The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days

Occupational inequalities in mortality from cardiovascular disease, 2020-2021

BACKGROUND

In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation.

METHODS

Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality.

RESULTS

After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services.

CONCLUSIONS

Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.

Geo-Demographic and Socioeconomic Determinants of Diagnosed Hypertension among Urban Dwellers in Ibadan, Nigeria: A Community-based Study

Background

The relationship between diagnosed high blood pressure (HBP) and proximity to health facilities and noise sources is poorly understood. We investigated the relationship between proximity to noise sources, sociodemographic and economic factors, and diagnosed HBP in Ibadan, Nigeria.

Methods

We investigated 13,531 adults from the African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study in Ibadan. Using a Geographic Information System (GIS), the locations of healthcare facilities, pharmaceutical shops, bus stops, churches, and mosques were buffered at 100m intervals, and coordinates of persons diagnosed with HBP were overlaid on the buffered features. The number of persons with diagnosed HBP living at every 100m interval was estimated. Gender, occupation, marital status, educational status, type of housing, age, and income were used as predictor variables. Analysis was conducted using Spearman rank correlation and binary logistic regression at p<0.05.

Results

There was a significant inverse relationship between the number of persons diagnosed with HBP and distance from pharmaceutical shops (r=-0.818), churches (r=-0.818), mosques (r=-0.893) and major roads (r=-0.667). The odds of diagnosed HBP were higher among the unemployed (AOR=1.58, 95% CI: 1.11-2.24), currently married (AOR=1.45, CI: 1.11-1.89), and previously married (1.75, CI: 1.29-2.38). The odds of diagnosed HBP increased with educational level and age group.

Conclusion

Proximity to noise sources, being unemployed and educational level were associated with diagnosed HBP. Reduction in noise generation, transmission, and exposure could reduce the burden of hypertension in urban settings.

Network stressors, personal stressors, and ambulatory blood pressure in African-American women-Does superwoman schema play a role?

OBJECTIVE

Life stressors have been linked to cardiovascular risk; however, studies typically focus on stressors that directly impact the individual, that is, personal stressors. Research suggests that women, particularly African-American women, may be more vulnerable to network stressors that involve family members and friends-potentially due to norms around needing to be a "Superwoman." Yet few studies have examined these phenomena.

METHOD

We examined associations between network, versus personal, stressors, and elevated blood pressure (BP) in N = 392 African-American women aged 30-46. Questionnaire-assessed negative life events were classified into upsetting network or personal stressors. BP was assessed in clinic and via 48-hr ambulatory monitoring. Linear and logistic regression models examined associations between type of stressors and 48-hr daytime and nighttime systolic BP (SBP) and diastolic BP (DBP), and sustained hypertension after adjusting for relevant covariates. Interactions with questionnaire-assessed superwoman schema (SWS) were tested in exploratory analyses.

RESULTS

In age and sociodemographic-adjusted models, network stressors were significantly associated with daytime SBP, β (SE) = 2.01 (0.51), p ≤ .0001, and DBP, β (SE) = 1.59 (0.37), p ≤ .0001, but personal stressors were not (p values > .10). Associations persisted after adjustment for cardiovascular and psychosocial risk factors. Patterns were similar for nighttime BP and sustained hypertension. There were no interactions with SWS.

CONCLUSIONS

Network, but not personal, stressors were associated with elevated rates of daytime SBP and DBP, as well as sustained hypertension in African-American women, irrespective of SWS endorsement. Future research is needed to determine whether stress-management interventions focused on network stressors might impact BP in this high-risk population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Expectations of respect and appreciation in daily life and associations with subclinical cardiovascular disease

OBJECTIVE

To test whether expectations of respect and appreciation from others, assessed in daily life, are associated with preclinical vascular disease.

METHOD

Participants were an urban community sample of 483 employed adults (47% male, 17% Black, mean age = 42.8 years). Carotid intima-media thickness (IMT) was measured using B-mode ultrasound. Expectations of being treated with respect and appreciation were measured using the average of hourly assessments over the course of 4 days, and home and work averages were also examined separately.

