L. Larabi

Job constraints and arterial hypertension: different effects in men and women: the IHPAF II case control study

Aims: To examine, in a working population of men and women, the relation between organisational job constraints (job strain, passive and active jobs) and incident hypertension and the buffering effect of social support at work on this relation. Methods: A nested case control study was designed within the IHPAF (Incidence of Hypertension in a French Working Population) cohort study. The 20 worksite physicians participating in the study enrolled 203 cases and matched each case for age (SD 10 years) and sex with two normotensive subjects attending the follow up screening immediately after him or her. As a result, 426 men and 183 women were included in the study. Results: Mean age was 41.8 (SD 7.8) years in men and 43.5 (SD 7.5) years in women. Relations between job constraints and hypertension were stronger in women than in men. Odds ratios (OR) were 3.20 (95% CI 0.92 to 11.12) in women and 2.60 (95% CI 1.15 to 5.85) in men for job strain, 4.73 (95% CI 1.36 to 16.42) in women and 2.30 (95% CI 1.01 to 5.26) in men for passive jobs, and 4.51 (95% CI 1.24 to 16.43) in women and 2.39 (95% CI 1.10 to 5.18) in men for active jobs. Low social support at work was not related to hypertension and did not decrease the association with organisational risk factors. In both hypertensive men and women, obesity was related to hypertension (OR = 13.20 (95% CI 3.34 to 52.14) in women and 6.54 (95% CI 2.99 to 14.29) in men) and the prevalence of recent stressful life events was significantly lower in hypertensive women (OR = 0.32 (95% CI 0.12 to 0.89)) and men (OR = 0.37 (95% CI 0.20 to 0.67) compared with normotensives. Alcohol consumption was a significant risk factor for hypertension in women (OR = 3.47 (95% CI 1.18 to 10.25)). Conclusion: A stronger relation between job constraints and hypertension was observed in women compared with men. These findings emphasise the need of addressing more sex-specific concepts of work related stress on the one hand, and of understanding the direct and indirect mechanisms linking psychosocial factors and hypertension in both sexes on the other hand.

Prevalence and therapeutic control of hypertension in French Caribbean regions.

Objective To describe characteristics of hypertension in French Caribbean regions. Design A cross-sectional worksite study. Setting and participants A random sample of 6136 workers referred for annual check-up from Martinique, French Guyana and Guadeloupe. An average of three consecutive measurements was taken as the blood pressure (BP) level. An additional visit was required in subjects not taking antihypertensive medications with an average BP over 140/90 mmHg. Interventions None. Main outcome measures Hypertension prevalence, awareness, treatment and control. Results The age-specific prevalence of hypertension, based on two visits, increased from 3.2% in men below 30 years to 46.9% in those older than 50 years. The corresponding values found in women were 1.8 and 42.6%. The overall prevalence was 19.5% in men and 18.9% in women. The rate of awareness remained low while age increased. The use of antihypertensive medications slowly increased with age, but overall the rate remained lower in men compared with women. Up to 71% of hypertensive women received antihypertensive medications. Compared with previous studies, a high proportion of adequately treated patients was found among women (44.9%). Only 30.4% of hypertensive men were treated, and as a result the control rate was lower (13.3%). Conclusion Major sex-related differences are found in the control of high BP, with an unexpected high rate observed among Caribbean women. Better awareness and higher treatment rates play an important role in explaining such results. This may be important, especially in developing countries, where poor control of hypertension is a major cause of cardiovascular diseases.

One-year hypertension incidence and its predictors in a working population: the IHPAF study

The aims of our study were: (i) to estimate the yearly incidence rates based on one vs two visits in a working population and (ii) to identify incident hypertension modifiable risk factors. A total of 21 566 normotensive subjects were included in a 1-year cohort study. Blood pressure (BP) levels at inclusion and at the second year screening were measured on the basis of two visits, that is, if BP was over 140/90 mmHg in untreated subjects, they were invited to a control visit 1 month later. Height and weight were measured and behavioural risk factors were collected. Among the 17 465 subjects who completed the entire protocol (9691 men and 7774 women), 17 026 remained normotensive at a 1-year interval and 439 (325 men and 114 women) became hypertensive. Crude yearly incidence rates based on one visit were 6.21% in men and 3.06% in women, compared with 3.04% in men and 1.34% in women when incidence rates were based on two visits, a more than twofold difference. Age and body mass index at baseline were the two major independent determinants of incident hypertension in both genders. Smoking and alcohol consumption were significant risk factors in men but not in women, and a low educational level only in women. BP measurement on separate occasions is necessary to avoid overestimation of incidence. Weight in both genders and alcohol consumption in men were the main modifiable predictors of hypertension.

