Interaction abetween occupational stress and dyslipidemia on the prevalence of hypertension
-
摘要:
目的 探讨职业紧张和血脂异常的交互作用与高血压患病的关系。 方法 (1) 采用随机整群抽样方法，最终纳入克拉玛依8所油田分公司的2 149名油田工人作为研究对象，发放付出-回报失衡(effort-return imbalance, ERI)量表并收集体检指标，最终纳入研究对象。(2)通过logistic回归分析模型和Delta法分析职业紧张和血脂异常交互作用与高血压患病的关系。 结果 高血压患病率为27.3%，职业紧张和血脂异常组的高血压患病率均较高(均P < 0.05)；校正混杂因素后，职业紧张(OR=1.243, 95% CI: 1.027~1.505, P=0.025)和血脂异常(OR=2.089, 95% CI: 1.712~2.548, P＜0.001)是高血压的危险因素，两者与高血压存在相加[交互作用超额相对危险度(relative excess risk of interaction，RERI)=5.556, 交互作用归因比(attributable proportion of interaction，API)=0.649, 交互作用指数(synergy index，S)=3.774]和正的相乘交互作用(OR=2.327, 95% CI: 1.755~3.085, P＜0.001)；职业紧张和血脂异常同时存在罹患高血压的风险是两者均不存在者的8.6倍(95% CI: 6.443~11.371)。 结论 职业紧张、血脂异常及其交互作用均与高血压的患病风险增加有关。 Abstract:Objective This study aimed to investigate the interaction between occupational stress and dyslipidemia on the prevalence of hypertension. Methods Using cluster sampling, the study selected 2 149 oilfield workers from eight Karamay oilfield branches. Participants′ occupational stress was investigated using the Effort-Reward Imbalance (ERI) scale, and their physical indicators were also assessed. Logistic regression analysis and Delta method were used to determine the association between the interaction of occupational stress and dyslipidemia and hypertension prevalence. Results The prevalence of hypertension was found to be 27.3%. The prevalence of hypertension was significantly higher both in the occupational stress group and dyslipidemia group(all P < 0.05). After adjustment for confounding factors, logistic regression analysis showed that occupational stress (OR=1.243, 95% CI: 1.027-1.505, P=0.025) and dyslipidemia (OR=2.089, 95% CI: 1.712-2.548, P < 0.001) were independently associated with the risk of hypertension. Occupational stress and dyslipidemia had additive (RERI=5.556, API=0.649, S=3.774) and positively multiplicative (OR=2.327, 95% CI: 1.755-3.085, P < 0.001) interaction on hypertension. Occupational stress combined with dyslipidemia was associated with 8.6 times higher risk compared to the group without occupational stress and dyslipidemia. Conclusions Occupational stress, dyslipidemia and their interaction were associated with an increase risk of hypertension. -
Key words:
- Occupational stress /
- Dyslipidemia /
- Interaction /
- Hypertension
-
表 1 高血压患病率在不同特征组间的比较
Table 1. Comparison of the hypertension prevalence among different characteristic groups
变量Variable 合计
Total
(n=2 149)高血压①
Hypertension ①χ2值
valueP值
value变量Variable 合计
Total
(n=2 149)高血压①
Hypertension ①χ2值
valueP值
