哮喘联盟

   摘要
   研究目的：研究证据提示工作压力与哮喘的发生成正相关。但之前的研究数量较少，且研究使用的是不成熟的工作压力测定法，从而制约了研究结果对现象的解释及研究结论的推广。本研究通过使用一种成熟的付出回报失衡（ERI）模型测定工作压力，从而重新检验哮喘与工作压力间的关联。
   研究方法：研究数据从两个横断面研究中获取。第一项研究由一家大型医药公司在2013年开展（n=1464）。第二项研究数据来自2011年以人群为基础的德国社会经济面板（n= 8388）。采用验证有效的问卷进行ERI测定。哮喘病情的确定基于内科医生的诊断，由患者自行报告。采用logistic回归模型计算ERI或其组成部分（“付出”、“报酬”和“超负荷”）与哮喘的关联，结果以校正后的优势比（ORs）表达，置信区间（CI）设为95%。
   研究结果：ERI分数每增加一个标准差（即代表更高的工作压力）与哮喘优势比上升22%-48%相关（研究1：OR 1.48,95%CI 1.13-1.85；研究2：OR 1.22,95%CI 1.10-1.36）。通过Z评分分析ERI分数的组成，结果发现两项研究中付出、回报及过量均与哮喘发生有中等程度的联系（研究1: OR 付出 1.25, 95 % CI 0.95-1.64, OR报酬0.67, 95 % CI 0.51-0.87, OR 超负荷 1.32, 95 % CI 1.01-1.72; 研究2: OR 付出 1.21, 95 % CI 1.09-1.34, OR 报酬 0.83, 95 % CI 0.76-0.92, OR 超负荷 1.12, 95 % CI 1.01-1.25）。危险因素分类分析法大致证实了这些观察结果。
   结论：本研究首次使用成熟的工作压力测定法证实哮喘与工作压力间的关联。此关联的方向性需要纵向研究以进一步证实。
 

（苏楠 审校）
Int Arch Occup Environ Health. 2014 Jul 27. [Epub ahead of print]

 

The association of effort-reward imbalance and asthma: findings from two cross-sectional studies.
 

Loerbroks A1, Herr RM, Li J, Bosch JA, Seegel M, Schneider M, Angerer P, Schmidt B.
 

ABSTRACT
PURPOSE: There is evidence to suggest that work stress is positively associated with the occurrence of asthma. A limitation is that the small number of prior studies utilized unestablished work stress measures, thus constraining interpretation and generalizability. The present study re-examined this association by assessing work stress based on the well-established effort-reward imbalance (ERI) model.
METHODS: We drew on data from two cross-sectional studies. Study 1 was conducted in a large pharmaceutical company in 2013 (n = 1,464). Study 2 was based on data from the 2011 wave of the population-based German Socio-Economic Panel (n = 8,388). ERI was assessed by validated questionnaires. Asthma was determined by self-report of a physician-based diagnosis. Associations between ERI or its subcomponents "effort", "reward" and "overcommitment" (z scores or categorized) with asthma were estimated by logistic regression models and reported as adjusted odds ratios (ORs) with 95 % confidence intervals (CIs).
RESULTS: A one standard deviation increase of the ERI score (reflecting higher work stress) was associated with a 22-48 % elevated odds of asthma (Study 1: OR 1.48, 95 % CI 1.13-1.95, and Study 2: OR 1.22, 95 % CI 1.10-1.36). Z score-based analyses of the separate ERI components generally suggested moderate associations of effort, reward and overcommitment with asthma in both studies (Study 1: OR effort 1.25, 95 % CI 0.95-1.64, OR reward 0.67, 95 % CI 0.51-0.87, OR overcommitment 1.32, 95 % CI 1.01-1.72; and Study 2: OR effort 1.21, 95 % CI 1.09-1.34, OR reward 0.83, 95 % CI 0.76-0.92, OR overcommitment 1.12, 95 % CI 1.01-1.25). Analyses of categorized exposures largely confirmed these observations.
CONCLUSIONS: This is the first study to demonstrate a link between an established work stress measure and asthma. Longitudinal studies are needed to determine the direction of these associations.
 

Int Arch Occup Environ Health. 2014 Jul 27. [Epub ahead of print]