RESULTS

Expectations of greater respect and appreciation from others were associated with significantly less carotid IMT even after adjustment for demographic factors, general positivity and negativity of social interactions, neuroticism, optimism, perceived discrimination, and concurrent biological risk factors. This association was similar across social contexts of work and home and also when expectations of respect and appreciation were examined separately. Lower expectations of respect and appreciation and more negative social interactions were both independently associated with greater IMT in fully adjusted models and effect sizes were similar to traditional biological risk factors such as BMI.

CONCLUSIONS

Midlife adults who anticipate greater respect and appreciation from others in everyday life evidence less preclinical vascular disease. Consistent with the literature showing that anticipation of social threats and unfair treatment may increase cardiovascular risk, expectations of being valued and treated with respect by others is associated with decreased risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stress-induced arterial hypertension

Stress is considered as one of the factors associated with the development of many diseases, including the cardiovascular system. The history of studying stress as a risk factor for hypertension began in the first half of the 20th century and continued after the introduction of 24-hour blood pressure monitoring (ABPM) into clinical practice. Then it turned out that there is normotension, stable hypertension and latent hypertension: masked (when clinical BP is within the normal range, and arterial hypertension is recorded according to ABPM and/or self-monitoring of BP) and white coat hypertension (increased BP during a visit to the doctor when normal values of blood pressure according to ABPM or self-monitoring of BP). Currently, both variants of latent hypertension are classified as stress-induced arterial hypertension. Several models have been proposed for the study of stress, but two of them are more common in clinical studies: the Karasek model (based on an imbalance between job demands and job decision latitude) and the Siegrist model (based on an imbalance of effort and reward). There are only few studies in where attempts have been made to link the increase in BP with the parameters of stress response (for example, with hormonal levels) or genetic predisposition. The review discusses the most significant studies of stress-induced arterial hypertension published to date.

A Longitudinal Study of Age-Based Change in Blood Pressure Reactivity and Negative Affect Reactivity to Natural Stressors

OBJECTIVE

Aging is theoretically accompanied by emotional gains, but physiological self-regulatory losses. Emotional and physiological regulation can be operationalized as the extent of an increase in negative affect and blood pressure upon experiencing a stressor (i.e., reactivity). The direction of age-based changes in negative affect reactivity to stressors is uncertain. In addition, evidence for age-based increases in blood pressure reactivity to stressors is based largely on age-based differences observed in cross-sectional and laboratory-based studies. The present study is the first to examine long-term longitudinal changes in stress-related reactivity for both blood pressure and negative affect in the natural environment.

METHODS

A total of 375 healthy adults aged 50 to 70 years completed 6 days of hourly ambulatory blood pressure assessment and electronic diary reports of social conflict and task demand and control. Two hundred fifty-five participants repeated 3 days of assessment in a 6-year follow-up. With reactivity operationalized as the change in an outcome in association with momentary social conflict, task strain, or task demand (i.e., a model-derived slope parameter), multilevel models were used to assess aging-based change in blood pressure and negative affect reactivity over the course of the 6-year follow-up.

RESULTS

Aging is associated with increased diastolic blood pressure reactivity to social conflict and task demand (βsocial_conflict = 0.48, p = .007; βtask_demand = 0.19, p = .005), increases in negative affect reactivity to social conflict and task strain (βsocial_conflict = 0.10, p < .001; βtask_strain = 0.08, p = .016), and increases in systolic blood pressure reactivity to task-based stress (βtask_strain = 1.29, p = .007; βtask_demand = 0.23 p = .032).

CONCLUSION

Findings suggest age-based increases in affective and cardiovascular reactivity to natural stressors.

Occupational Segregation And Hypertension Inequity: The Implication Of The Inverse Hazard Law Among Healthcare Workers