value性别Gender 93.24 < 0.001 是否饮酒Drinking 25.60 < 0.001 男Male 1 159 416(35.9) 否No 959 210(21.9) 女Female 990 171(17.3) 是Yes 1 190 377(31.7) 年龄组/岁Age group/years 105.25 < 0.001 ② BMI/(kg·m-2) 144.50 < 0.001 ② < 30 226 20(8.8) < 18.5 55 5(9.1) 30~ < 45 1 054 234(22.2) 18.5~ < 24.0 911 148(16.2) ≥45 869 333(38.3) 24.0~ < 28.0 789 251(31.8) 工龄/年Length of service/years 69.83 < 0.001 ② ≥28.0 394 183(46.4) < 10 539 84(15.6) 职业紧张Occupational stress 4.92 0.028 10~ < 20 280 55(19.6) 否No 1 189 302(25.4) ≥20 1 330 448(33.7) 是Yes 960 285(29.7) 轮班情况Shift assignment 4.27 0.043 TG/(mmol·L-1) 47.93 < 0.001 固定白班Day shift 760 228(30.0) ≥2.3 385 160(41.6) 轮班Shifts work 1 389 359(25.8) < 2.3 1 764 427(24.2) 文化程度Educational level 59.45 < 0.001 TC/(mmol·L-1) 13.07 < 0.001 中专及以下High school or below 863 313(36.3) ≥6.2 150 60(40.0) 大专及以上College degree or above 1 273 269(21.1) < 6.2 1 999 527(26.4) 婚姻状况 22.28 < 0.001 HDL-C/(mmol·L-1) 30.10 < 0.001 未婚Unmarried 194 25(12.9) ≥1.0 1 747 433(24.8) 已婚Married 1 747 491(28.1) < 1.0 402 154(38.3) 离异及丧偶Divorced or widowed 208 71(34.1) LDL-C/(mmol·L-1) 12.13 0.001 月收入/元Monthly income/Yuan 0.12 0.769 ≥4.1 134 54(40.3) < 5 000 1 884 517(27.4) < 4.1 2 015 533(26.5) ≥5 000 265 70(26.4) 血脂异常Dyslipidemia 55.81 < 0.001 是否吸烟Smoking 46.49 < 0.001 否No 1 474 331(22.5) 否No 1 320 292(22.1) 是Yes 675 256(37.9) 是Yes 829 295(35.6) 合计Total 2 149 587(27.3) 注：TC, 总胆固醇; TG, 三酰甘油; HDL-C, 高密度脂蛋白胆固醇; LDL-C, 低密度脂蛋白胆固醇。
①以[人数(占比/%)]表示。②趋势χ2检验结果。
Note: TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
① [Number of people (proportion/%)]. ② Tend chi-square test results.
下载: 导出CSV
表 2 职业紧张和血脂异常的logistic回归分析
Table 2. Logistic regression analysis of occupational stress and dyslipidemia
变量Variable 单因素Single factor 多因素Multifactor OR值value (95% CI) P值value OR值value (95% CI) P值value 职业紧张Occupational stress 无No 1.000 1.000 有Yes 1.240(1.052~1.500) 0.027 1.243(1.027~1.505) 0.025 血脂异常Dyslipidemia 否No 1.000 1.000 是Yes 2.110(1.731~ 2.571) < 0.001 2.089(1.712~2.548) < 0.001
下载: 导出CSV
表 3 职业紧张和血脂异常对高血压的相乘交互作用
Table 3. Multiplied interaction of occupational stress and dyslipidemia on hypertension
变量Variable 模型1 ① Model 1 ① 模型2 ② Model 2 ② OR值value (95% CI) P值value OR值value (95% CI) P值value 职业紧张Occupational stress 1.422(1.112~1.817) < 0.001 1.428(1.117~1.827) < 0.001 血脂异常Dyslipidemia 2.590(1.968~3.408) 0.005 2.576(1.955~3.393) 0.005 职业紧张×血脂异常
Occupational stress×Dyslipidemia2.335(1.778~3.118) < 0.001 2.327(1.755~3.085) < 0.001 注：①未调整其他变量。②调整性别、年龄、轮班、文化程度、婚姻、吸烟、饮酒、BMI。
Note: ① Not adjusted for other variables. ② Adjusted for gender, age, shift work, education, marriage, smoking, alcohol use, BMI.
