Comparison of Cardiovascular Disease Characteristics According to the Employment Status among Emergency Department Patients

대학병원 응급실에 방문한 뇌.심혈관질환자의 직업 유무에 따른 특성 비교

  • Rhie, Jeong-Bae (Graduate School of Public Health Yonsei University) ;
  • Ryu, Inn-Shil (Graduate School of Public Health Yonsei University) ;
  • Jeong, In-Chul (Graduate School of Public Health Yonsei University) ;
  • Park, Yoo-Seok (Department of Emergency Medicine, College of Medicine, Yonsei University) ;
  • Lim, Yong-Su (Department of Emergency Medicine, Gachon University Gil Hospital) ;
  • Kim, Sun-Hyu (Department of Emergency Medicine, University of Ulsan College of medicine, Ulsan University Hospital) ;
  • Won, Jong-Uk (Department of Preventive Medicine-Institute for Occupational Health, College of Medicine, Yonsei University)
  • 이정배 (연세대학교 보건대학원) ;
  • 유인실 (연세대학교 보건대학원) ;
  • 정인철 (연세대학교 보건대학원) ;
  • 박유석 (연세대학교 의과대학 응급의학교실) ;
  • 임용수 (가천의과대학 길병원 응급의학교실) ;
  • 김선휴 (울산대학교 의과대학 울산대학교병원 응급의학과) ;
  • 원종욱 (연세대학교 의과대학 예방의학교실-산업보건 연구소)
  • Published : 2011.06.30

Abstract

Objectives: The object of this study was to indentify characteristics of cardiovascular disease in the employed population in comparson with the non-employed group. Methods: The study subjects were patients aged 20~65 from 3 university based hospital emergency centers and a structured questionnaire were used for comparing the characteristics of cardiovascular disease according to employment status. Multivariate logistic regression was used to analyze the association between employment status and cardiovascular disease risk factors. Results: Among the patients, 573 people were employed (482 males, 91 females) and 251 were nonemployed (117 males, 134 females). Compared to the non-employed group, the employed group was distinctive in that it contained patients of younger age, had a male dominant gender distribution, and a higher proportion of smoking and drinking patients. The employed group was less likely to be previouslydiagnosed with diabetes, hypertension, chronic renal failure, cardiovascular disease, or cerebrovascular disease. The employed group was generally more stressed out but there was no significant differences in sleeping time. Infarction was more frequent in the employed group, but hemorrhage was more frequent in the non-employed group. According to the multivariate logistic regression analysis results, the odds ratio of drinking and stress was 1.89(95% CI: 1.25~2.86) and 2.68(95% CI: 1.80~3.99) respectively. Conclusions: Infarction was more frequent in the employed group. Drinking and stress were also more frequent in the employed group. The results of this study don't necessarily mean that stress and drinking are more important than other risk factors but, it means stress and drinking control are more important in the employed group compared to the non-employed group.

목적: 직장인과 비직장인의 뇌 심혈관질환 발생의 특성을 비교하여 직장인 뇌 심혈관질환의 특성을 알아보고자 한다. 방법: 3개 대학병원 응급의료센타에 뇌 심혈관질환으로 방문한 20세 이상 65세 미만의 환자를 대상으로 구조화된 조사표를 사용하여 직업에 따른 뇌 심혈관질환의 특성을 비교 분석한다. 직업의 유무를 독립변수로 하고 뇌 심혈관질환 위험요인을 종속변수로 하여 다변량 로지스틱 회귀 분석을 시행하였다. 결과: 조사대상자 중 직장인은 573명(남자 482, 여자 91명)이고, 비직장인은 251명(남자 117, 여자 134명)이다. 직업이 있는 경우 비직장인에 비해 평균 연령이 적었고, 남자의 비율이 높았고, 체질량 지수가 높았다. 현재 흡연 및 음주하는 경우가 비직장인에 비해 많았다. 직장인의 경우 당뇨, 고혈압, 만성신부전으로 진단된 경우가 적었고 이전에 심혈관질환 및 뇌혈관질환으로 진단 받은 경우도 적었다. 스트레스의 경우 직장인에서 많았고, 수면 시간은 차이가 없었다. 경색은 직장인에서 많았고, 비직장인의 경우 출혈이 많았다. 다변량 로지스틱 회귀분석을 통하여 비교해 본 결과 직업이 있는 경우 현재 음주할비차비가 1.89(95% CI: 1.25~2.86)이고, 스트레스가 있었을 비차비는 2.68(95% CI: 1.80~3.99)이었다. 결론: 직장인은 비직장인에 비하여 경색증이 더 많이 발생하고 있으며, 위험요인으로는 음주와 스트레스가 더 많았다. 직장인의 경우 뇌 심혈관질환 관리에 있어서 비직장인 보다는 스트레스와 음주에 대한 관리가 좀 더 필요함을 의미한다.

