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Molarius A, Hasselgren M. Socioeconomic status, lifestyle factors and asthma prevalence: results from a population-based study in Sweden. Scand J Public Health 2021:14034948211060821. [PMID: 34903097 DOI: 10.1177/14034948211060821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences. METHODS The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression. RESULTS The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3-1.7). Also, physical inactivity 1.2 (1.1-1.3) and obesity 1.6 (1.4-1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma. CONCLUSIONS In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.
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Affiliation(s)
- Anu Molarius
- Centre for Clinical Research, Region Värmland, Sweden.,Department of Public Health Sciences, Karlstad University, Sweden
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2
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Bjerkeli PJ, Skoglund I, Holmgren K. Does early identification of high work related stress affect pharmacological treatment of primary care patients? - analysis of Swedish pharmacy dispensing data in a randomised control study. BMC FAMILY PRACTICE 2020; 21:70. [PMID: 32334516 PMCID: PMC7183611 DOI: 10.1186/s12875-020-01140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
Background The study is part of a randomised controlled trial with the overall aim to evaluate if use of the Work Stress Questionnaire (WSQ), combined with feedback at consultation, can be used by healthcare professionals in primary health care to prevent sickness absence. The specific aim of the present study was to investigate whether there were differences in pharmacy dispensing of prescription medications between the intervention group and the control group. Methods The study was a randomized controlled trial. Non-sick-listed employed women and men, aged 18 to 64 years, seeking care at primary health care centres (PHCCs) were eligible participants. The intervention included early identification of work-related stress by the WSQ, general practitioner (GP) training and GP feedback at consultation. Pharmacy dispensing data from the Swedish Prescription Drug Register for a period of 12 months following the intervention was used. Primary outcomes were the number of different medications used, type of medication and number of prescribing clinics. Data was analysed using Mann Whitney U tests and chi-square tests. Results The study population included 271 individuals (132 in the intervention group and 139 in the control group). The number of different medications used per individual did not differ significantly between the control group (median 4.0) and the intervention group (median 4.0, p-value 0.076). The proportion of individuals who collected more than 10 different medications was higher in the control group than in the intervention group (15.8% versus 4.5%, p = 0.002). In addition, the proportion of individuals filling prescriptions issued from more than three different clinics was higher in the control group than in the intervention group (17.3% versus 6.8%, p = 0.007). Conclusion Systematic use of the WSQ combined with training of GPs and feedback at consultation may affect certain aspects of pharmacological treatment in primary health care patients. In this randomised control trial, analysis of pharmacy dispensing data show that patients in the intervention group had less polypharmacy and filled prescriptions issued from a smaller number of different clinics. Trial registration ClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
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Affiliation(s)
- Pernilla J Bjerkeli
- School of Health and Education, University of Skövde, PO Box 408, SE-521 28, Skövde, Sweden.
| | - Ingmarie Skoglund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454, SE-405 30, Gothenburg, Sweden, Sweden.,The Research and Development Department, Region Västra Götaland, Södra Älvsborg, Borås, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 455, SE-405 30, Gothenburg, Sweden
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Heinrichs K, Hummel S, Gholami J, Schultz K, Li J, Sheikh A, Loerbroks A. Psychosocial working conditions, asthma self-management at work and asthma morbidity: a cross-sectional study. Clin Transl Allergy 2019; 9:25. [PMID: 31168356 PMCID: PMC6509772 DOI: 10.1186/s13601-019-0264-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Adverse psychosocial working conditions—in particular poor job decision latitude and poor social support at work—may impair the effective implementation of asthma self-management behaviour at work and may be associated with increased asthma morbidity. In this study, we investigate for the first time the association of job decision latitude and social support at work with (1) four asthma-specific self-management behaviours at work (i.e., physical activity, trigger avoidance, acute symptom management, and communication) and with (2) asthma morbidity.
