Abstract
OBJECTIVES: Hypertension is an increasingly important health concern in Canada. This paper examines the risks associated with psychosocial working conditions compared to health behaviours on the risk of hypertension over a 9-year period in Ontario, Canada.
METHODS: We used data from Ontario respondents to the 2000–01 Canadian Community Health Survey linked to the Ontario Health Information Plan database covering physician services and the Canadian Institute for Health Information database for hospital admissions. We focused on labour market participants aged 35 to 60, who had not been previously diagnosed with hypertension, were not self-employed, and were working more than 10 hours per week, more than 20 weeks in the previous 12 months (N = 6,611). Subjects were followed for a nine-year period to ascertain incidence of hypertension.
RESULTS: Low job control was associated with an increased risk of hypertension among men, but not among women. The population attributable fraction associated with low job control among males was 11.8% in our fully adjusted model. There was no consistent pattern of increased risk of hypertension across different levels of health behaviours.
CONCLUSION: Primary prevention efforts to reduce the incidence of hypertension predominantly target modifiable health behaviours. Evidence from this longitudinal cohort suggests that modifiable characteristics of the work environment should also be considered in the design of cardiovascular disease prevention programs, in particular for male labour market participants.
Key words: Hypertension, psychosocial factors, work, gender
Résumé
OBJECTIFS: L’hypertension artérielle est un problème de santé qui gagne en importance au Canada. Nous avons comparé sur une période de neuf ans les risques d’hypertension associés aux conditions de travail psychosociales et ceux associés aux habitudes de santé en Ontario, au Canada.
MÉTHODE: Nous avons utilisé les données fournies par les répondants ontariens de l’Enquête sur la santé dans les collectivités canadiennes de 2000–2001 et nous les avons reliées à la base de données de l’Assurance-santé de l’Ontario, qui couvre les services médicaux, et à la base de données de l’Institut canadien d’information sur la santé pour ce qui est des hospitalisations. Nous nous sommes limités aux actifs de 35 à 60 ans n’ayant jamais reçu de diagnostic d’hypertension, n’étant pas travailleurs autonomes et ayant travaillé plus de 10 heures par semaine pendant plus de 20 semaines au cours des 12 mois précédents (N = 6 611). Les sujets ont été suivis sur une période de neuf ans pour vérifier leur incidence d’hypertension.
RÉSULTATS: Le faible contrôle sur le travail était associé à un risque accru d’hypertension chez les hommes, mais pas chez les femmes. Chez les hommes, la fraction attribuable dans la population associée au faible contrôle sur le travail était de 11,8 % dans notre modèle entièrement ajusté. Nous n’avons pas observé de hausse systématique du risque d’hypertension entre les différents niveaux d’habitudes de santé.
CONCLUSION: Les efforts de prévention primaire qui visent à réduire l’incidence de l’hypertension ciblent surtout les habitudes de santé modifiables. Selon les preuves de cette étude de cohorte longitudinale, les caractéristiques modifiables du milieu de travail devraient aussi être prises en considération lorsqu’on conçoit des programmes de prévention des maladies cardiovasculaires, en particulier pour les actifs de sexe masculin.
Mots clés: hypertension artérielle, facteurs psychosociaux, travail, sexe
Footnotes
Sources of Support: This work was supported by a grant from the Canadian Institutes of Health Research (#201246). Peter Smith was supported by a New Investigator Award from the Canadian Institutes of Health Research while undertaking this work, and is currently supported by a Discovery Early Career Research Award from the Australian Research Council. Approval for the secondary data analyses was obtained through the University of Toronto, Health Sciences I Ethics committee. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
Conflict of Interest: None to declare.
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