Keywords

References

  1. Korea National Statical Office. Annual Report on the Cause of Death Statics 2009. Korea National Statical Office. Daejeon. 2010. pp 4-27. (Korean)
  2. Korea Ministry of Labor. Statics of Occupational Injuries and Diseases 2009. Korea Ministry of Labor. Gwacheon. 2010. pp 6-24. (Korean)
  3. World Health Organization. The World Health Report 2003-Shaping the Future. World Health Organization. Geneva. 2003. pp 154-65.
  4. Jeong YH, Go SJ. Estimating socioeconomic costs of five major diseases. The Korean Journal of Public Finance 2004;18(2):77-104. (Korean)
  5. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation 2002;106(3):388-91.
  6. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, Degraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JV, Sacco RL. Primary prevention of ischemic stroke: a guideline from the American Heart Association/ American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke 2006;37(6):1583-633.
  7. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation 2008;117(23):3031-8.
  8. Poirier P. Healthy lifestyle: even if you are doing everything right, extra weight carries an excess risk of acute coronary events. Circulation 2008;117(24):3057-9.
  9. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419.
  10. Korea Centers for Disease Control and Prevention. The Korea National Health statistics 2008 (translated by Rhie JB). Korea Centers for Disease Control and Prevention. Seoul. 2009. pp 50-55. (Korean)
  11. Korea Ministry of Health and Welfare. Guide to Major Chronic Disease Management Program 2010 (translated by Rhie JB). Korea Ministry of Health and Welfare. Seoul. 2010. pp 1-46. (Korean)
  12. Korea Ministry of Labor. The First 5 yesrs the Industrial Accident Prevention Plan 2000 (translated by Rhie JB). Korea Ministry of Labor. Gwacheon. 2000. pp 52-3. (Korean)
  13. Korea Occupational Safety and Health Agency. KOSHA Guide H-1-2010: Guidelines for Assessment and Management of Cardiovascular Risk at Workplace (translated by Rhie JB). Korea Occupational Safety and Health Agency. Incheon. 2010. pp 1-16.(Korean)
  14. Korea Occupational Safety and Health Agency. Guidelines for Prevention of Cardiovascular Disease (translated by Rhie JB). Korea Occupational Safety and Health Agency. Incheon. 2008. pp 3-186. (Korean)
  15. Gupta R, Deedwania P. Interventions for cardiovascular disease prevention. Cardiology Clinics 2011;29(1):15-34.
  16. Korea Centers for Disease Control and Prevention. Health Behavior and Chronic Disease Statistics 2005. Korea Centers for Disease Control and Prevention. Seoul. 2006. pp 47-86. (Korean)
  17. Cha BS. Occupational Disease (translated by Rhie JB). Gyecheugmunhwasa. Seoul. 2007. pp 1-9. (Korean)
  18. O'Donnell MP. Health Promotion in the Workplace, 3rd ed. Delmar. New York. 2002. pp 1-77.
  19. Kwak WS, Won JU, Rhie JB, Lee MS, Kang EJ, Roh JH. A workplace cardiovascular health promotion program and its short-term health effects. Korean J Occup Environ Med 2009;21(1):46-52. (Korean)
  20. Korea National Statical Office. Annual Report on the Economically Active Population Survey 2009. Available: http://kosis.kr/ups/ups_01List01.jsp?grp_no=1003&pubcode=WA&type=F [cited 15 April 2011].
  21. WHO/IASO/IOTF. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Health Communications Australia Pty Ltd, 2000. pp 15-21.
  22. Liu Y, Tanaka H. Overtime work, insufficient sleep, and risk of non-fatal acute myocardial infarction in Japanese men. Occup Environ Med 2002;59:447-51.
  23. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of Ischemic and Hemorrhagic Stroke: Incidence, Prevalence, Mortality, and Risk Factors. Neurol Clin 2008;26:871-95.
  24. Braunwald E, Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed. Saunders Elsevier. Philadelphia. 2011. pp 914-27.
  25. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med 2001;344(19):1450-60.
  26. Gorelick PB. Alcohol and stroke. Stroke 1987;18(1):268-71.
  27. Jang KH. Healthy worker effect in cardiovascular disease. master's dissertation, Chonnam National University Graduate School. 2010. pp 1-14. (Korean)
  28. Park JA. Prevalence and management status of combined hypertension and hypercholesterolemia in south Korea. Doctorial's dissertation, Hanyang University Graduate School. 2008. pp 1-37. (Korean)
  29. O'Keefe JH Jr, Poston WS, Haddock CK, Moe RM, Harris W. Psychosocial stress and cardiovascular disease: how to heal a broken heart. Compr Ther 2004;30(1):37-43.
  30. Chida Y, Steptoe A. Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension 2010;55(4):1026-32.
  31. Jood K, Redfors P, Rosengren A, Blomstrand C, Jern C. Self-perceived psychological stress and ischemic stroke: a case-control study. BMC Med 2009;7:53.
  32. Hwang CK, Koh SB, Chang SJ, Park CY, Cha BS, Hyun SJ, Park JH, Lee KM, Cha KT, Park WJ, Jhun HJ. Occupational stress in relation to cerebrovascular and cardiovascular disease: Longitudinal analysis from th NSDSOS Project. Korean J Occup Environ Med 2007;19(2):105-14. (Korean)
  33. Vlastelica M. Emotional stress as a trigger in sudden cardiac death. Psychiatr Danub 2008;20(3):411-4.
  34. Ikehara S, Iso H, Toyoshima H, Date C, Yamamoto A, Kikuchi S, Kondo T, Watanabe Y, Koizumi A, Wada Y, Inaba Y, Tamakoshi A. Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women: the Japan collaborative cohort study. Stroke 2008;39(11):2936-42. https://doi.org/10.1161/STROKEAHA.108.520288
  35. Sull JW, Yi SW, Nam CM, Ohrr H. Binge drinking and mortality from all causes and cerebrovascular diseases in korean men and women: a Kangwha cohort study. Stroke 2009;40(9):2953-8. https://doi.org/10.1161/STROKEAHA.109.556027
  36. Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 2010;8(7):917-32. https://doi.org/10.1586/erc.10.56
  37. Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, Diaz R, Rashed W, Freeman R, Jiang L, Zhang X, Yusuf S. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 2006;368(9536):647-58.