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ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus

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:

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ISMF’s Årsmøde 12. november 2004 Eigtveds Pakhus

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  1. ISMF’s Årsmøde12. november 2004Eigtveds Pakhus Hjertekarsygdomme - risikofaktorer i arbejdsmiljøet Tage Søndergård Kristensen Arbejdsmiljøinstituttet

  2. General model for the relationship between work environment and cardiovascular diseases WORK ENVIRON- MENT CVD risk factors: Diet, obesity, blood pressure, smoking etc. CARDIO-VASCULAR DISEASES. 2 1 3 The significance of work: 1 + 3 DK-2004-017

  3. Social & Environmental Factors Individual Characteristics Behavior Physiology Precursors Cholesterol Job strain Physical activity Fitness Athero-sclerosis SES & Occupa- tion CVD Tobacco Blood pressure Social isolation Obesity Thrombosis Uemploy-ment Diet Type A Fibrinogen Arrhythmia Alcohol ECG-changes Noise Stress Glucose …. …. …. …. …. Upstream Downstream Causal network for CVD DK-2004-010

  4. The cardiovascular tradition fromFramingham and onwards Risk factors are individual Physiological: Behavioral: • Smoking • Physical inactivity • Type A • Salt intake • Diet • Alcohol • Cholesterol • Fibrinogen • Triglycerides • Glucose • Blood pressure • Heart rate • Obesity DK-2004-012

  5. The occupational medicine tradition from Ramazzini and onwards Risk factors are environmental • Physical • Chemical • Psychosocial • Ergonomic • Biological DK-2004-011

  6. Arbejdsmiljøets betydning for hjertekarsygdomme

  7. Etiological fractions of work environment for cardiovascular diseases in Denmark Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10 DK-2004-016

  8. The significance of work environment for mortality Nurminen & Karjalainen. Scand J Work Environ Health 2001;27:161-213.

  9. The significance of work environment for hospitalisations Tüchsen et al. Sci Total Environ 2004

  10. Etiologic fractions of psychosocial factors for acute myocardial infarctions: The INTERHEART STUDY * Adjusted for cardiovascular risk factors Rosengren et al. www.thelancet.com Sept. 3,2004:1-10

  11. Risikofaktorer i arbejdet

  12. The pioneering studies Coronary heart disease among London bus drivers and conductors Cases/1000 person-years 2 1.5 1.5 1 0.8 0.8 0.4 0.5 0 Bus drivers Conductors Morris et al. Lancet 1953;iii:1053-7. DK-2004-004

  13. Ischemic heart disease 5.3 years of follow-up The effort-reward model in Whitehall II OR 4.0 3.6 Men Women Total* 3.0 3.0 2.4 2.2 2.1 1.8 2.0 1.0 1.0 1.0 1.0 0.0 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. L.E. H.R. H.E. or L.R. H.E. L.R. *Fully adjustedBosma et al. Am J Public Health 1998;88:68-74 DK-2004-014

  14. RR* RR* Job strain and effort-reward imbalance as predictors of CVD mortality A 26 years’ follow-up of 812 Finnish employees Effort-reward imbalance Job strain * Adjusted for smoking, physical activity, SBP, cholesterol, BMI, age and occupation. 73 cases. Kivimäki et al. BMJ 2002;325:857-60

  15. RR* Psychosocial factors and acute myocardial infarction: The INTERHEART STUDY 11,119 cases and 13,648 controls from 52 countries Life events Financial stress Home stress Work stress Rosengren et al. www.the lancet.com Sept. 3,2004:1-10

  16. RR* RR* Is marraige worse than work? (For women) A follow-up study of 292 female heart patients in Stockholm Work stress Marital stress For new events* For new events* (NS) (NS) * Adjusted for age, diagnosis, SBT, DM, smoking, lipids and estrogen status. Orth-Gomér et al. JAMA 2000;284:3008-14

  17. Standardized Hospitalization Ratios (SHR’s) for IHD among Danish men aged 20 – 59 years (4 years of follow-up. N = 407,000) SHR 250 215 193 200 172 168 150 100 100 50 0 Day Night Late evening 24 hour rosters Other irregular Tüchsen. Int J Epidemiol 1993;22:215-21. DK-2004-015

  18. 1.8 1.60 1.6 1.4 1.2 1.04 1 0.80 0.8 0.6 0.4 0.2 0 After factory closure (3 years) Before factory closure (2 years) During factory closure (3 years) 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

