Impact of acute coronary syndrome (ACS) on work-relatedness evaluation in cerebrovascular and cardiovascular diseases among workers

Significant Impacts of Work-Related Cerebrovascular and Cardiovascular Diseases among Young Workers: A Nationwide Analysis

Background: While occupational factors linked to the onset of cerebrovascular and cardiovascular diseases (CVDs) have been reported among workers, much remains unknown about the impacts that occupation has on the onset of CVDs in various age groups. We attempted to describe temporal trends in total and work-related CVDs (WRCVDs) rates stratified by age and year and explore the relative contributions of work to the CVD risk. Methods: This study was conducted using two populations from the Labor Insurance Database as the working population and the National Health Insurance Research Database as the general population. We included all people aged 15⁻75 years from 2006 to 2013. All CVD events and WRCVD events were identified. A Poisson regression was used to estimate the morbidity rate ratio (RR) stratified by age and period, and an RR adjusted for residual confounding was also used. Results: Incident CVD rates increased with aging in the general population (from 1113.55 to 1853.32 per 100,000 persons), and WRCVD rates increased in the working population over time (from 2.10 in 2006 to 8.60 in 2013 per 100,000 persons). In the age and period analysis, CVD attacks showed disparities in different populations. The RR of the WRCVD risk was mainly in the working population aged >45 years, and the RR of the CVD risk occurred in the oldest group (aged 55⁻64 years) of the general population. The population-attributable risk of working exposure was 13.5%. After eliminating residual confounding factors, higher population attributed risk (PAR) work-related excessive CVD risk mainly occurred in workers aged 25⁻34 and 35⁻44 years. A decreasing PAR trend was found in the age groups as follows: 15⁻24, 25⁻34, 35⁻44, 45⁻54, and 55⁻64 years, with percentages of 17.64%, 16.89%, 16.46%, 10.6%, and 0.65%, respectively. Conclusions: There is evidence that period and age trends of CVD rates differed between the working population and general population. Relative effects attributed to work were more severe in younger workers, particularly in workers aged <55 years.

Cardiovascular disease risk of bus drivers in a city of Korea

Objective

To prevent the occurrence of CV events such as MI and stroke among professional drivers in Korea, bus drivers were compared to other occupations through the Framingham risk scoring system (FRS) or metabolic syndrome (MS) of cardiovascular disease (CVD) risk assessment methods.

Methods

In October 2012, a health examination survey was conducted for 443 male bus drivers in a big city. Their CVD risk factors were compared to those of a ‘total employed’ (A group) and ‘crafts and machine operators’ (B group) extracted from Fifth Korea National Health and Nutrition Examination Survey (KNHANES, 2010) data by using FRS and MS. We calculated proportions of the CVD risk factors distribution between bus drivers and the A, B groups by the bootstrapping method. The Odds ratio (OR) between CV event risk combining MS with CHD equivalent risk of FRS and occupational factors like shift patterns and professional driving duration/age ratios (PDAR) of bus drivers was calculated through multinominal logistic regression.

Results

The proportion of BMI ≥ 25 kg/m² was 53.9% and waist circumference ≥ 90cm was 40.9% among bus drivers. Hypertension and MS prevalence of bus drivers was 53.3%, 49.9% which is higher than 17.6%, 22.6% in the A group and 19.7%, 23.8% in the B group respectively. OR of high CV event risk in alternate shift was 2.58 (95% CI 1.33~5.00) in comparison with double shift pattern and OR in PDAR ≥ 0.5 was 2.18 (95% CI 1.15~4.14).

Conclusion

Middle aged male drivers in a big city of Korea stand a higher chance of developing CV event than other professions of the same age.

A comparison of the recognition of overwork-related cardiovascular disease in Japan, Korea, and Taiwan

In Japan, Korea, and Taiwan, cerebrovascular and cardiovascular diseases (CVDs) caused by overwork are recognized by government as work-related. These three countries are the only countries in the world that officially recognize CVDs caused by psychosocial factors (e.g., overwork) as work-related cerebrovascular and cardiovascular diseases (WR-CVDs), and compensate employees accordingly. The present study compared the similarities and differences among the recognition of overwork-related CVDs in Japan, Korea, and Taiwan. The criteria by which WR-CVDs are identified are very similar in the three countries. However, in the interval surveyed (1996-2009), Korea had a remarkably larger number of recognized WR-CVD patients than did Japan or Taiwan. Recognition of occupational diseases is influenced by various factors, including socio-cultural values, the nature of occupational health care schemes, the extent of the social security umbrella, national health insurance policy, and scientific evidence. Our results show that social factors may be very different among the three countries studied, although the recognition criteria for WR-CVDs are quite similar.

Work-related cerebrovascular and cardiovascular diseases (WR-CVDs) in Korea

The effects of work on the heart are mediated by chemical, physical, and psychological stressors. It is standard clinical practice to assess personal risk factors such as cigarette smoking, hypertension, and cholesterol. Evaluation of a patient's acute symptoms and activity level at the time of presentation is also standard practice. However, clinicians typically do not assess workplace risk factors; nor do they usually identify the location and its possible exposures that may have contributed to the patient's symptoms. In Korea, work-related cerebrovascular and cardiovascular diseases (WR-CVDs) are among the most compensated cases, second only to work-related musculoskeletal disorders (WR-MSDs). The average accumulated insurance benefit per injured worker is an estimated USD 75,000, which is thought to have a major impact on the financial stability of insurers. Therefore, the present study was performed to 1) review the physicochemical agents of cardiovascular diseases in Korea, 2) review the effects of psychosocial factors such as work-related stress on WR-CVDs in Korea, and 3) discuss the concepts and perspectives of WR-CVDs in Korea by comparing with those in Japan.

Overtime, job stressors, sleep/rest, and fatigue of Japanese workers in a company

To ascertain the usefulness of a 21-item checklist that assesses accumulated fatigue due to overwork, we examined (1) the associations between overtime work, job stressors, or the quantity of sleep/rest and subjective symptoms of fatigue, and (2) whether sleeping hours and monthly days off are associated with the accumulated fatigue parameter using the checklist. Questionnaire surveys were administered twice to Japanese workers at a plant of a manufacturing company. Among the 390 registered workers, 383 workers (284 males and 99 females) in the first survey and 350 workers (260 males and 90 females) in the second survey responded. The subjective symptoms score significantly increased according to the order of grade of overtime work, other job stressors, and sleep/rest subscales in both sexes by ANOVA. The subjective symptoms grade was significantly associated with the other job stressors grade and sleep/rest grade, but not with overtime work. The accumulated fatigue parameter was negatively correlated with daily sleeping hours (significant Spearman's correlation coefficient (r(s)) =-0.318 and -0.340 in the 1st and 2nd surveys) and with monthly days off (r(s)=-0.250 and -0.151) among all of the subjects. It may be possible to assess overwork by the accumulated fatigue parameter.