In the United States (US), Black-particularly Black female-healthcare workers are more likely to hold occupations with high job demand, low job control with limited support from supervisors or coworkers and are more vulnerable to job loss than their white counterparts. These work-related factors increase the risk of hypertension. This study examines the extent to which occupational segregation explains the persistent racial inequity in hypertension in the healthcare workforce and the potential health impact of workforce desegregation policies. We simulated a US healthcare workforce with four occupational classes: health diagnosing professionals (i.e., highest status), health treating professionals, healthcare technicians, and healthcare aides (i.e., lowest status). We simulated occupational segregation by allocating 25-year-old workers to occupational classes with the race- and gender-specific probabilities estimated from the American Community Survey data. Our model used occupational class attributes and workers' health behaviors to predict hypertension over a 40-year career. We tracked the hypertension prevalence and the Black-white prevalence gap among the simulated workers under the staus quo condition (occupational segregation) and the experimental conditions in which occupational segregation was eliminated. We found that the Black-white hypertension prevalence gap became approximately one percentage point smaller in the experimental than in the status quo conditions. These findings suggest that policies designed to desegregate the healthcare workforce may reduce racial health inequities in this population. Our microsimulation may be used in future research to compare various desegregation policies as they may affect workers' health differently.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41996-022-00098-5.

What Can We Learn From More Than 140,000 Moments of Ecological Momentary Assessment-Assessed Negative Emotion and Ambulatory Blood Pressure? A Systematic Review and Meta-Analysis

OBJECTIVE

Two decades of research has examined within-person associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify moderators, review strengths and weaknesses in conceptual and measurement approaches, and provide recommendations.

METHODS

We searched databases (PsycINFO, PubMed), identified 15 studies, and obtained data from 13 studies (n = 2511; 142,307 observations).

RESULTS

Random-effects meta-analyses demonstrated small effect r values between momentary negative emotions and systolic ABP (r = 0.06) and diastolic ABP (r = 0.05; p values < .001). Meta-regressions found that effects were larger among studies focused on anxiety, multidimensional negative emotions, predominantly female samples, or less observations of each participant (p values from .003 to .049). A qualitative review found that few studies examined moderators contributing to the substantial interindividual differences in this association.

CONCLUSIONS

The small association between momentary negative emotion and ABP extends laboratory findings on the association between the experiential and physiological aspects of emotion to the daily, natural emotional experiences of individuals. This literature could be strengthened by determining interindividual and intraindividual moderators of this association (e.g., trait negative emotion and state positive emotion), examining differential associations of different negative emotions with ABP, and standardizing EMA protocols. Although the effect is small, to the extent that repeated emotion-related cardiovascular reactivity may contribute to cardiovascular disease risk, identifying daily life triggers of emotion is important.

Psychosocial work factors and blood pressure among 63 800 employees from The Netherlands in the Lifelines Cohort Study

OBJECTIVES

Previous studies on the association between psychosocial work factors and blood pressure mainly focused on specific occupations or populations and had limited sample sizes. We, therefore, investigated the associations between psychosocial work factors and blood pressure in a large general working population in the Netherlands.

METHODS

We included 63 800 employees from the Netherlands, aged 18-65 years, with blood pressure measurements and a reliable job code at baseline. Psychosocial work factors (job strain, effort-reward imbalance (ERI) and emotional demands) in the current job were estimated with three recently developed psychosocial job exposure matrices. To examine the associations, regression analyses adjusted for covariates (age, sex, body mass index, education, monthly income, pack-years, smoking, alcohol consumption and antihypertensive medication (not included for hypertension)) were performed.

RESULTS

Higher job strain was associated with higher systolic blood pressure (SBP) (B (regression coefficients) (95% CI) 2.14 (1.23 to 3.06)) and diastolic blood pressure (DBP) (B (95% CI) 1.26 (0.65 to 1.86)) and with higher odds of hypertension (OR (95% CI) 1.43 (1.17 to 1.74)). Higher ERI was associated with higher DBP (B (95% CI) 4.37 (3.05 to 5.68)), but not with SBP or hypertension. Higher emotional demands were associated with lower SBP (B (95% CI) -0.90 (-1.14 to -0.66)) and lower odds of hypertension ((OR) (95% CI) 0.91 (0.87 to 0.96)).

CONCLUSIONS

In the general working population, employees in jobs with high job strain and ERI have higher blood pressure compared with employees with low job strain and ERI. Emotional demands at work are inversely associated with blood pressure.

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

Ambulatory blood pressure monitoring among emergency medical services night shift workers

OBJECTIVES

Higher 24-hour blood pressure (BP) and blunted BP dipping during sleep and night-time hours are associated with adverse health outcomes. Night shift work may affect 24-hour BP and dipping patterns, but empirical data in emergency medical services (EMS) clinician shift workers are sparse. We implemented ambulatory blood pressure monitoring (ABPM) in EMS workers to characterise BP during night shift work versus a non-workday, and sleep versus wake.