  19. Passive smoking and IHDThe Nurses’ Health Study N = 32,046 never smokers Adjusted RR 1.9 1.6 1.0 Exposure to passive smoking (work or home) Kawachi et al. Circulation 1997;95:2374-9. DK-2004-019

  20. Carotid artery wall thickness and(passive) smoking The ARIC Study mm (adjusted) 1.00 Men Women 0.90 0.82 0.78 0.74 0.80 0.73 0.70 0.68 0.67 0.60 0.40 0.20 0 P.S Ex S. No P.S. P.S Ex S. No P.S. Smoking status Diez-Roux et al. Prev med 1995;24:48-55. DK-2004-020

  21. The Seaton – Sjögren hypothesis Air pollution (dust) IHD Alveolar inflammation (low grade) Increased level of plasma fibrinogen Release of mediators Seaton et al. Lancet 1995;345:176-8Sjögren. Occup Environ Med 1997;54:466-9

  22. Den nye træthed

  23. 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% RR* for IHD* Burnout * Controlled for age, BP, smoking, cholesterol. 59 cases. Appels & Schouten. Behav Med 1991;Summer:53-59

  24. Vital exhaustion, IHD and death 6 years of follow-up of 9,563 adults from Copenhagen RR* IHD Mortality Vital exhaustion * Adjusted for 13 biological, behavioural and social factors Prescott et al. Int J Epidemiol 2003;32:990-7

  25. Work-related burnout and sleeping problems two years later Results from the PUMA baseline and 2 years’ follow-up Karolinska sleep questionnaire (scale) 44.6 34.4 32.6 25.1 Work-related burnout Low High Quartiles N = 1014 DK-2004-007

  26. RR CVD, sleep quality and ”need for recovery” after work Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue Need for recovery Sleep quality N=7,944 workers. 18-65 years. 42 cases. Van Amelsvoort et al. Occup Environ Med 2003;60:83-87

  27. Sleep and risk of IHD A study of 71,617 American nurses followed for 10 years Adjusted for 14 factors Age-adjusted RR 1.8 1.6 1.4 1.4 1.3 1.2 1.1 1.1 1.0 1.0  5 6  9  5 6  9 7 8 7 8 The Nurses’ Health Study Ayas et al. Arch Intern Med 2003;163:205-9 DK-2004-008

  28. Long working hours and short sleep as risk factors for AMI A case control study of working Japanese men 40-79 years of age 260 cases and 445 matched healthy controls RR* Days/week within <5 hours of sleep Working hours/week past year *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

  29. Bullying at work and CVD A 2-year follow-up study of 5,432 hospital employees in Finland RR for CVD* Subjected to bullying *Adjusted for gender and income Bullying was associated with obsesity and depression Kivimäki et al. Occup Environ Med 2003;6:779-83

  30. The new fatigue Long working hours Fatigue Burnout Family/ work conflict Shift work, 24 h society Need for recovery Stress High work pace High emotional demands Depression Withdrawal Conflicts, bullying Sleep problems Cardiovascular disease

  31. 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

  32. SLUT!!

  33. The pioneering studies Coronary heart disease in the postal service Morris et al. Lancet 1953;iii:1053-7. DK-2004-005

  34. DK-2004-009 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

  35. The most important social and occupational CVD risk factors • Social • Social class • Social network • Life events • Social stressors • Occupational • Sedentary work • Work stressors - Job strain - Effort reward imbalance • Shift work • Chemicals • Passive smoking • Noise • Lead DK-2004-018

  36. Dioxin and CVD A German study of 1,189 chemical workers and 2,528 controls RR (mortality) CVD IHD 2.7 2.1 1.7 1.2 1.6 1.6 1.5 1.1 1.0 1.0 1.0 1.0 1.0 0.9 0.9 Low Low High High Toxic equivalents of PCDD Flesch-Janys et al. Am J Epidemiol 1995;142:1165-75 DK-2004-021

  37. Vinyl chloride and hypertension A five-year follow-up study of Bugarian workers 105 exposed and 105 non-exposed workers RR (adjusted) 4.2 2.0 1.0 1.0 Exposure Kotseva. Int Arch Occup Environ Health 1996;68:377-9 DK-2004-022

  38. CO exposure, CVD and IHD A study of Finnish foundry workers RR (mortality) 6.9 CO exposed IHD CVD 2.6 1.4 1.4 1.0 1.0 1.0 1.0 Koskela. Scand J Work Environ Health 1994;20:286-93 DK-2004-023

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