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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Why is evidence on job strain and coronary heart disease mixed? An illustration of measurement challenges in the Whitehall II study.
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Why is evidence on job strain and coronary heart disease mixed? An illustration of measurement challenges in the Whitehall II study.

机译：为什么关于工作压力和冠心病的证据混杂？白厅II研究中的测量挑战说明。

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OBJECTIVE: Evidence regarding the status of job strain as a risk factor for coronary heart disease (CHD) is mixed, including both results supporting the risk status and null findings. However, previous studies have typically assessed job strain at one point in time only. We examined whether the failure of such measurement to reflect long-term job strain could contribute to false null findings. METHODS: Job strain and its components, as stress indicators, were assessed twice (3-year time lag) for 5043 men and 2210 women who were free of apparent CHD at baseline. Incident CHD after the stress measurement comprised CHD death, a first nonfatal myocardial infarction, or definite angina (mean follow-up, 10.4 years). The data analysis was based on Cox proportional-hazard models adjusted for age, sex, and employment grade and corrected using regression dilution ratios calculated from short-term repeat data in a random subsample. RESULTS: In the total cohort, incidence of new CHD was higher for higher levels ofjob strain and demands. For these stress indicators, the corrected excess CHD risk was 30% and 29% higher than the corresponding uncorrected estimates, whereas the corresponding increase for job control was only 13%. Effects of job strain and work demands, but not job control, were stronger for a subgroup, with consistent exposure measurements over time than for the total cohort. CONCLUSION: This evidence suggests that use of single-time exposure measures may underestimate the status of long-term job strain as a CHD risk factor.
机译：目的：关于作为劳累性冠心病（CHD）危险因素的工作压力状况的证据不一，包括支持危险状况的结果和无效的发现。但是，以前的研究通常只在一个时间点评估工作压力。我们检查了这种测量方法是否不能反映长期的工作压力是否会导致虚假的无效发现。方法：对基线时无明显冠心病的5043名男性和2210名女性的工作压力及其组成部分（作为压力指标）进行了两次评估（3年时间滞后）。压力测量后发生的冠心病包括冠心病死亡，首次非致命性心肌梗塞或明确的心绞痛（平均随访时间为10.4年）。数据分析基于针对年龄，性别和就业等级进行调整的Cox比例风险模型，并使用从随机子样本中的短期重复数据计算得出的回归稀释比进行校正。结果：在整个队列中，由于较高的工作压力和需求，新CHD的发生率较高。对于这些压力指标，校正后的冠心病过量风险比相应的未校正估计值高30％和29％，而工作控制的相应增加仅为13％。一个亚组的工作压力和工作需求的影响，而不是工作控制的影响要强得多，随着时间的推移接触量的测量要比整个人群的要长。结论：这一证据表明，使用一次性接触措施可能会低估长期工作压力作为冠心病的危险因素的地位。

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