Relationship between cumulative exposure to occupational lifting throughout working life and risk of ischemic heart disease in men and women. The Copenhagen Aging and Midlife Biobank.

Ischemic heart disease (IHD) causes mortality and morbidity. High levels of occupational physical activity (OPA) increases IHD risk, and occupational lifting (OL) is suggested as a detrimental OPA exposure. This study investigated the association between accumulated OL throughout working life, and risk for IHD, and potential sex and hypertension differences. Data from Copenhagen Ageing and Midlife Biobank linked to register-based information on incident IHD during 9 years follow-up in the Danish National Patient Registry were included. The outcome was the odds of IHD from baseline (2009-2011) to end of follow-up (2018), among participants without IHD at baseline. Accumulated OL was assessed by linking occupational codes to a Job Exposure Matrix, creating a measure in ton-years (lifting 1,000 kg/day/year). Multivariable logistic regression tested associations between level of accumulated OL and IHD, among the 6,606 included individuals (68% men). During follow-up, 7.3% men and 3.6% women were hospitalized with IHD. Among all participants, the odds for IHD were 47% (OR 1.47, 95% CI 1.05-2.06) higher among those with ≥5 to <10 ton-years, 39% (OR 1.39, 95% CI 1.06-1.83) higher among those with ≥10 to <30 ton-years, and 62% (OR 1.62, 95% CI 1.18-2.22) higher among those with ≥30 ton-years, compared to no accumulated OL. However, these increased odds were in the same direction in the fully-adjusted model but statistically insignificant, ≥5 to <10 ton-years OR 1.28, 95% CI 0.88-1.88; ≥10 to <30 ton-years OR 1.20, 95% CI 0.85-1.69; and ≥30 ton-years OR 1.22, 95% CI 0.81-1.84. No statistically significant interactions, nor any associations, between OL and sex, or hypertension were seen.

Occupational physical activity predicts baseline and 8-year progression of carotid atherosclerosis among women.

INTRODUCTION: Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker survivor effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT) among women. METHODS: Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between preexisting CVD and OPA intensity have previously been reported. RESULTS: Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those working at baseline. CONCLUSIONS: Higher levels of OPA predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis.

Prospective relationship between occupational physical activity and risk of ischaemic heart disease: are men and women differently affected?

AIMS: High occupational physical activity (OPA) seems to increase risk of cardiovascular diseases among men. However, findings are mixed, and it is not known if women are differently affected. Therefore, the aim of this study is to investigate the relationship between OPA and risk for ischaemic heart disease (IHD), and whether it differs across sex. METHODS AND RESULTS: This prospective cohort study was based on 1399 women and 1706 men, aged 30-61 years, participating in the Danish Monica 1 study in 1982-84, actively employed, without prior IHD and answering an OPA question. The information on incidence of IHD, before and during the 34-years follow-up, was retrieved by individual linkage to the Danish National Patient Registry. Cox proportional hazards models were used to investigate the association between OPA and IHD. Compared to women with sedentary work, women in all other OPA categories had lower hazard ratio (HR) for IHD. Among men, the risk of IHD was 22% higher among those with light OPA, and 42% and 46% higher among those with moderate OPA with some lifting or strenuous work with heavy lifting, respectively, compared to men with sedentary OPA. Compared to women with sedentary work, HR for IHD was higher among men in all OPA categories. There was statistically significant interaction between OPA and sex. CONCLUSION: Demanding or strenuous OPA seems to be a risk factor for IHD among men, whereas a higher level of OPA seems to protect women from IHD. This emphasizes the importance of taking sex differences into account in studies of health effects of OPA.

In the Danish Monica I study among 1399 women and 1706 men, we investigated whether high physical activity at work was associated with higher risk of ischaemic heart disease and whether this association was different among men and women. The association between occupational physical activity and ischaemic heart disease was different among men and women. High physical activity at work was associated with around 45% higher risk of ischaemic heart disease in men, but with around 65% lower risk in women. The underlying mechanisms for this difference, e.g. differences in exposure and physiology, should be further investigated in future studies.

Poor social support and loneliness in chronic headache: Prevalence and effect modifiers.

OBJECTIVE: To explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health. BACKGROUND: Poor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache. METHODS: The Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification. RESULTS: The response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache (p < 0.0001 for both). Odds ratios for the combination of chronic headache and poor social support were very high for stress (odds ratio 8.1), medication overuse (odds ratio 21.9), and poor self-rated health (odds ratio 10.2) compared to those without chronic headache and with good social support. Those who reported both chronic headache and loneliness had a very high odds ratio for stress (odds ratio 14.4), medication overuse (odds ratio 20.1), and poor self-rated health (odds ratio 15.9) compared to those without chronic headache and low loneliness score. When adjusted for sociodemographic factors, poor social support and loneliness were not significant effect modifiers in almost all these associations. Loneliness was a significant effect modifier in the association between chronic headache and medication overuse, but exerted greater effect among those who did not report they were lonely. CONCLUSION: Poor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.

