Occupational and Environmental Medicine

Siegrist, Johannes; Goldberg, Marcel; Zins, Marie; Wahrendorf, Morten

doi: 10.1136/oemed-2022-108794pmid: 37369582

BackgroundStudies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP.MethodsWe used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30–70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort–reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale.ResultsSEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort–reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found.ConclusionsDisadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.

Strand, Leif Aage; Rudvin, Inger; Martinsen, Jan Ivar; Fadum, Elin Anita; Grimsrud, Tom K

doi: 10.1136/oemed-2023-108877pmid: 37474304

ObjectivesIn a previous cohort study of 28 300 Navy servicemen, vessel crews showed higher cancer incidence and mortality than did land-based personnel. We have extended the follow-up to look for changes in cancer risk, and to explore temporal trends in cancer incidence and cancer mortality during more than six decades of follow-up.MethodsCancer incidence and total cancer mortality were compared with the general population by calculating standardised ratios (standardised incidence ratios (SIRs), standardised mortality ratios) for the entire follow-up, with temporal trends through seven consecutive 10-year time spans from individual entry to follow-up. Rates were compared between the subgroups using Poisson regression, expressed as rate ratios (RRs).ResultsCancer incidence in Navy servicemen suggested a healthy soldier effect limited to the first three decades of follow-up and confined to land-based personnel. Overall, vessel crews showed 13% higher cancer incidence and 36% higher cancer mortality than other Navy servicemen. Some of the differences may be explained by a higher risk in vessel crews of cancers known to have less than 25% 5-year relative survival (RR=1.71), such as cancers of the lung, liver, pancreas and mesothelioma.ConclusionThrough most of the observation time, vessel crews had an overall cancer SIR that was higher than that of land-based personnel. Much of this excess involved cancers with a generally poor prognosis, linked to lifestyle and work environment. The contrasts in cancer incidence and mortality between the two subgroups of Navy servicemen persisted through more than six decades.

Durand-Moreau, Quentin V

doi: 10.1136/oemed-2023-109084pmid: 37591795

Leung, Lisa; Lavoué, Jérôme; Siemiatycki, Jack; Guénel, Pascal; Koushik, Anita

doi: 10.1136/oemed-2022-108557pmid: 37429725

ObjectivesTo investigate employment in an occupation or industry and specific occupational exposures in relation to ovarian cancer risk.MethodsIn a population-based case–control study conducted in Montreal, Canada (2011–2016), lifetime occupational histories were collected for 491 cases of ovarian cancer and 897 controls. An industrial hygienist coded the occupation and industry of each participant’s job. Associations with ovarian cancer risk were estimated for each of several occupations and industries. Job codes were linked to the Canadian job-exposure matrix, thereby generating exposure histories to many agents. The relationship between exposure to each of the 29 most prevalent agents and ovarian cancer risk was assessed. Odds ratios and 95% confidence intervals (OR (95% CI)) for associations with ovarian cancer risk were estimated using logistic regression and controlling for multiple covariates.ResultsElevated ORs (95% CI) were observed for employment ≥10 years as Accountants (2.05 (1.10 to 3.79)); Hairdressers, Barbers, Beauticians and Related Workers (3.22 (1.25 to 8.27)); Sewers and Embroiderers (1.85 (0.77 to 4.45)); and Salespeople, Shop Assistants and Demonstrators (1.45 (0.71 to 2.96)); and in the industries of Retail Trade (1.59 (1.05 to 2.39)) and Construction (2.79 (0.52 to 4.83)). Positive associations with ORs above 1.42 were seen for high cumulative exposure versus never exposure to 18 agents: cosmetic talc, ammonia, hydrogen peroxide, hair dust, synthetic fibres, polyester fibres, organic dyes and pigments, cellulose, formaldehyde, propellant gases, aliphatic alcohols, ethanol, isopropanol, fluorocarbons, alkanes (C5–C17), mononuclear aromatic hydrocarbons, polycyclic aromatic hydrocarbons from petroleum and bleaches.ConclusionsCertain occupations, industries and specific occupational exposures may be associated with ovarian cancer risk. Further research is needed to provide a more solid grounding for any inferences in this regard.

