Occupational Heart Disease
AUTHORS: Steenland K, Johnson J, Nowlin S
SOURCE: Am J Ind Med 1997 Feb;31(2):256-260
ABSTRACT: The relationship between job strain and heart disease was evaluated via the National Health and Nutrition Survey 1 (NHANES1) completed by a sample of US workers from 1971 to 1975. Because of the lack of job strain scores for women, the study was restricted to 3,575 men with no history of heart disease. Analyses were conducted using Cox regression by means of SAS PHREG. Two principal scores were analyzed: job control (decision authority and latitude) and job demand. Job control and job demand were strongly and positively correlated, and both were positively correlated with education and income, and negatively correlated with systolic blood pressure. Job demand was negatively correlated with age, but job control showed no correlation. Job demand remained highly correlated with job control after adjusting for education, age, and race for white and blue collar workers. Blue collar workers in high control and high demand jobs had a significantly decreased risk of heart disease compared with other blue collar workers. The same trend for white collar workers did not appear. The authors conclude that there is no evidence from this study of an increased risk of heart disease for those with high strain jobs, however, those with the highest job control may have a significantly decreased risk of heart disease. The authors suggest that the variable of job demand should be measured in future studies.
AUTHORS: Stayner LT, Dannenberg AL, Thun M, Reeve G, Bloom TF, Boeniger M, Halperin W
SOURCE: Scand J Work, Environ & Health 1992 Feb;18(1):34-43
ABSTRACT: A study of cardiovascular mortality among munitions workers exposed to nitroglycerin and dinitrotoluene (DNT) was conducted. The cohort consisted of 15654 current or former white male employees at a United States Army munitions factory in Radford, Virginia. A total of 5529 were potentially exposed to nitroglycerin and 4989 to DNT; 5136 were exposed to neither. The vital status of the subjects was determined on December 31, 1982. Death certificates were reviewed, and standardized mortality ratios (SMRs) and rate ratios (SRRs) were computed using the general United States population as the reference. Data were also analyzed by Poisson regression techniques. Mortality from all causes was close to that expected for the nitroglycerin and DNT exposed and unexposed subjects; SMRs were 1.03, 1.00, and 0.99, respectively. Mortality from cerebrovascular disease was less than expected in nitroglycerin and DNT exposed subjects; SMRs were 0.90 and 0.95, respectively. Death due to ischemic heart disease (IHD) was close to that expected in DNT exposed subjects, but slightly increased in subjects exposed to nitroglycerin (SMRs 0.98 and 1.07). When expressed as SRRs, IHD mortality was significantly increased in nitroglycerin subjects under the age of 35 (SRR 5.46). Cerebrovascular mortality was elevated in subjects 55 to 59 years old exposed to DNT (SRR 4.46). Poisson regression analysis showed a significant interaction between age and nitroglycerin exposure for IHD mortality. The strongest effect was observed in workers actively exposed to nitroglycerin before the age of 45 (SRR 3.30).
AUTHORS: Stern FB, Lemen RA, Curtis RA
SOURCE: Arch Environ Health 1981;36(2):59-66
ABSTRACT: The effect of exhaust emissions, including carbon-monoxide (CO), on motor vehicle examiners was investigated. Mortality rates among 1,558 examiners employed for at least 6 months between 1944 and 1973 were determined from local records. CO readings were taken at 31 of 38 inspection stations and 27 examiners were administered carboxyhemoglobin (COHb) tests. The mean CO concentrations for indoor and outdoor inspection stations were 24.4 and 10.0 parts per million, respectively. The mean pre and post shift COHb concentrations were 3.3 and 4.7 percent, respectively. There were 237 deaths from all causes during the period of study, as opposed to an expected 260.4 deaths. Among the examiners, there were 124 deaths from cardiovascular diseases compared to 118.4 expected, and 52 deaths from malignant neoplasms compared to 47.8 expected. There were fewer deaths than expected from diseases of the nervous system, nonmalignant diseases of the respiratory and digestive systems, and accidents. The authors suggest that the excess of deaths due to cardiovascular diseases is due to CO exposure. The excess cancer death rate may be due to contaminants other than CO.