Methods A total of 221 employees with asthma recruited through three rehabilitation clinics completed questionnaires (response rate = 29.3%). Job decision latitude and social support were measured using items from the Copenhagen Psychosocial Questionnaire. The four asthma self-management behaviours were mainly assessed by self-developed items. We used the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire to measure asthma morbidity. We dichotomized all variables and conducted logistic regression analyses to calculate odds ratios with 95% CIs. Results Low job decision latitude and low social support were significantly associated with poorer trigger avoidance (odds ratios ≥ 2.09) and poorer acute symptom management (odds ratios ≥ 2.29); low social support was further related to significantly less communication (odds ratio = 2.82). Low job decision latitude and low social support were also associated with significantly poorer asthma control (odds ratios ≥ 1.95) and poorer asthma-specific quality of life (odds ratios ≥ 2.05). The relationships with asthma morbidity were attenuated after adjustment for the four asthma self-management behaviours (odds ratios ranging from 1.1 to 1.9). Conclusions Adverse psychosocial working conditions are associated with poorer asthma self-management behaviour at work and with increased asthma morbidity. The latter association may be mediated by asthma self-management behaviour. Trial registration German Clinical Trials Register, registration number: DRK S00011309, date of registration: 22.12.2016. Electronic supplementary material The online version of this article (10.1186/s13601-019-0264-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherina Heinrichs
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Stefan Hummel
- MEDIAN Klinik Heiligendamm, Kinderstrand 1, 18209 Bad Doberan, Germany
| | - Jalal Gholami
- Nordseeklinik Borkum der DRV Rheinland, Bubertstraße 4, 26757 Borkum, Germany
| | - Konrad Schultz
- 4Klinik Bad Reichenhall der DRV Bayern Süd, Salzburger Str. 8, 83435 Bad Reichenhall, Germany
| | - Jian Li
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.,5Department of Environmental Health Sciences, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA.,6School of Nursing, University of California Los Angeles, Los Angeles, CA 90095-1772 USA
| | - Aziz Sheikh
- 7Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Adrian Loerbroks
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
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What Does a Single-Item Measure of Job Stressfulness Assess? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091480. [PMID: 31027356 PMCID: PMC6539290 DOI: 10.3390/ijerph16091480] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022]
Abstract
Single-item measures of global job stressfulness are increasingly used in occupational health research, yet their construct validity remains unexplored. This study used a qualitative approach to identify frames of reference that underlie self-ratings on such a measure. Data were collected from a convenience sample of 55 adults in full-time employment who completed a single-item measure inviting a rating of the extent to which their job is generally stressful. A cognitive interview schedule was used to explore the factors taken into account when providing a global rating, with thematic analysis applied to identify themes in the interview transcripts. The most common frames of reference were the presence of problematic psychosocial working conditions, particularly job demands. Health characteristics, predominantly poor psychological wellbeing, emerged as a further less dominant secondary theme. Almost half the sample cited four or more referents. In terms of the timeframe under consideration, most participants referred to a long timeframe such as their work in general, with some specifying their current job and, a few, recent weeks. These findings shed light on the frames of reference used to inform judgements on global job stressfulness elicited by a single-item measure and in doing so contribute to the evidence base to support the application of such measures in occupational health research and organisational psychosocial risk management activities.
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Forster F, Weinmann T, Gerlich J, Schlotz W, Weinmayr G, Genuneit J, Windstetter D, Vogelberg C, von Mutius E, Nowak D, Radon K. Work-related stress and incident asthma and rhinitis: results from the SOLAR study. Int Arch Occup Environ Health 2019; 92:673-681. [PMID: 30656403 DOI: 10.1007/s00420-019-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study analyzes the association of work-related stress with incident asthma and rhinitis in young adults with a special focus on gender-specific differences. METHODS Incident asthma, wheezing and rhinitis were measured in a cohort of 2051 young German adults (aged 16-18 years at baseline) recruited by the prospective population-based SOLAR study (Study of Occupational Allergy Risks). Work-related stress was measured by the Trier Inventory for the Assessment of Chronic Stress (TICS). Two TICS scales, work overload and work discontent, were analysed. Logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS In females, the odds for incident asthma were found to be 17% higher for each increase of the work discontent score by one point (OR 1.17, 95% CI 1.04-1.31). In males, no association was statistically significant. Incident rhinitis showed no association with any exposure variable. CONCLUSION This study shows a link between work-related stress and incident asthma which seems to be confined to women. This study adds evidence about the association of work-related stress and asthma in young adults and can contribute to prevention for that particular age group.
