Psychosocial stress – typically resulting from difficulty coping with challenging environments – may work synergistically to put women at significantly higher risk of developing coronary heart disease, according to a study by researchers at Drexel University's Dornsife School of Public Health.
The study specifically suggests that the effects of job strain and social strain – the negative aspect of social relationships – on women is a powerful one-two punch. Together they are associated with a 21% higher risk of developing coronary heart disease. Job strain occurs when a woman has inadequate power in the workplace to respond to the job's demands and expectations.
The study also found that high-stress life events, such as a spouse's death, divorce/separation or physical or verbal abuse, as well as social strain, were each independently linked with a 12% and 9% higher risk of coronary heart disease, respectively.
The Drexel study used data from a nationally representative sample of 80,825 post-menopausal women from the Women's Health Initiative Observational Study, which tracked participants from 1991 to 2015, to find better methods of preventing cancer, heart disease and osteoporosis in women. In the current follow-up study, Drexel researchers evaluated the effect of psychosocial stress from job strain, stressful life events and social strain (through a survey), and associations among these forms of stress, on coronary heart disease.
Nearly 5% of the women developed coronary heart disease during the 14-year, seven-month study. Adjusting for age, time at a job, and socioeconomic characteristics, high-stress life events were associated with a 12% increased coronary heart disease risk, and high social strain was associated with a 9% increased risk of coronary heart disease.
Work strain was not independently associated with coronary heart disease.
Coronary heart disease, the leading cause of death in the US, occurs with the heart's arteries become narrow and cannot bring sufficient oxygenated blood to the heart. The latest work builds on earlier studies linking psychosocial stress to coronary heart disease by finding out how job strain and social strain work together to compound disease risk.
"The COVID-19 pandemic has highlighted ongoing stresses for women in balancing paid work and social stressors. We know from other studies that work strain may play a role in developing CHD, but now we can better pinpoint the combined impact of stress at work and at home on these poor health outcomes," said senior author Dr Yvonne Michael, an associate professor in the Dornsife School of Public Health. "My hope is that these findings are a call for better methods of monitoring stress in the workplace and remind us of the dual-burden working women face as a result of their unpaid work as caregivers at home."
The study's authors say that future studies should look at the effects of shift work on coronary heart disease and explore the effects of job demands according to gender.
"Our findings are a critical reminder to women, and those who care about them, that the threat of stress to human health should not go ignored," said lead author Dr Conglong Wang, a recent Dornsife graduate who conducted the research while at Drexel. "This is particularly pertinent during the stressors caused by a pandemic."
Associations of Job Strain, Stressful Life Events, and Social Strain With Coronary Heart Disease in the Women’s Health Initiative Observational Study
Conglong Wang, Félice Lê‐Scherban, Jennifer Taylor, Elena Salmoirago‐Blotcher, Matthew Allison, David Gefen, Lucy Robinson, Yvonne L Michael
Published in the Journal of the American College of Cardiology on 23 February 2021
The association between psychosocial stress and coronary heart disease (CHD) may be stronger in women than men and may differ across types of stressors. In this study, we assessed associations of psychosocial stressors, including job strain, stressful life events, and social strain with the incidence of CHD in women.
Methods and Results
We used longitudinal data from 80 825 WHI‐OS (Women's Health Initiative Observational Study) participants with a mean age of 63.4 years (7.3 years) at baseline. Job strain was assessed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain were assessed via validated self‐reported questionnaires. Cox proportional hazard models were used to evaluate associations of each stressor with CHD separately and jointly. A total of 3841 (4.8%) women developed CHD during an average of 14.7 years of follow‐up. After adjustment for age, other stressors, job tenure, and socioeconomic factors, high stressful life events score was associated with a 12% increased CHD risk, and high social strain was associated with a 9% increased CHD risk. Job strain was not independently associated with CHD risk, but we observed a statistically significant interaction between job strain and social strain (P=0.04), such that among women with high social strain, passive job strain was associated with a 21% increased CHD risk.
High stressful life events and social strain were each associated with higher CHD risk. Job strain and social strain work synergistically to increase CHD risk.
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