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30 mayo, 2013

Associations of job strain and lifestyle risk factors with risk of coronary artery disease

Source: http://www.cmaj.ca/content/early/2013/05/27/cmaj.121735

Via: Salud Juntos

Influencia del estilo de vida sobre el riesgo de enfermedad coronaria en las personas con estrés laboral -> Las personas con estrés laboral y una vida sana tienen la mitad de riesgo de enfermedad arterial coronaria, respecto de las que tienen un estilo de vida poco saludable. Un estilo de vida saludable puede reducir el riesgo de enfermedad en las personas con tensión laboral.

CMAJ, 13/05/2013 "Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data".

Antecedentes: No está claro si un estilo de vida saludable reduce los efectos adversos del estrés laboral sobre la enfermedad de las arterias coronarias. Se examinaron las asociaciones de tensión en el trabajo y los factores de riesgo del estilo de vida con el riesgo de enfermedad de las arterias coronarias. Métodos: Se agruparon los datos a nivel individual de 7 estudios de cohortes que comprenden 102.128 hombres y mujeres libres de enfermedad de las arterias coronarias al inicio del estudio (1985-2000). Se utilizaron cuestionarios para medir la tensión laboral (si v no) y 4 factores de riesgo del estilo de vida: tabaquismo, inactividad física, consumo excesivo de alcohol y obesidad. Se agruparon los participantes en 3 categorías: estilo de vida saludable (sin factores de riesgo de estilo de vida), moderadamente saludables (1 factor de riesgo) y no saludables (2-4 factores de riesgo). El resultado primario fue la enfermedad de la arteria coronaria incidente (definida como primer infarto de miocardio no fatal o muerte relacionada con el corazón). Resultados: Hubo 1.086 incidentes de eventos en 743.948 años-persona en riesgo durante un seguimiento medio de 7,3 años. El riesgo de enfermedad arterial coronaria en las personas que no tenían un estilo de vida saludable en comparación con aquellos que tenían un estilo de vida saludable (hazard ratio [HR] fue de 2,55, intervalo de confianza del 95% [IC]: 2,18 a 2,98; riesgo poblacional atribuible del 26,4%) fue mayor que el riesgo entre los participantes que tenían tensión laboral en comparación con aquellos que no tenían tensión laboral (HR 1,25, IC del 95%: 1,06 a 1,47; riesgo atribuible poblacional del 3,8%). La incidencia en 10 años de enfermedad coronaria entre los participantes con tensión laboral y de un estilo de vida saludable (14,7 por 1.000) fue un 53% menor que la incidencia entre las personas con la tensión laboral y de un estilo de vida saludable (31,2 por 1.000). Interpretación: El riesgo de enfermedad arterial coronaria fue mayor entre los participantes que informaron estrés laboral y un estilo de vida poco saludables. Las personas con la tensión laboral y una vida sana tenían la mitad de la tasa de enfermedad. Un estilo de vida saludable puede reducir sustancialmente el riesgo de enfermedad en las personas con tensión laboral.

Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data

+ Author Affiliations

From the Department of Epidemiology and Public Health (Kivimäki, Ferrie, Hamer, Steptoe, Singh-Manoux, Batty), University College London, London, UK; the Centre of Expertise for the Development of Work and Organizations (Nyberg, Heikkilä, Oksanen, Pentti, Salo, Vahtera, Virtanen), Finnish Institute of Occupational Health, Helsinki, Finland; the School of Health Sciences (Fransson), Jonkoping University, Jonkoping, Sweden; the Institute of Environmental Medicine (Fransson, Alfredsson), Karolinska Institutet, Stockholm, Sweden; the Centre for Occupational and Environmental Medicine (Alfredsson), Stockholm County Council, Stockholm, Sweden; the Stress Research Institute (Fransson, Theorell, Westerlund), Stockholm University, Stockholm, Sweden; the School of Public Health (Casini, Kittel), Universite Libre de Bruxelles, Brussels, Belgium; the Department of Public Health (Clays, De Bacquer), Ghent University, Ghent, Belgium; the Department of Medical Sociology (Dragano, Siegrist), University of Dusseldorf, Dusseldorf, Germany; the School of Community and Social Medicine (Ferrie), University of Bristol, Bristol, UK; Inserm U1018 (Goldberg, Singh-Manoux, Zins), Institut national de la sante et de la recherche medicale, Villejuif Cedex, France; Versailles–Saint Quentin University (Goldberg, Zins), Versailles, France; the Institute of Behavioral Sciences (Jokela) and the Department of Public Health (Koskenvuo), University of Helsinki, Helsinki, Finland; the Department of Work Environment (Karasek), University of Massachusetts, Lowell, Mass.; the Department of Health Sciences (Knutsson), Mid Sweden University, Sundsvall, Sweden; the Department of Psychology (Nordin), Umea University, Umea, Sweden; the National Research Centre for the Working Environment (Rugulies), Copenhagen, Denmark; the Departments of Public Health and Psychology (Rugulies), University of Copenhagen, Copenhagen, Denmark; the Department of Psychology (Salo) and the Department of Public Health (Suominen, Vahtera), University of Turku, Turku, Finland; the Folkhälsan Research Center (Suominen), Helsinki, Finland; the Nordic School of Public Health, (Suominen), University of Gothenburg, Gothenburg, Sweden; Turku University Hospital (Vahtera), Turku, Finland; Occupational and Environmental Medicine (Westerholm), Uppsala University, Uppsala, Sweden; and the Centre for Cognitive Ageing and Cognitive Epidemiology (Batty), University of Edinburgh, Edinburgh, UK

