen
Københavnske mænd (Bispebjerg): Finn Gyntelberg, Hans Ole Hein,Poul Suadicani
Arbejdsmiljøinstituttet: Finn Tüchsen, Reiner Rugulies
Ålborg: Henrik Bøggild
![Page 32: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/32.jpg)
SLUT!!
![Page 33: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/33.jpg)
The pioneering studies
Coronary heart disease in the postal service
Morris et al. Lancet 1953;iii:1053-7.DK-2004-005
Degree of physical activity
Active Medium Sedentary
(Postmen)
(Cases per 1000 person years)
35 – 44 years 0.5 0.6 0.8
45 – 54 years 2.7 2.8 3.4
55 – 59 years 4.6 5.0 5.4
Total, standardized 1.8 2.0 2.4
![Page 34: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/34.jpg)
Hostility and mortality in the Kuopio Study(Relative hazards)
All RHs are controlled for age. N = 2,125 men.
Everson et al. Am J Epidemiol 1997;146:142-52
DK-2004-009
HostilityLow High
1 2 3 4
Total mortality 1.0 1.30 1.33 2.30
Cardiovascular mortality 1.0 1.76 1.85 2.70
Non-CVD mortality 1.0 1.07 1.07 2.09
![Page 35: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/35.jpg)
The most important social and occupational CVD risk factors
DK-2004-018
Social
• Social class• Social network• Life events• Social stressors
• Passive smoking• Noise• Lead
Occupational
• Sedentary work• Work stressors
- Job strain
- Effort reward
imbalance• Shift work• Chemicals
![Page 36: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/36.jpg)
0
1
2
3
Dioxin and CVD
A German study of 1,189 chemical workers and 2,528 controls
Flesch-Janys et al. Am J Epidemiol 1995;142:1165-75 DK-2004-021
1.0 1.0 1.0 1.0
RR (mortality)
1.1
2.7
1.2
1.0 0.9 0.9
Toxic equivalents of PCDD
1.71.5 1.6 1.6
2.1
IHD CVD
Low High Low High
![Page 37: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/37.jpg)
Vinyl chloride and hypertension
Kotseva. Int Arch Occup Environ Health 1996;68:377-9 DK-2004-022
0
1
2
3
4
5
Controls Low Medium High
1.0 1.0
RR (adjusted)
A five-year follow-up study of Bugarian workers105 exposed and 105 non-exposed workers
Exposure
2.0
4.2
![Page 38: ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus](https://reader035.vdocuments.net/reader035/viewer/2022062315/56815994550346895dc6da51/html5/thumbnails/38.jpg)
CO exposure, CVD and IHD
Koskela. Scand J Work Environ Health 1994;20:286-93 DK-2004-023
0
1
2
3
4
5
6
7
8
Non-smokers
Smokers Non-smokers
Smokers
1.0
2.6
RR (mortality)
A study of Finnish foundry workers
1.01.4 1.4
1.0 1.0
6.9CO exposed
CVD IHD