Occupational cardiovascular disease

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Occupational cardiovascular disease
Specialty Cardiology

Occupational cardiovascular diseases (CVD) are diseases of the heart or blood vessels caused by working conditions, [1] making them a form of occupational illness. [2] These diseases include coronary heart disease, stroke, cardiomyopathy, arrhythmia, and heart valve or heart chamber problems. Cardiovascular disease is the leading cause of death in the United States and worldwide. [3] [4] In the United States, cardiovascular diseases account for one out of four deaths. [5] The 6th International Conference on Work Environment and Cardiovascular Diseases found that within the working age population about 10-20% of cardiovascular disease deaths can be attributed to work. [6] Ten workplace stressors and risk factors (shift work, long work hours, low job control, low job security, high job demand, work-family imbalance, low work social support, low organizational justice, unemployment, and no health insurance) were estimated to be associated with 120,000 U.S. deaths each year and account for 5-8% of health care costs. [7]

Contents

Research related to the association between work and cardiovascular disease is on-going. Links have been established between cardiovascular disease risk and occupational exposure to chemicals, noise, psychosocial stressors, physical activity, and certain workplace organization factors. Additionally, work-related risk factors for cardiovascular disease may also increase the risk of other cardiovascular disease risk factors such as hypertension, [8] [9] diabetes, [10] [11] [12] obesity, [13] [14] unhealthy diet, [15] leisure-time physical inactivity, [14] and excessive alcohol use. [16] Work may also increase risk of depression, [17] burnout, [18] sleeping problems, [19] and physiological and cardiorespiratory stress mechanisms in the body which may also affect the risk for cardiovascular disease.

Age-adjusted cardiovascular disease death rates in the U.S. are no longer declining, as they previously had been since the 1960s. [20] Cardiovascular disease death rates are increasing in older (45–64 years) working-age people. [21] In fact, death rates from all causes have been increasing since about 2012 in working-age people (25–64 years), primarily due to increases in drug (mainly opioid) overdoses, alcohol abuse, suicides, and chronic diseases, such as cardiovascular diseases, hypertension and diabetes. [20] Between 2000-2015, the cardiovascular disease mortality gap between the U.S. and other wealthy countries has widened. [22] These trends are occurring despite improvements in the medical treatment of cardiovascular diseases. Primary prevention of cardiovascular diseases, including workplace health promotion, is key to reducing death rates.

Related explanations for cardiovascular disease trends are increases in the prevalence of other stress-related (including work-related stress) conditions, obesity, [23] diabetes, [23] metabolic syndrome, [23] and short sleeping hours. [24] The age-adjusted prevalence of hypertension increased in the U.S. between 1988-2010 and increased again between 2010-2018 for most gender-race groups. [23] Mental health disorders, including depression and anxiety, are increasing globally and in the U.S. [25] [26]

A 2021 National Academy of Sciences report [27] points out that "social, economic, and cultural changes that have undermined economic security, intergenerational mobility, and social support networks can adversely affect cardiometabolic health through stress-mediated biological pathways and reduced access to care".

Recent research indicates working conditions that may be contributing to the cardiovascular disease trends in the U.S. include,

Deaths due to long working hours per 100,000 people (15+), joint study conducted by World Health Organization and International Labour Organization in 2016. Deaths from Karoshi.png
Deaths due to long working hours per 100,000 people (15+), joint study conducted by World Health Organization and International Labour Organization in 2016.

Hypertension develops more often in those who experience job strain and who have shift-work. [40] Differences between women and men in risk are small, however men risk having and dying of heart attacks or stroke twice as often as women during working life. [40]

Chemicals are used in many workplaces. Workers can be exposed to chemicals by breathing them in, eating or drinking contaminated food and drinks, or absorbing them through the skin.

A 2017 Swedish government report found evidence that workplace exposure to silica dust, engine exhaust or welding fumes is associated with heart disease. [51] Associations also exist for exposure to arsenic, benzopyrenes, lead, dynamite, carbon disulphide, carbon monoxide, metalworking fluids and occupational exposure to tobacco smoke. [51] Working with the electrolytic production of aluminum or the production of paper when the sulphate pulping process is used is associated with heart disease. [51] An association was also found between heart disease and exposure to compounds which are no longer permitted in certain work environments, such as phenoxy acids containing TCDD (dioxin) or asbestos. [51]

Workplace exposure to silica dust or asbestos is also associated with pulmonary heart disease. There is evidence that workplace exposure to lead, carbon disulphide, phenoxy acids containing TCDD, as well as working in an environment where aluminum is being electrolytically produced, is associated with stroke. [51]

According to a 2021 WHO study, working 55+ hours a week raises the risk of stroke by 35% and the risk of dying from heart conditions by 17%, when compared to a 35-40 hours week. [52]