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Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany. .,Institute for Medical Informatics, Biometry, and Epidemiology, LMU Munich, Munich, Germany. .,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
| | - Wolff Schlotz
- Max Planck Institute of Empirical Aesthetics, Frankfurt am Main, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Doris Windstetter
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr. v. Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.,Comprehensive Pneumology Centre Munich, Member of German Centre for Lung Research, Munich, Germany.,Munich Center of Health Sciences (MC-Health), Munich, Germany
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Loerbroks A, Nguyen XQ, Vu-Eickmann P, Krichbaum M, Kulzer B, Icks A, Angerer P. Psychosocial working conditions and diabetes self-management at work: A qualitative study. Diabetes Res Clin Pract 2018; 140:129-138. [PMID: 29608978 DOI: 10.1016/j.diabres.2018.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 12/01/2022]
Abstract
AIMS We conducted a qualitative study to expand our current understanding of the potential link between psychosocial working conditions and diabetes self-management at work. METHODS Thirty employed adults with diabetes mellitus living in Germany (n = 19 with type 1, n = 11 with type 2, 57% female, aged 24-64 years) were recruited. Using a topic guide, we carried out in-depth interviews in face-to-face contact or by telephone. Interviews were transcribed and content-analyzed using MaxQDA. RESULTS Psychosocial working conditions perceived to detrimentally affect self-management activities included, amongst others, a high workload, poor job control, unhygienic working environments, the requirement to work under high or fluctuating temperature, perceived social norms at the workplace, and the attitude to prioritize work-related demands as opposed to diabetes-related demands. The types of self-management activities considered to be adversely affected related to glucose monitoring, insulin injections, dietary control, the ability to recognize hypoglycemia and health care use. CONCLUSIONS Various types of occupational psychosocial factors may determine diabetes self-management practices at the workplace. Quantitative studies are needed to confirm our observations. Subsequently, interventions could be developed and evaluated to improve opportunities to adequately engage into diabetes self-management at work.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany; Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany.
| | - Xuan Quynh Nguyen
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Patricia Vu-Eickmann
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Michael Krichbaum
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Theodor Klotzbücher Str. 12, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim, Theodor Klotzbücher Str. 12, 97980 Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Theodor Klotzbücher Str. 12, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim, Theodor Klotzbücher Str. 12, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; Institute for Health Services Research and Health Economics, German Diabetes Centre, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Centre for Diabetes Research, Ingolstädter Landstraβe 1, 85764 München-Neuherberg, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
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Abstract
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non-Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Loerbroks A, Ding H, Han W, Wang H, Wu JP, Yang L, Angerer P, Li J. Work stress, family stress and asthma: a cross-sectional study among women in China. Int Arch Occup Environ Health 2017; 90:349-356. [PMID: 28220243 DOI: 10.1007/s00420-017-1201-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/12/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Research addressing links of work stress or family stress with asthma is constrained by (1) inconsistent evidence, (2) failure to consider the combined exposure to work stress and family stress, and (3) its primary focus on Western study populations. We aimed to address these knowledge gaps. METHODS We used cross-sectional data collected in 2015 among 7816 women from five professional groups in five Chinese cities. Work stress was measured by the 10-item effort-reward imbalance (ERI) questionnaire. Family stress was assessed by a psychometrically evaluated instrument comprising five items on, e.g., familial conflicts or domestic workload. Asthma was operationalized by self-reports of a physician diagnosis. Associations were examined by multivariable logistic regression estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Both high work stress (i.e., ERI score >1) and high family stress (i.e., score above the median) were associated with asthma (OR 1.66, 95% CI 1.22-2.27 and OR 1.48, 95% CI 1.10-1.99, respectively). Women with combined exposure (versus none) had somewhat higher odds of asthma (OR 2.13, 95% CI 1.42-3.19) than those with sole exposure to either work stress (OR 1.89, 95% CI 1.20-2.96) or family stress (OR 1.71, 95% CI 1.03-2.84). Interaction terms were significant for continuous variables (p = 0.046), but not for dichotomized variables (p = 0.199). CONCLUSIONS The present study suggests that both work stress and family stress are positively associated with asthma in women in China. Further, the combined exposure may be associated with a further excess of asthma occurrence. Longitudinal studies are needed to confirm our findings and to explore potential temporal relationships.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Hui Ding
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, 100026, Beijing, People's Republic of China. .,School of Public Health, Capital Medical University, Beijing, People's Republic of China.
| | - Wei Han
- Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China
| | - Hong Wang
- Shenzhen Maternity and Child Health Care Hospital, Shenzhen, People's Republic of China
| | - Jiang-Ping Wu
- Nanjing Maternity and Child Health Care Hospital, Nanjing, People's Republic of China
| | - Liu Yang
- Shenyang Women and Children Health Care Center, Shenyang, People's Republic of China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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9
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Hartmann B, Leucht V, Loerbroks A. Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study. J Asthma 2016; 54:210-216. [PMID: 27328314 DOI: 10.1080/02770903.2016.1201836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap. METHODS In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression. RESULTS Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively). CONCLUSIONS The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.