下载: 导出CSV
表 4 职业紧张和血脂异常对高血压的相加交互作用
Table 4. Additive interaction of occupational stress and dyslipidemia on hypertension
职业紧张
Occupational stress血脂异常
Dyslipidemia总人数
Total number of people高血压
[人数(占比/%)]
Hypertension
[Number of people
(Proportion /%)]模型1 ①
Model 1 ①模型2 ②
Model 2 ②OR值value
(95% CI)OR值value
(95% CI)无No 否No 843 167 (19.8) - - 无No 是Yes 346 135 (39.0) 1.422(1.110~1.822) 2.575(1.952~3.398) 有Yes 否No 631 164 (26.0) 2.591(1.964~3.418) 1.428(1.114~1.829) 有Yes 是Yes 329 121 (36.8) 8.671(6.527~11.519) 8.559(6.443~11.371) 注：“-”表示参照组。
①未调整其他变量。②调整性别、年龄、轮班、文化程度、婚姻、吸烟、饮酒、BMI。
Note: “-”Indicates reference group.
① Not adjusted for other variables. ② Adjusted for gender, age, shift work, education, marriage, smoking, drinking, BMI.
下载: 导出CSV
表 5 职业紧张和血脂异常对高血压的相加交互作用评价指标
Table 5. Evaluation indicators of the additive interaction of occupational stress and dyslipidemia on hypertension
模型Model RERI(95% CI) API(95% CI) S(95% CI) 模型1 ①
Model 1 ①5.658 (3.415~7.902) 0.653 (0.542~0.763) 3.811 (2.468~5.885) 模型2 ②
Model 2 ②5.556 (3.343~7.770) 0.649 (0.537~0.761) 3.774 (2.443~5.831) 注：①未调整其他变量。②调整性别、年龄、轮班、文化程度、婚姻、吸烟、饮酒、BMI。
Note: ① Not adjusted for other variables. ② Adjusted for gender, age, shift work, education, marriage, smoking, drinking, BMI.
下载: 导出CSV
-
[1] Egan BM, Kjeldsen SE, Grassi G, et al. The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard?[J]. J Hypertens, 2019, 37(6): 1148-1153. DOI: 10.1097/HJH.0000000000002021. [2] Chang PY, Chiou ST, Lo WY, et al. Stressors and level of stress among different nursing positions and the associations with hyperlipidemia, hyperglycemia, and hypertension: a national questionnaire survey[J]. BMC Nurs, 2021, 20(1): 250. DOI: 10.1186/s12912-021-00777-y. [3] Yang F, Qiu R, Abudoubari S, et al. Effect of interaction between occupational stress and polymorphisms of MTHFR gene and SELE gene on hypertension[J]. Peer J, 2022, 10: e12914. DOI: 10.7717/peerj.12914. [4] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002.Writing Group of 2018 Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Hypertension Society, Chinese Society of Cardiology, Chinese Medical Doctor Association, et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002. [5] 高晓燕. 煤化工企业工人职业紧张、基因多态性及其交互作用与职业倦怠的关系研究[D]. 乌鲁木齐: 新疆医科大学, 2018.Gao XY. Study on the relationship between occupational stress, gene polymorphism and their interaction on job burnout in coal chemical enterprises' workers[D]. Urumqi: Xinjiang Medical University, 2018. [6] 诸骏仁, 高润霖, 赵水平, 等. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志, 2016, 31(10): 937-953. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htmChu JR, Gao RL, Zhao SP, et al. 2016 Chinese guideline for the management ofdyslipidemia in adults[J]. Chin Circul J, 2016, 31(10): 937-953. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htm [7] Andersson T, Alfredsson L, Källberg H, et al. Calculating measures of biological interaction[J]. Eur J Epidemiol, 2005, 20(7): 575-9. DOI: 10.1007/s10654-005-7835-x. [8] 丁帅, 缪伟刚, 覃玉, 等. 打鼾与BMI对高血压患病的交互作用[J]. 中华疾病控制杂志, 2021, 25(5): 589-593. DOI: 10.16462/j.cnki.zhjbkz.2021.05.017.Ding S, Miao WG, Qin Y, et al. A study on the interaction of snoring and body mass index on hypertension[J]. Chin J Dis Control Prev, 2021, 25(5): 589-593. DOI: 10.16462/j.cnki.zhjbkz.2021.05.017. -
