Gymnastik- och idrottshögskolan, GIH

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Mediation of lifestyle-associated variables on the association between occupation and incident cardiovascular disease
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.ORCID iD: 0000-0002-0958-0094
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.ORCID iD: 0000-0002-3185-9702
HPI Health Profile Institute, Department of Research, Danderyd, Stockholm, Sweden.
HPI Health Profile Institute, Department of Research, Danderyd, Stockholm, Sweden.
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2023 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, article id 107411Article in journal (Refereed) Published
Abstract [en]

The main aim was to examine the association between occupational groups and incident cardiovascular disease (CVD), and to which extent associations are mediated by lifestyle-associated variables (cardiorespiratory fitness, smoking, BMI, exercise, and diet). A total of 304.702 participants (mean age 42.5 yrs., 47% women), who performed a health profile assessment in Sweden between 1982 and 2019, were included in the analyses. CVD incidence was obtained from national registers. All participants were free from CVD prior to the health profile assessment. Occupational group was defined using the Swedish Standard Classification of Occupations and analyzed separately (13 different occupational groups) as well as after aggregation into four occupational groups (white-collar high-skilled, white-collar low-skilled, blue-collar high-skilled and blue-collar low-skilled). Cardiorespiratory fitness, BMI, exercise, smoking, and diet were included as mediators and analyzed separately in single models and simultaneously in one multiple mediation model. All mediation analyses were adjusted for sex, age, length of education and calendar time. White-collar high-skilled was set as reference in all analyses. Blue-collar and low-skilled occupation had a higher risk of incident CVD compared to reference. Cardiorespiratory fitness, BMI, exercise, smoking, and diet mediated 48% to 54% of the associations between reference and the other aggregated occupational groups. In the single model, the strongest mediators were cardiorespiratory fitness, smoking and BMI. In conclusion, blue-collar and low skilled occupations had a significantly higher risk for incident CVD compared to white-collar high-skilled workers, with the association mediated to a large extent by variation in lifestyle-associated variables.

Place, publisher, year, edition, pages
Elsevier, 2023. article id 107411
Keywords [en]
Cardiorespiratory fitness, mediation, mechanisms, occupation, white-collar, blue-collar, lifestyle
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-7463DOI: 10.1016/j.ypmed.2022.107411ISI: 000993846700001PubMedID: 36592676OAI: oai:DiVA.org:gih-7463DiVA, id: diva2:1725440
Available from: 2023-01-11 Created: 2023-01-11 Last updated: 2023-06-26Bibliographically approved
In thesis
1. Cardiorespiratory fitness, physical workload, and lifestyle-related factors in occupational groups: associations with sickness absence and cardiovascular disease
Open this publication in new window or tab >>Cardiorespiratory fitness, physical workload, and lifestyle-related factors in occupational groups: associations with sickness absence and cardiovascular disease
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aim of this thesis was to study cardiorespiratory fitness, physical workload, and lifestyle-related factors, with a special emphasis on cardiorespiratory fitness in an occupational context and the associations with cardiovascular disease and sickness absence across a wide range of occupations. A secondary aim was to study trends in cardiorespiratory fitness in different occupational groups over the last decades.

The thesis is based on data from health profile assessments performed in the Swedish working population over the last decades and consists of four studies. Paper I examines health risk factors across a diverse range of occupational groups and finds that high-skilled occupations have a more favorable health risk profile than low-skilled occupations, with some sub-major categories displaying a more unfavorable health risk profile than others. Paper III demonstrates that individuals in low-skilled and blue-collar occupations have a significantly higher risk of incident cardiovascular disease than high-skilled white-collar workers. Cardiorespiratory fitness, smoking, and body mass index partially explain this association. Paper IV shows that occupational physical workload is associated with sickness absence, where a higher physical workload is related with a higher risk of total sickness absence due to musculoskeletal and cardiorespiratory causes but a lower risk of sickness absence due to psychiatric causes. Higher cardiorespiratory fitness is associated with reduced predicted days of sickness absence, mainly for cardiorespiratory diagnoses and musculoskeletal diagnoses, with some variations between occupational groups. Paper II finds a consistent decline in cardiorespiratory fitness from 2001 to 2020. This decline is more pronounced in low-skilled occupations, regardless of their classification as white-collar or blue-collar. Forecast analyses revealed a continuing downward trend in cardiorespiratory fitness, particularly in low-skilled occupations.

In conclusion, promoting smoking cessation, reduced obesity, and physical activities to improve cardiorespiratory fitness may reduce the disparity in cardiovascular disease incidence observed across occupational groups. The decline in cardiorespiratory fitness, particularly in low-skilled occupations, is concerning and calls for targeted interventions that can reach out to those who need it most. This could be achieved through structural and individual-level changes at the workplace and in society at large.

Place, publisher, year, edition, pages
Stockholm: Gymnastik- och idrottshögskolan, GIH, 2023. p. 134
Series
Avhandlingsserie för Gymnastik- och idrottshögskolan ; 30
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-7633 (URN)978-91-988127-1-8 (ISBN)
Public defence
2023-06-09, Aulan, GIH, Lidingövägen 1, 09:00 (English)
Opponent
Supervisors
Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2023-09-27Bibliographically approved

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Väisänen, DanielKallings, LenaHemmingsson, ErikEkblom Bak, Elin

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