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Affiliation(s)
- Bettina Hartmann
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Verena Leucht
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Adrian Loerbroks
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
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Lin RT, Christiani DC, Kawachi I, Chan TC, Chiang PH, Chan CC. Increased Risk of Respiratory Mortality Associated with the High-Tech Manufacturing Industry: A 26-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060557. [PMID: 27271647 PMCID: PMC4924014 DOI: 10.3390/ijerph13060557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
Global high-tech manufacturers are mainly located in newly industrialized countries, raising concerns about adverse health consequences from industrial pollution for people living nearby. We investigated the ecological association between respiratory mortality and the development of Taiwan's high-tech manufacturing, taking into account industrialization and socioeconomic development, for 19 cities and counties-6 in the science park group and 13 in the control group-from 1982 to 2007. We applied a linear mixed-effects model to analyze how science park development over time is associated with age-adjusted and sex-specific mortality rates for asthma and chronic obstructive pulmonary disease (COPD). Asthma and female COPD mortality rates decreased in both groups, but they decreased 9%-16% slower in the science park group. Male COPD mortality rates increased in both groups, but the rate increased 10% faster in the science park group. Science park development over time was a significant predictor of death from asthma (p ≤ 0.0001) and COPD (p = 0.0212). The long-term development of clustered high-tech manufacturing may negatively affect nearby populations, constraining health advantages that were anticipated, given overall progress in living standards, knowledge, and health services. National governments should incorporate the long-term health effects on local populations into environmental impact assessments.
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Affiliation(s)
- Ro-Ting Lin
- Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei 11529, Taiwan.
| | - Po-Huang Chiang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 35053, Taiwan.
| | - Chang-Chuan Chan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
- Global Health Center, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
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Loerbroks A, Herr RM, Li J, Bosch JA, Seegel M, Schneider M, Angerer P, Schmidt B. The association of effort-reward imbalance and asthma: findings from two cross-sectional studies. Int Arch Occup Environ Health 2014; 88:351-8. [PMID: 25064121 DOI: 10.1007/s00420-014-0962-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/10/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE There is evidence to suggest that work stress is positively associated with the occurrence of asthma. A limitation is that the small number of prior studies utilized unestablished work stress measures, thus constraining interpretation and generalizability. The present study re-examined this association by assessing work stress based on the well-established effort-reward imbalance (ERI) model. METHODS We drew on data from two cross-sectional studies. Study 1 was conducted in a large pharmaceutical company in 2013 (n = 1,464). Study 2 was based on data from the 2011 wave of the population-based German Socio-Economic Panel (n = 8,388). ERI was assessed by validated questionnaires. Asthma was determined by self-report of a physician-based diagnosis. Associations between ERI or its subcomponents "effort", "reward" and "overcommitment" (z scores or categorized) with asthma were estimated by logistic regression models and reported as adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). RESULTS A one standard deviation increase of the ERI score (reflecting higher work stress) was associated with a 22-48 % elevated odds of asthma (Study 1: OR 1.48, 95 % CI 1.13-1.95, and Study 2: OR 1.22, 95 % CI 1.10-1.36). Z score-based analyses of the separate ERI components generally suggested moderate associations of effort, reward and overcommitment with asthma in both studies (Study 1: OR effort 1.25, 95 % CI 0.95-1.64, OR reward 0.67, 95 % CI 0.51-0.87, OR overcommitment 1.32, 95 % CI 1.01-1.72; and Study 2: OR effort 1.21, 95 % CI 1.09-1.34, OR reward 0.83, 95 % CI 0.76-0.92, OR overcommitment 1.12, 95 % CI 1.01-1.25). Analyses of categorized exposures largely confirmed these observations. CONCLUSIONS This is the first study to demonstrate a link between an established work stress measure and asthma. Longitudinal studies are needed to determine the direction of these associations.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany,
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