METHODS

Participants worked night shifts. Hourly ABPM and wrist actigraphy (to measure sleep) were collected during two 24-hour periods, one scheduled night shift and one non-workday. Blunted BP dipping was defined as a BP decrease of <10%.

RESULTS

Of 56 participants, 53 (53.6% female, mean age 26.5 (SD 7.5) years) completed the study. During daytime sleep on a workday, 49.1% of participants had blunted systolic BP (SBP) or diastolic BP (DBP) dipping. During night-time sleep on a non-workday, 25% had blunted SBP dipping and 3.9% blunted DBP dipping. Blunted SBP or DBP dipping occurred among all participants who did not nap during the night shift or who napped <60 min. Blunted SBP dipping occurred in only 14.3% of participants who napped 60-120 min.

CONCLUSIONS

During night shift work, the BP dipping of EMS shift workers is blunted; however, most who nap for 60 min or longer experience a healthy dip in BP. The potential health consequences of these observations in EMS clinicians warrant further study.

What is the most important determinant of cardiometabolic risk in 60-65-year-old subjects: physical activity-related behaviours, overall energy expenditure or occupational status? A cross-sectional study in three populations with different employment status in Poland

OBJECTIVES

The aim of the study was to determine whether cardiovascular risk factors may differ according to occupational status and whether physical activity related to total energy expenditure (PA-EE) and related to health-related behaviours (PA-HRB) is associated with common cardiovascular risk factors or metabolic syndrome in pre-elderly subjects.

METHODS

Three hundred subjects aged 60-65 were recruited and divided into three equal groups of white-collar, blue-collar workers and unemployed subjects; 50% were women. The subjects were tested for major cardiovascular risk factors such as smoking, anthropometric indices, blood pressure, lipid levels, glucose, uric acid and homocysteine. PA-EE and PA-HRB were assessed with PA questionnaires.

RESULTS

Blue-collar workers displayed higher anthropometric indices, blood pressure and higher PA-EE in comparison with other two groups. PA-HRB had a positive impact on body mass indices, lipids, glucose, uric acid and the prevalence of metabolic syndrome, with no such relationship observed for PA-EE.

CONCLUSIONS

The greatest cardiovascular risk was observed in the blue-collar workers group. Only PA-HRB had a positive association with cardiometabolic risk profile. No relationship was observed for PA-EE. Thus, promoting everyday life and leisure time PA behaviours is crucial for preventing cardiometabolic risk in pre-elderly subjects, even in blue-collar workers with high work-related EE.

Vacation frequency is associated with metabolic syndrome and symptoms

Objective: To examine the extent to which vacationing behavior is associated with metabolic outcomes. Specifically, we consider how total vacation episodes and total vacation days from the past 12 months relate to metabolic syndrome and metabolic symptoms.Design: Sixty-three workers eligible for paid vacation attended a lab visit during which their blood was drawn and they completed an interview assessing vacationing behavior in the past 12 months.Main outcome measures: Metabolic syndrome and metabolic symptoms are the main outcome measures.Results: Over the past 12 months, participants took approximately five vacations (M = 5.44, SD = 3.16) and used about 2 weeks of their paid vacation days (M = 13.80, SD = 7.25). Participants rated vacations positively, expressing low levels of travel-, childcare- and financial burden-related stress. As vacation episodes increased, metabolic syndrome incidence (OR = 0.76, p = 0.051) and number of metabolic symptoms met (IRR = 0.92, p = 0.035) decreased. Notably, risk for metabolic syndrome decreased by nearly a quarter with each additional vacation taken by participants.Conclusions: Overall, vacations are experienced as positive events. This positive subjective experience may translate into physical health benefits given that vacation frequency may protect against metabolic syndrome and symptoms.

Physical activity moderates the effects of daily psychosocial stressors on ambulatory blood pressure

OBJECTIVE

Previous literature has shown an inconsistent relationship between physical activity and stressor-evoked blood pressure reactivity. Use of ecological momentary assessment (EMA) may facilitate detecting such a relationship. In this study, the moderating effects of regular physical activity on the magnitude of ambulatory blood pressure (ABP) responses to psychosocial stressors experienced in daily life were examined.