Physical activity, self-rated fitness and stress among 55,185 men and women in the Danish Capital Region Health survey 2017.

Previous studies have indicated that both low physical activity and low physical fitness are associated with a higher level of stress but the influence of age and health status on the associations is unknown. This was examined in a cross-sectional study based on data from the Danish Capital Region Health Survey 2017. Among all adults ≥ 16 years residing in the largest of five regions in Denmark 1. January 2017 a random sample of 104,950 was invited to participate. Hereof, 55.185 responded (52,6%). Physical activity during leisure time, fitness, self-rated health and stress (Cohens Perceived Stress Scale) was self-reported by questionnaire. Logistic regression weighted for size of municipality and non-response was used. Age modified the associations. In all age-groups odds ratio (OR) for a high level of stress was increasingly higher the lower the level of physical activity. The association was strongest among the 16-24-year-olds and persisted after adjustment for self-rated health, that otherwise attenuated the associations to an increasing extent the older the age-group. Similar models investigating the modifying effect of age on the association between self-rated fitness and stress showed the same patterns and tendencies. This study showed that physical activity and self-rated fitness were both associated with stress. The OR for a high level of stress was increasingly higher the lower the level of physical activity or self-rated fitness. This was found in all age-groups, but most pronounced among the 16-24-year-olds. Furthermore, findings suggest that health condition explains the associations to an increasing extent with increasing age.

Monitoring chronic headache and medication-overuse headache prevalence in Denmark.

OBJECTIVES: To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. BACKGROUND: Chronic headache and MOH prevalence in Denmark were last estimated in 2010. METHODS: In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. RESULTS: Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3-3.2) and MOH prevalence was 2.0% (95% CI: 1.8-2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. CONCLUSIONS: The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.

Daily domain-specific time-use composition of physical behaviors and blood pressure.

BACKGROUND: Previous research has shown contrasting effects on hypertension for occupational and leisure-time physical behaviors-physical activity and sedentary behavior and time in bed. However, (a) none of these studies have addressed the compositional property of the physical behaviors and (b) most knowledge on the association between domain-specific physical behaviors and hypertension relies upon self-reported physical behaviors information primarily on white-collar worker study samples. We aimed to be the first to disentangle the relationship between technically measured 24-h time-use behaviors in work and leisure domains and blood pressure among blue-collar workers using a compositional data analysis approach. METHODS: Workers (n = 669) wore accelerometers to measure daily minutes of work and leisure sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), and time in bed which were isometrically log-transformed. Cross-sectional linear association between time-use composition and systolic (SBP) and diastolic (DBP) blood pressure were determined using compositional isotemporal substitutions models. RESULTS: The time-use composition at the work and leisure domains was significantly associated with SBP (F = 4.98, p < 0.001) and DBP (F = 2.91, p = 0.008). Reallocating sedentary time to remaining behaviors within each domain-work and leisure-was favorably associated with SBP. Similar results were observed when reallocating time in bed from the remaining leisure behaviors. Results for reallocating time to/from MVPA and LPA at both domains were non-significant. Results regarding all physical behaviors for DBP were generally non-significant. CONCLUSIONS: Time-use composition of physical behaviors at work and leisure is associated with blood pressure among blue-collar workers. At both domains, reallocating sedentary time to remaining behaviors, especially to time in bed at leisure may reduce blood pressure. Our results, based on a compositional data approach, can be used to better design accurate and comprehensive time-use recommendations both at work and leisure for high-risk groups like blue-collar workers.

Does influence at work modify the relation between high occupational physical activity and risk of heart disease in women?

PURPOSE: To investigate whether influence at work modifies the association between demanding and strenuous occupational physical activity (OPA) and risk of ischaemic heart disease (IHD). METHODS: A sample of 12,093 nurses aged 45-64 years from the Danish Nurse Cohort Study was followed for 20.6 years by individual linkage to incident IHD in the Danish National Patient Registry. Information on OPA, influence at work, other occupational factors and known risk factors for IHD was collected by self-report in 1993. RESULTS: During follow-up 869 nurses were hospitalised with incident IHD. Nurses exposed to strenuous OPA and low influence at work had a 46% increased risk of IHD [hazard ratio (HR) 1.46 (95% confidence interval (CI) 1.02-2.09)] compared to the reference group of nurses with moderate OPA and high influence at work. Nurses exposed to strenuous OPA and high influence at work were not at an increased risk of IHD [HR 1.10 (95% CI 0.59-2.06)]. An additive hazards model showed there were 18.0 (95% CI -0.01 to 36.0) additional cases of IHD per 10,000 person years among nurses with strenuous OPA and low influence at work compared to nurses with moderate OPA and high influence at work. A detrimental additive interaction between strenuous OPA and low influence at work that could explain the additional cases of IHD among nurses with strenuous OPA and low influence at work was indicated. CONCLUSION: The findings suggest that high influence at work may buffer some of the adverse effects of strenuous OPA on risk of IHD.

