COMMENTARY

Salt, Salt, Salt -- Plus Sleep and Job Stress: More Data to Share With Your Patients

Linda Brookes, MSc

Disclosures

September 09, 2009

In This Article

Hypertension Among Lower-Status Employees Persists Into Retirement

Occupation-related hypertension is not necessarily resolved by retirement, according to the results of a study from the University of California, Davis. On the contrary, the association between socioeconomic status and hypertension recorded in working persons in many previous studies persists beyond age 65 years, say J Paul Leigh, PhD, and Juan Du, PhD, in the Journal of Occupational and Environmental Medicine.[17] Their study, which was funded by the National Institute for Occupational Safety and Health, is the first to show that retirement-aged Americans who hold higher-status jobs (managers and professionals) tend to have the lowest rates of hypertension, while those who had lower-status jobs tend to have the highest rates. Previously only 1 European study correlated pre-retirement occupation with heart disease among people 65 years of age and older[18]; most similar research has focused on working people between the ages of 25 and 65 years.

Drs. Leigh and Du based their research on data compiled by the University of Michigan Health and Retirement Study. Funded by the National Institute on Aging, the study surveys > 22,000 noninstitutionalized Americans older than the age of 50 every 2 years and includes detailed information on job history, health status, lifestyle, and socioeconomic factors. The study used data collected between March 2004 and February 2005 from 3645 men and 3644 women who were 65 years of age and older who reported ≥ 1 year's tenure in the same occupation. Occupations during working years ranged from managers and white-collar professionals to clerical and blue-collar workers. A small percentage of people in the sample were working at the time the data were collected: 10% of 65-year-olds and < 2% of 75-year-olds. Hypertension, which was identified on self-report based on physician diagnosis, was present in 59% of men and 63% of women.

The researchers analyzed the data as 12 gender-specific subsamples (age ≥ 65, ≥ 70, and ≥ 75 years). After adjusting for control variables including education, race, income, smoking, drinking, body mass, and number of comorbidities, a number of occupations were found to be significantly (P < .05) more likely than managers to report hypertension: in men, these occupations were salespersons, personal service workers, mechanics, construction trade workers, precisions production workers, and operators. In women, the occupations were professionals, salespeople, private household cleaning service workers, and personal service workers. These results were consistent with studies of those who are currently employed: higher-status occupations are associated with less hypertension than lower-status occupations.

Senior author Dr. Leigh explained that unlike executives and professionals such as architects and engineers, workers in positions such as sales, administrative support, construction, and food preparation have little control over decision-making, are under pressure to get a specified amount of work done in a certain amount of time, and may feel inadequate about their positions in the workplace hierarchy.[19] Consequently, their stress levels tend to be higher, which can lead to high blood pressure and, eventually, hypertension. Overall, the link between higher-status occupation and lower prevalence of hypertension was stronger for male than for female seniors. Females in professional positions had more hypertension than female managers, whereas male professionals did not have more hypertension than male managers. Dr. Leigh suggested that this anomaly could reflect the fact that women have historically held lower-status professional jobs than men. "Whatever the reason, the link between women in professional jobs and their risks of hypertension deserves more study," he says.

The most important study outcome, according to Dr. Leigh, is that the pool of people thought to have job-related hypertension may be significantly greater than previously assumed. They calculate that an additional 3.6 million people aged 18-64 years and 2.1 million people aged 65 years and older in the United States may have occupation-related hypertension. Dr. Leigh hopes that this study will support consideration of job history along with lifestyle factors when physicians consider hypertension risks with their patients. "Even among the obese, we found that occupation correlated closely with hypertension," he said. "We don't want to downplay the importance of lifestyle issues and health, but, in addition to recommending lifestyle changes and prescribing medication, physicians could advocate for a change of working conditions for these jobs in society at large to improve health outcomes for workers."

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