Mika Kivimäki, E-mail m.kivimaki@ucl.ac.uk

Abstract

Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.

Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985–2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2–4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).

Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18–2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06–1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).

Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain.

16 mayo, 2013

Global action on social determinants of health

Source: WHO - Global action on social determinants of health

Michael Marmot ^a

a. Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, England.

Correspondence to Michael Marmot (e-mail: m.marmot@ucl.ac.uk).

Bulletin of the World Health Organization 2011;89:702-702. doi: 10.2471/BLT.11.094862

Closing the gap in a generation is a rousing call.¹ Did the World Health Organization’s Commission on Social Determinants of Health (CSDH) really believe it to be possible? Technically, certainly. Yes, there is a greater than 40-year spread in life expectancy among countries and dramatic social gradients in health within countries. But the evidence suggests that we can make great progress towards closing the health gap by improving, as the CSDH put it, the conditions in which people are born, grow, live, work and age. These include ensuring: equity for every child from the start, healthier environments, fair employment and decent work, social protection across the life course and universal health care. To make such progress, we must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale. At a more fundamental level, our vision is to create the conditions so that every person may enjoy the freedoms that lead to improved health – what we call empowerment.

In the three years since Closing the gap in a generation was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in health inequity.

On the positive side, however, much has happened to support my claim that I am an evidence-based optimist. First at the World Health Organization (WHO) itself, the doubting voices (what do social determinants have to do with a disease control organization?) were countered by the argument that WHO could not possibly ignore what the CSDH called “the causes of the causes” of ill-health. Specialists across WHO, who formed the CSDH’s knowledge network on priority public health conditions, showed that action on social determinants of health was fundamental to disease control programmes.² Importantly, a resolution was passed at the World Health Assembly in 2009 that called on WHO and all Member States to take action on the social determinants.

Each of the WHO Regions has expressed interest in this issue. The WHO Regional Office for the Americas will make social determinants a theme for its publication Health in the Americas 2012, has developed training courses and has been promoting health equity in the region. Zsuzsanna Jakab, WHO Regional Director for Europe, thought it essential that work be done to adapt the CSDH findings to the diverse countries that make up the WHO European Region. She therefore invited me to lead the European Review of Social Determinants and the Health Divide. The recommendations from this review will feed in to Europe’s new public health strategy, Health 2020. WHO, with the government of Brazil, is organizing the World Conference on Social Determinants of Health in Rio de Janeiro.

Several countries have explicitly taken on the social determinants of health agenda. Brazil, Denmark, England, Norway, Scotland and Slovenia are among many countries that have commissioned reviews and/or produced strategies for action on this subject. In other countries such as Argentina, Chile, Costa Rica and Sri Lanka, there is much focus on and concern about the social determinants of health and a variety of actions have been taken. The state of South Australia has made the Health in All Policies approach a central plank of government action. India, while not explicitly addressing the social determinants of health has, nevertheless, pursued policy initiatives that will have important impact on health equity. These include: rural employment guarantees, food security, universal health care, social security for informal workers, education, housing and rights of tribal and forest dwellers. These new policies and programmes are all welcome but the proof will come from monitoring their effect on social determinants and health outcomes.

The review of health inequalities in England, published as Fair society, healthy lives,³ adapted the CSDH recommendations into six domains: (i) give every child the best start in life, (ii) improve education and life-long learning, (iii) create fair employment and jobs, (iv) ensure a minimum income for a healthy standard of living, (v) build healthy and sustainable communities, and (vi) apply a social determinants’ approach to prevention. In the wake of this review there are encouraging signs of impact on policy and practice at national and local level in the United Kingdom of Great Britain and Northern Ireland.

The ambition of the CSDH was to create a global movement for social determinants and health equity. As the global community gathers in Rio de Janeiro in October for the conference on social determinants of health, we are at a crucial juncture. Will the call for social justice and the need to formulate all policies to benefit health equity remain something, at best, honoured in speech alone? Or will the global community recognize that action on social determinants of health is not only vital for health equity but has other highly desirable societal outcomes including social cohesion, reduction of crime and civil unrest, a more educated workforce and the freedom for people to lead lives they have reason to value.⁴

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