Are hypertensive women at additional risk of ischaemic heart disease from physically demanding work?

BACKGROUND: The combination of hypertension and high physical activity at work may increase blood pressure considerably and increase the risk of atherosclerosis and thereby ischaemic heart disease (IHD), but only a few studies in men, and none among women, have examined this topic. DESIGN: This was a prospective cohort study. METHODS: In 1993, 12,093 female nurses from the Danish Nurse Cohort Study, aged 45-64 years answered a baseline questionnaire on physical activity at work, history of hypertension, a selection of known risk factors for IHD and occupational factors. Information on incident IHD from baseline to 2008 was retrieved by individual linkage to the National Register of Hospital Discharges. RESULTS: In a fully adjusted Cox model, hypertensive nurses with high physical activity at work had nearly three times higher risk of IHD (hazard ratio (HR) 2.87 (95% confidence interval (CI) 2.12-3.87)) compared to normotensive nurses with moderate physical activity at work. Significant additive interaction between physical activity at work and hypertension was found measured by the relative excess risk due to additive interaction (RERI) (1.20 (95% CI 0.26-2.14), and in an additive hazards model. Hypertensive nurses with high physical activity at work had 60 additional cases of IHD per 10,000 person years compared to normotensive nurses with moderate physical activity at work (60.0 (95% CI 38.1-81.9; p < 0.001)), of which more than half was explained by additive interaction (40.7 (95% CI 11.7-69.7; p = 0.006)). No multiplicative interaction (p = 0.249) was found. CONCLUSIONS: This study among Danish nurses indicated that hypertensive women may be at particular high risk of IHD from physically demanding work.

High occupational physical activity and risk of ischaemic heart disease in women: the interplay with physical activity during leisure time.

BACKGROUND: Recent studies indicate that physically demanding work is a risk factor for heart disease among men, especially those with low or moderate physical activity during leisure time. Among women, present evidence is inconclusive. DESIGN: The design was a prospective cohort study. METHODS: This investigation in the Danish Nurse Cohort Study included 12,093 female nurses aged 45-64 years, who answered a self-report questionnaire on physical activity at work and during leisure time, known risk factors for ischaemic heart disease (IHD) and occupational factors at baseline in 1993. Information on the 15-year incidence of IHD was obtained by individual linkage in the National Register of Hospital Discharges to 2008. RESULTS: During follow-up 580 participants were hospitalised with IHD. A significant interaction between occupational and leisure time physical activity was found with the lowest risk of IHD among nurses with the combination of moderate physical activity at work and vigorous physical activity during leisure time. Compared to this group high physical activity at work was associated with a higher risk of IHD at all levels of physical activity during leisure time increasing from hazard ratio 1.75 (95% confidence interval (CI) 1.10-2.80) among nurses with vigorous physical activity during leisure time to 2.65 (95% CI 1.44-4.88) among nurses being sedentary during leisure time. CONCLUSIONS: This study among Danish nurses suggests that high physical activity at work is a risk factor for IHD among women. Vigorous physical activity during leisure time lowered but did not completely counteract the adverse effect of occupational physical activity on risk of IHD.

Psychosocial work environment and risk of ischaemic heart disease in women: the Danish Nurse Cohort Study.

OBJECTIVES: To investigate the effect of work pressure and job influence on the development of ischaemic heart disease (IHD) in women. METHODS: The effect of work pressure and job influence on the 15-year incidence of IHD in women participating in the Danish Nurse Cohort Study was prospectively studied. A total of 12 116 participants, aged 45-64 years, were examined in 1993 using a questionnaire and were followed by individual linkage in the National Register of Hospital Discharges to the beginning of 2008. Work pressure, job influence, occupational characteristics, demographic factors and known biological and behavioural risk factors for IHD were collected at baseline. RESULTS: During follow-up, 580 participants were hospitalised with IHD. In the fully adjusted model, nurses who reported work pressure to be much too high had a 1.4-fold increased risk of incident IHD (95% CI 1.04 to 1.81) compared with nurses who reported work pressure to be suitable. A tendency towards a dose-response effect was found. Age-stratified analysis showed that this effect was significant only among the younger nurses (<51 years old at baseline). No association was found between job influence and IHD. CONCLUSIONS: In this study we find that work pressure that is too high is a significant risk factor for IHD in younger female employees (<51 years of age). The results should be taken into account in the planning of primary prevention.