AUTHORS: Stern FB, Halperin WE, Hornung RW, Ringenburg VL, McCammon CS
SOURCE: Am J Epidemiol 1988 Dec;128(6):1276-1288
ABSTRACT: Heart disease mortality among bridge and tunnel officers occupationally exposed to carbon-monoxide was examined in a retrospective study of 5,529 subjects employed between 1952 and 1981 at any one of nine New York City water crossings. Among former tunnel officers, there were 61 deaths from arteriosclerotic heart disease, a 35 percent excess risk compared with the New York City population. Examination of the risk of mortality from arteriosclerotic heart disease among tunnel officers in comparison to the less exposed bridge officers using a proportional hazards model indicated no observable association of arteriosclerotic heart disease with length of exposure; there was, however, significant interaction of exposure with age. The elevated risk of arteriosclerotic heart disease among tunnel officers declined after cessation of exposure, with much of the increased risk dissipating within as a little as 5 years. The authors conclude that exposure to carbon-monoxide may be a major factor in arteriosclerotic heart disease mortality; the parallel findings of this study and studies showing the relation of cigarette smoking to cardiovascular mortality suggest that carbon-monoxide may play an important role in the pathophysiology of cardiovascular mortality associated with cigarette smoking.
AUTHOR: Fine LJ
SOURCE: Environmental and Occupational Medicine, Second Edition 1992:593-600
ABSTRACT: Chemical and nonchemical causes of occupational heart disease were reviewed. Several chemical agents were considered to have a direct effect on the myocardium. Evidence for a direct causal relationship between carbon-disulfide and coronary artery disease (CAD) was strongest. Epidemiologic studies of cardiovascular disease in exposed workers from Pennsylvania, Finland, and Belgium were quoted. Researchers in Japan found no increased CAD in exposed workers, but a striking increase in retinal microaneurysms. The association between CAD and occupational exposure to nitroglycerin, ethylene-glycol-dinitrate and other aliphatic nitrates, carbon-monoxide , nonhalogenated and halogenated industrial solvents, arsenic, and cobalt, as well as blood pressure problems caused by cadmium and lead were discussed. Passive smoking was described as an important public health factor in deaths from CAD. Nonchemical factors in occupational CAD were shift work, noise, and stressors due to organization, work or psychosocial factors. Cardiac disease secondary to occupational lung disease was a result of pulmonary hypertension. The prevalence of CAD was reduced in occupations with very high levels of energy expenditure.
AUTHOR: Steenland K
SOURCE: Occup Med 2000 Jan-Mar;15(1):7-17
ABSTRACT: Data from industrialized countries suggests that irregular patterns of work, such as shift work and extensive overtime work, have become increasingly common. In conjunction with this trend, there are more epidemiologic studies of the health effects of such irregular patterns of work, a number of which focus on heart disease. The following is a review of the literature, with comments on possible mechanisms linking irregular hours and heart disease as well as on the methodologic difficulties of studying this topic. Shift work and heart disease are the primary focus, because most of the epidemiologic efforts have been directed at his area, but the epidemiology of overtime work and heart disease also is reviewed.
AUTHORS: Steenland K, Fine L
SOURCE: Am J Ind Med 1996 Mar;29(3):278-281
ABSTRACT: The effect of current shift and recent shift change, on risk of contracting ischemic heart disease, was studied among workers at heavy equipment factories. A nested case/control study was conducted in a cohort of 21,000 men at four heavy equipment factories. The study compared 163 men who died of ischemic heart disease at work or within a week of having worked to control workers. The cases had no prior history of heart disease. Each case was matched with five controls, based on age, factory and race. Shifts worked by cases and controls were determined from personnel records. Data were analyzed by conditional logistic regression with retained matching. Mean time worked on the current shift, at the time of case death, was 9 years, with 72% of study subjects working on the first shift, 22% on second shift and 6% on third shift. Differences in heart disease associated with current shifts were not detected. Recent change from second or third, to first shift lowered the risk of heart disease initially, but the effect decreased with time. There was no corresponding negative effect associated with changing from first to second or third shifts. The authors conclude that there was little evidence for effects on risk of death from heart disease, due to current shift. Their data suggest a temporary lowering of risk after change from second or third to first shift.
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