Occupations at higher risk for cardiovascular disease

Occupational cardiovascular disease in firefighters

Firefighter using a hose to combat a fire US Navy 080730-N-5277R-003 A Commander, Naval Forces Japan firefighter douses a fire on a dummy aircraft during the annual off-station mishap drill at Naval Support Facility Kamiseya.jpg
Firefighter using a hose to combat a fire

Given the many hazards present during career firefighting, firefighters are at a greater risk for occupational cardiovascular disease. CVD is the leading cause of death in firefighters, and accounts for 45% of on-duty deaths. [55] About 90% of CVD in firefighters is attributed to coronary heart disease. [36] Other researchers have found that blood plasma volume decreases after just minutes of firefighting which increases blood pressure and causes the heart to work harder to distribute blood systemically. Firefighting has also shown to increase arterial stiffness and overall cardiovascular strain. [43] In a study by Barger, et al., a positive screening for a sleep disorder increased the odds a firefighter would also have cardiovascular disease (OR = 2.37, 95% CI 1.54-3.66, p < 0.0001). [56]

Group of firefighters in gear carrying a long hose to the fire scene. Firefighters 2020 El Dorado Fire Sep10.jpg
Group of firefighters in gear carrying a long hose to the fire scene.

CVD risk factors in firefighting

Prevention of occupational cardiovascular disease

Primary Prevention

Common programs to reduce CVD risk have been worksite-based health promotion, wellness, or stress management. However, rigorous research has suggested small effects of such programs. [58] [59] Organizational and workplace interventions have been effective in reducing sources of stress at work. [60] [61] [62] [63] [64] Other strategies for reducing work stressors include legislative and regulatory-level interventions with examples including laws providing for better nurse-patient staffing ratios, bans on mandatory overtime, paid sick days, paid family leave or retail worker schedule predictability (see case studies on-line, Healthy Work Campaign, 2021 [65] ). However, such legislative interventions are rarely evaluated and thus are typically not included in review articles.

The 7th International Conference on Work Environment and Cardiovascular Diseases emphasized the need to bridge the gap between knowledge and preventive interventions at the workplace, to reduce cardiovascular diseases, through effective collaboration between health operators involved in prevention of CVD. [66] The NIOSH Total Worker Health Program conveys the innovative concept that only holistic interventions at the workplace which reduce both work-related and life-style risk factors, may be effective to prevent CVDs. [67] As examples, the interactions between job strain and sedentarism at work [68] as well as the findings that the relations of job strain and CVD incidence is more pronounced among salaried workers (white and blue collars) [69] are crucial in the perspectives to convey "the right preventive interventions to the right people".

Unfortunately, no organizational intervention studies have been carried out to prevent CVD at work, and few to prevent CVD risk factors, such as hypertension. The following are three examples of organizational interventions to reduce blood pressure, which provided some evidence of their effectiveness:

See also

Related Research Articles

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. CAD can cause stable angina, unstable angina, myocardial ischemia, and myocardial infarction.

<span class="mw-page-title-main">Firefighter</span> Rescuer trained to extinguish fires and save people

A firefighter is a first responder trained in firefighting, primarily to control and extinguish fires that threaten life and property, as well as to rescue persons from confinement or dangerous situations. Male firefighters are sometimes referred to as firemen.

<span class="mw-page-title-main">Sitting</span> Resting position of human body weight, primarily supported by buttocks in contact with objects

Sitting is a basic action and resting position in which the body weight is supported primarily by the bony ischial tuberosities with the buttocks in contact with the ground or a horizontal surface such as a chair seat, instead of by the lower limbs as in standing, squatting or kneeling. When sitting, the torso is more or less upright, although sometimes it can lean against other objects for a more relaxed posture.

<span class="mw-page-title-main">Exercise</span> Physical activity that improves health

Exercise is physical activity that enhances or maintains fitness and overall health. It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardiovascular system, prevent injuries, hone athletic skills, improve health, or simply for enjoyment. Many people choose to exercise outdoors where they can congregate in groups, socialize, and improve well-being as well as mental health.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Sedentary lifestyle</span> Type of lifestyle involving little or no physical activity

Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and/or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socializing, watching TV, playing video games, reading or using a mobile phone or computer for much of the day. A sedentary lifestyle contributes to poor health quality, diseases as well as many preventable causes of death.

The Type A and Type B personality concept describes two contrasting personality types. In this hypothesis, personalities that are more competitive, highly organized, ambitious, impatient, highly aware of time management, or aggressive are labeled Type A, while more relaxed, "receptive", less "neurotic" and "frantic" personalities are labeled Type B.

Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."

<span class="mw-page-title-main">Health effects from noise</span> Health consequences of exposure to elevated sound levels

Noise health effects are the physical and psychological health consequences of regular exposure to consistent elevated sound levels. Noise from traffic, in particular, is considered by the World Health Organization to be one of the worst environmental stressors for humans, second only to air pollution. Elevated workplace or environmental noise can cause hearing impairment, tinnitus, hypertension, ischemic heart disease, annoyance, and sleep disturbance. Changes in the immune system and birth defects have been also attributed to noise exposure.