METHOD

Four hundred seventy-seven healthy working adults (ages 30-54) provided ABP readings and recorded their daily experiences, using electronic diaries (ED), over 4 monitoring days. Measures of momentary Task Strain (high demand, low control) and Social Conflict (rating of recent social interaction quality) were used as indices of stressor exposure, and an accelerometry device was used to create 2 indices of physical activity: weekly average and recent (30 min prior to each ED interview). Multilevel models were used to examine the moderating between- and within-person effects of physical activity on ABP fluctuations corresponding with the momentary psychosocial stressors.

RESULTS

Weekly physical activity moderated the effects of ABP responses to Task Strain (systolic blood pressure [SBP]: p = .033; diastolic blood pressure [DBP]: p = .028) and Social Conflict (DBP: p = .020), with significant increases in SBP and DBP shown for less physically active individuals but not for more physically active individuals. Similarly, recent physical activity moderated within-person DBP responses to Task Strain (p = .025), with greater DBP increases following less active periods.

CONCLUSION

Our results demonstrate that weekly and recent physical activity may moderate the effects of ABP responses to daily psychosocial stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program

Background

Stress is highly prevalent in the U.S. society, especially in executives, and is a well-documented risk factor for a wide range of medical disorders. Knowledge of common sources of stress and predictive factors may help identify executives at risk of high stress and allow us to appropriately refer them for stress management treatment.

Objective

The primary aim of this study was to identify common sources of stress, predictors of high stress, and other correlates among executives.

Methods

This was a cross-sectional survey of executives who requested a stress management consult at our institution. We abstracted the data from a 14-item intake survey as well as from the patient interview.

Results

Of the 839 executives, 827 executives (98.6%) who were referred for individual stress management consults completed the stress-related questions of the survey; 51.3% of these executives reported having a high stress level. Study participants mostly struggled with the well-being measures of sleep, anxiety, energy level, and diet. The majority reported that their main stressor was work related (n = 540, 64.4%) followed by family related (n = 371, 44.2%), health related (n = 170, 20.3%), and work–life balance (n = 62, 7.4%). In unadjusted analysis, high stress was associated with younger age (P = .006), lower quality-of-life scores (P < .001), and less physical activity (P < .001). In multivariable analyses, the strongest predictors for high stress level were younger age (odds ratios [OR] = 0.84, P = .045) and worse quality-of-life indicators such as anxiety (OR = 2.72, P < .001), diet (OR = 0.78, P = .02), and sleep (OR = 0.74, P < .003).

Conclusion

These findings suggest that executives with a high level of stress might be best helped through a multimodality stress management program. Our findings merit replication in larger studies and more definitive confirmation with prospective clinical trials.

Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study

While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.

Systemic inflammation and resting state connectivity of the default mode network

The default mode network (DMN) encompasses brain systems that exhibit coherent neural activity at rest. DMN brain systems have been implicated in diverse social, cognitive, and affective processes, as well as risk for forms of dementia and psychiatric disorders that associate with systemic inflammation. Areas of the anterior cingulate cortex (ACC) and surrounding medial prefrontal cortex (mPFC) within the DMN have been implicated specifically in regulating autonomic and neuroendocrine processes that relate to systemic inflammation via bidirectional signaling mechanisms. However, it is still unclear whether indicators of inflammation relate directly to coherent resting state activity of the ACC, mPFC, or other areas within the DMN. Accordingly, we tested whether plasma interleukin (IL)-6, an indicator of systemic inflammation, covaried with resting-state functional connectivity of the DMN among 98 adults aged 30-54 (39% male; 81% Caucasian). Independent component analyses were applied to resting state fMRI data to generate DMN connectivity maps. Voxel-wise regression analyses were then used to test for associations between IL-6 and DMN connectivity across individuals, controlling for age, sex, body mass index, and fMRI signal motion. Within the DMN, IL-6 covaried positively with connectivity of the sub-genual ACC and negatively with a region of the dorsal medial PFC at corrected statistical thresholds. These novel findings offer evidence for a unique association between a marker of systemic inflammation (IL-6) and ACC and mPFC functional connectivity within the DMN, a network that may be important for linking aspects of immune function to psychological and behavioral states in health and disease.