Lambreghts, Charlotte; Vandenbroeck, Sofie; Goorts, Kaat; Godderis, Lode

doi: 10.1136/oemed-2023-108867pmid: 37500536

Burnout is a work-related mental health problem that often causes long-term sickness absence. Return-to-work (RTW) interventions for burned-out sick-listed employees aim to prevent long-term work disability. This systematic review addresses two questions: (1) Which interventions for burned-out sick-listed employees have been studied?; (2) What is the effect of these interventions on RTW?We performed a systematic literature review and searched PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL and Web of Science from 1 January 2000 to 31 December 2022. We searched for articles of interventions for burned-out sick-listed employees. We conducted the review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Outcome was RTW.We identified 2160 articles after removal of all duplicates. Eight studies met inclusion criteria. RTW outcomes were number of sick-leave days, sick-leave rates, median period of RTW and worked hours per week. Five studies described person-directed interventions, one described a workplace-directed intervention, one described a combination of both intervention types and one study described all three types of intervention. Only the workplace-directed intervention showed a significant improvement in RTW compared with the comparator group: at 18-month follow-up, 89% of the intervention group had returned to work compared with 73% of the comparator group.Only a limited number of studies have explored interventions specifically focused on burned-out sick-listed employees and the effect on RTW. Due to heterogeneity and moderate to high risk of bias of these studies, no firm conclusions can be drawn on the described interventions and their effect on RTW.The study was registered with the International prospective register of systematic reviews (PROSPERO, registration number: CRD42018089155).

Kriebel, David

doi: 10.1136/oemed-2023-108939pmid: 37567765

Shields, Marissa; Spittal, Matthew J; Aitken, Zoe; Dimov, Stefanie; Kavanagh, Anne; King, Tania Louise

doi: 10.1136/oemed-2023-108853pmid: 37463765

ObjectiveYoung adults with disabilities are less likely to be employed and more likely to have poor mental health than peers without disabilities. Growing evidence shows that social determinants of health may be causally related to mental health outcomes of people with disabilities. We aimed to assess if the disability to mental health association was mediated by employment status among young adults aged 20–35 years.MethodsFour consecutive years (2016–2019) of data from the Household, Income and Labour Dynamics in Australia survey were used to conduct a causal mediation analysis. We decomposed the total causal effect of disability status on mental health (Short Form-36 Mental Health Inventory-5) into the natural direct effect from disability to mental health and the natural indirect effect representing the pathway through the employment mediator (being employed; being unemployed or wanting to work).Results3435 participants (3058 with no disabilities, 377 with disabilities) were included in the analysis. The total causal effect of disability status on mental health was an estimated mean decrease in mental health of 4.84 points (95% CI −7.44 to –2.23). The indirect effect, through employment status, was estimated to be a 0.91-point decline in mental health (95% CI −1.50 to –0.31).ConclusionsResults suggest disability has an effect on the mental health of young adults; a proportion of this effect appears to operate through employment. The mental health of young adults with disabilities could potentially be improved with interventions to improve employment outcomes among this group, and by supporting individuals with disabilities into suitable employment.

Liao, Xinqi; Wang, Yuqiang; Zeng, Qinglin; Wang, Jinfeng; Yang, Xiangyu; Yan, Wen; Wang, Guofu; Zeng, Yanli

doi: 10.1136/oemed-2023-108823pmid: 37468282

Exposure to workplace bullying increases the risk of sickness absence. However, the extent and direction of this relationship for different follow-up lengths are not well established. To provide evidence regarding the direction and extent of the relationship between workplace bullying and different durations of sickness absence. We searched nine databases from their inception to 29 November 2022. Multiple independent observers screened the literature, extracted the data and used the Risk Of Bias In Non-randomised Studies of Exposure to assess the methodological quality. The overall effect sizes of odds ratio, relative risk, hazard ratio and 95% confidence intervals were calculated. Our meta-analysis demonstrated a 26% increased risk of sick leave among workers exposed to workplace bullying for all follow-up lengths (95% CI 1.18 to 1.35), even after adjusting for confounding factors. Moreover, we found a significant association between long-term sickness absence and a higher likelihood of subsequent exposure to workplace bullying, with a pooled OR of 1.63 (95% CI 1.21 to 2.04). Our study established a bidirectional relationship between workplace bullying and long-term sickness absence, highlighting that it increases the risk of sickness absence at different follow-up lengths among employees who have been bullied. Hence, organisations should be mindful of workers who resume work after prolonged absences due to illness and adopt appropriate management strategies to prevent workplace bullying.

Friesen, Melissa C; Beane Freeman, Laura E

doi: 10.1136/oemed-2023-108948pmid: 37429726