<span class="mw-page-title-main">Musculoskeletal disorder</span> Pain in the muscular or skeletal systems

Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion, or they can arise from making the same motions repeatedly, or from repeated exposure to force, vibration, or awkward posture. Injuries and pain in the musculoskeletal system caused by acute traumatic events like a car accident or fall are not considered musculoskeletal disorders. MSDs can affect many different parts of the body including upper and lower back, neck, shoulders and extremities. Examples of MSDs include carpal tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck syndrome, and hand-arm vibration syndrome.

Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, psychosocial workplace factors that affect accident risk and safety, and interventions designed to improve and/or protect worker health. Although OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, for a long time the psychology establishment, including leaders of industrial/organizational psychology, rarely dealt with occupational stress and employee health, creating a need for the emergence of OHP. OHP has also been informed by other disciplines, including occupational medicine, sociology, industrial engineering, and economics, as well as preventive medicine and public health. OHP is thus concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. The World Health Organization and the International Labour Organization estimate that exposure to long working hours causes an estimated 745,000 workers to die from ischemic heart disease and stroke in 2016, mediated by occupational stress.

<span class="mw-page-title-main">Occupational burnout</span> Type of occupational stress

The ICD-11 of the World Health Organization (WHO) describes occupational burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy." It is classified as an occupational phenomenon, but is not recognized by the WHO as a medical condition.

<span class="mw-page-title-main">Occupational stress</span> Tensions related to work

Occupational stress is psychological stress related to one's job. Occupational stress refers to a chronic condition. Occupational stress can be managed by understanding what the stressful conditions at work are and taking steps to remediate those conditions. Occupational stress can occur when workers do not feel supported by supervisors or coworkers, feel as if they have little control over the work they perform, or find that their efforts on the job are incommensurate with the job's rewards. Occupational stress is a concern for both employees and employers because stressful job conditions are related to employees' emotional well-being, physical health, and job performance. The World Health Organization and the International Labour Organization conducted a study. The results showed that exposure to long working hours, operates through increased psycho-social occupational stress. It is the occupational risk factor with the largest attributable burden of disease, according to these official estimates causing an estimated 745,000 workers to die from ischemic heart disease and stroke events in 2016.

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work. The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise. The World Health Organization has prioritized the workplace as a setting for health promotion because of the large potential audience and influence on all spheres of a person's life. The Luxembourg Declaration provides that health and well-being of employees at work can be achieved through a combination of:

A psychosocial hazard or work stressor is any occupational hazard related to the way work is designed, organized and managed, as well as the economic and social contexts of work. Unlike the other three categories of occupational hazard, they do not arise from a physical substance, object, or hazardous energy.

Job strain is a form of psychosocial stress that occurs in the workplace. One of the most common forms of stress, it is characterized by a combination of low salaries, high demands, and low levels of control over things such as raises and paid time off. Stresses at work can be eustress, a positive type of stress, or distress, a negative type of stress. Job strain in the workplace has proved to result in poor psychological health, and eventually physical health. Job strain has been a recurring issue for years and affects men and women differently.

<span class="mw-page-title-main">Effects of overtime</span> Effects caused by overtime

Employees who work overtime hours experience numerous mental, physical, and social effects. In a landmark study, the World Health Organization and the International Labour Organization estimated that over 745,000 people died from ischemic heart disease or stroke in 2016 as a result of having worked 55 hours or more per week. Significant effects include stress, lack of free time, poor work-life balance, and health risks. Employee performance levels could also be lowered. Long work hours could lead to tiredness, fatigue, and lack of attentiveness. As a result, suggestions have been proposed for risk mitigation.

The benefits of physical activity range widely. Most types of physical activity improve health and well-being.

Psychosocial safety climate (PSC) is a term used in organisational psychology that refers to the shared belief held by workers that their psychological health and safety is protected and supported by senior management. PSC builds on other work stress theories and concerns the corporate climate for worker psychological health and safety. Studies have found that a favourable PSC is associated with low rates of absenteeism and high productivity, while a poor climate is linked to high levels of workplace stress and job dissatisfaction. PSC can be promoted by organisational practices, policies and procedures that prioritise the psychosocial safety and wellbeing of workers. The theory has implications for the design of workplaces for the best possible outcomes for both workers and management.

<span class="mw-page-title-main">Psychosocial distress</span>

Psychosocial distress refers to the unpleasant emotions or psychological symptoms an individual has when they are overwhelmed, which negatively impacts their quality of life. Psychosocial distress is most commonly used in medical care to refer to the emotional distress experienced by populations of patients and caregivers of patients with complex chronic conditions such as cancer, diabetes, and cardiovascular conditions, which confer heavy symptom burdens that are often overwhelming, due to the disease's association with death. Due to the significant history of psychosocial distress in cancer treatment, and a lack of reliable secondary resources documenting distress in other contexts, psychosocial distress will be mainly discussed in the context of oncology.

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