工作型態與心血管疾病相關之研究──以醫院病患為例

Work Characteristics and Cardiovascular Disease －－ A Hospital-Based Study

近年來工作壓力與心血管疾病的相關日益受到重視，台灣地區也發生許多疑似工作壓力引發心血管疾病之案例，但有關工作壓力、工作型態等工作相關因子與心血管疾病之間的關係仍不清楚。研究第一年初探性研究發現超時工作、突發工作負荷加重等工作型態有關之因子可能與心血管疾病有關，因此本研究以病例對照研究方式來釐清心血管疾病與不同工作型態之相關。病例組來自北部某家醫學中心，為首次因心血管疾病住院的病患 125 名 （50.1 ± 6.9 歲），依病例組年齡、性別進行配對，以 1:2 的比例收集來自同一家醫學中心健檢個案及同一行政區另一家區域醫院參與社區健檢居民 250 名（48.7 ± 6.3 歲）。個案資料的收集包括個案基本資料、工作型態、工作時間、睡眠障礙、生活習慣、疾病史、家族病史等問卷資料及相關病歷及生化檢查資料。條件式多變項邏輯分析結果發現傳統危險因子對心血管疾病造成顯著影響的變項包括教育程度為國中以下 (OR=3.6，95% CI=1.0-12.7)、沒有運動習慣 (OR=5.9，95% CI=2.1-16.4) 及有高血壓者 (OR=6.2，95% CI=2.5-15.6)。而在工作型態上，將工作分為藍領、白領、自營及專業或管理階層，以專業或管理階層為參考標準，結果顯示藍領階層罹患心血管疾病的勝算比最高為 17.5 (95% CI=2.8-110.8)，白領及自營業罹患心血管疾病的勝算比分別為 3.4 (95% CI=0.7-16.6)、1.6 (95% CI=0.6-8.1)，沒有達到統計學上的顯著意義。其他如工時、工作中活動度等則無顯著的相關；另外，有睡眠障礙者有顯著較高的心血管疾病危險性 (OR=3.8， 95%CI=1.1-13.1)。綜合本研究結果心血管疾病為多因素共同作用所造成，傳統之心血管疾病危險因素（如高血壓、無運動習慣等）仍是重要之影響因素。而工作型態尤其是藍領階級罹患心血管疾病的危險性顯著升高，屬於心血管疾病高危險族群，未來與工作相關心血管疾病防治工作應特別著重在此一族群上。而睡眠為傳統之心血管疾病危險因素與工作型態外之獨立影響因素，在工作相關心血管疾病防治工作上也應該將改善睡眠習慣及睡眠品質包括在內。

Work stress is considered to be a critical risk factor in CVD. However, the association between work stress and CVD is unclear. According to a pilot study, work characteristics such as overtime and unexpectedly increased work load are probably associated with the onset of CVD. This case-control study investigates the causal relationship between work characteristics and CVD. All subjects for the study were recruited from two major hospitals in Taipei. The cases studied were those of 125 patients admitted to a medical center--one of the two hospitals--with newly diagnosed CVD. These were matched by age and gender in a ratio of 1:2 with 250 controls who had received health examinations at hospitals or at community health service centers. In addition, information such as medical records and biochemistry indicators, as well as personal characteristics, work patterns, work hours, sleep disorders, life style, and family history, was collected. The results of conditional multiple logistic regression showed that subjects with lower education (OR=3.6,95% CI=1.0-12.7), physical inactivity (OR=5.9, 95%CI=2.1-16.4), sleep disorders (OR=3.8,95%CI=1.1-13.1), and hypertension (OR=6.2,95% CI=2.5-15.6) were significantly associated with CVD. Blue collar workers (OR=17.5, 95% CI=2.8-110.8) were also noticeably associated with an increased risk of CVD, but there were no differences for work hours and occupational physical activity between the CVD cases and the controls. In conclusion, the results showed that CVD was associated with multiple risk factors, and that blue collar workers had the highest probability of developing CVD when compared with workers having other work patterns. Because of the complexity of work characteristics, working hours had no effect on CVD. It is recommended that further investigations into the reduction of work-related CVD focus on blue collar workers. Efforts to alleviate sleep disorders should also be considered.