Detection of emerging diseases in occupational health: usefulness and limitations of the application of pharmacosurveillance methods to the database of the French National Occupational Disease Surveillance and Prevention network (RNV3P).

Objective: To test data mining methods used in pharmacosurveillance in order to identify potential emerging disease–nuisance associations in the national occupational disease surveillance and prevention network (RNV3P) database. Methods: Proportional reporting ratios (PRR) used in pharmacosurveillance were applied to detect disproportional reporting of disease–nuisance associations which are not compensated by the national social security system. Results: The 24 785 reports of the RNV3P were grouped into 1344 different disease–nuisance associations reported more than twice, of which 422 did not give entitlement to compensation by the social security system. Among these associations, 162 were potentially emergent and generated a signal, of which eight associations involve cancer. Conclusion: This work is the first stage of an exploratory investigation submitting the questions raised to experts and involving participants in the network in reflection on the hypotheses generated.

Reducing the burden of arterial hypertension: what can be expected from an improved access to health care? Results from a study in 2420 unemployed subjects in the Caribbean

High prevalence and poor control of hypertension have been observed in populations with low-socioeconomic status. Comparing an unemployed population with another employed population sharing the same culture, and another employed population living in another environment might enlighten the effects of factors accessible to primary prevention on the one hand and access to health care on the other hand. The objectives are, first, to describe blood pressure (BP) prevalence and control in an unemployed Caribbean population benefiting from State financial support and good access to health care and second, compare the results in this population with those observed, with the same methodology in two employed populations, one in the Caribbean and one in metropolitan France. A cross-sectional study of 2420 consecutive unemployed subjects referred for check-up in the two health centres of Guadeloupe, a French Caribbean island. Hypertension prevalence was 25.2% in men and 22.1% in women. BP was controlled in 17.3% of men and 37.2% of women receiving antihypertensive medication. Among women, 58% were overweight and 29% obese. Prevalence of hypertension was higher among the unemployed and employed Caribbean population, than among an employed metropolitan French population. A high prevalence of obesity was observed in the two Caribbean populations suggesting the interest of primary prevention in the Caribbean. Burden of hypertension in a population relates to the development of hypertension (primary prevention) and control of hypertension (secondary prevention). Identifying hypertensive patients and controlling blood pressure are both important to reduce the disease burden.

Analyse temporelle des couples nuisance/pathologie principale relevant des maladies professionnelles au sein du Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)

Resume But de l’etude Le Reseau national de vigilance et de prevention des pathologies professionnelles (RNV3P) enregistre depuis 2001 les problemes de sante au travail (PST) des consultations des pathologies professionnelles des CHU. Ces PST sont l’association d’une pathologie principale (associee eventuellement a des comorbidites) avec son environnement professionnel (nuisances, metier…). Cette etude a pour objectif d’analyser les tendances temporelles des couples nuisance/pathologie principale (CNP). Methode A l’issue de chaque consultation de pathologies professionnelles, un PST est cree. Au niveau local, des medecins experts codent ces donnees, qui sont alors exportees sur un info-centre national. Pour l’analyse de ce travail, une table des synonymes regroupe, pour chaque paragraphe d’un meme tableau, tous les codes CIM10 utilises par les experts afin de reduire le nombre de couples pathologies – nuisances a analyser et obtenir des effectifs suffisants. L’analyse des tendances evolutives est faite par chi-deux de tendance et de linearite. Resultats Entre 2002 et 2005, le RNV3P a enregistre 20.854 PST, dont 9.324 PST relevant potentiellement d’un tableau de maladies professionnelles ; ils se regroupent en 983 CNP differents, dont 17 d’entre eux ont un effectif cumule sur les 4 annees superieur a 80. Parmi ces principaux couples, seul le CNP amiante/plaque pleurale presente une tendance a la hausse, non lineaire. En revanche, les asthmes et hyperreactivite bronchique lies aux poussieres organiques ou aux isocyanates et les pneumoconioses et pathologies interstitielles liees aux poussieres montrent une tendance statistique a la diminution lineaire. La plupart des couples etudies sont stables sur les 4 annees. Conclusion Ces tendances evolutives de couples pathologies/nuisances font l’objet d’interrogation de la part des experts du reseau : moindre recours necessaire aux experts ou reduction de leur incidence du fait de l’amelioration de la prevention ? Seule l’approche RNV3P en services de medecine du travail, qui est en cours de mise en place, pourra apporter une reponse epidemiologique a ces interrogations a partir du recueil systematique des PST incidents sur le terrain.