Research Article: Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort
Abstract:
Objectives Distinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks. Design A cross-sectional and retrospective observational study. Setting A population-based French cohort (CONSTANCES). Participants 130?197 adults enrolled between 2012 and 2021 without missing values. Primary outcome measures The associations of social position, work environment and unemployment exposure with the prevalence of cardiovascular events and cancers simultaneously tested using logistic regression models adjusting for common risk factors. Results While social position, work environment and unemployment exposure are strongly inter-related with each other, they are not linked to the same cardiovascular and cancer outcomes. Low social position and long unemployment duration are significantly associated with an increased prevalence of angina pectoris, myocardial infarction and peripheral arterial disease (OR=1.22?to 1.90, p<0.04?to p<0.0001) but not of stroke. In contrast, a bad work environment is associated with an increased prevalence of stroke (OR=1.29, p<0.01) but not of angina pectoris, myocardial infarction and peripheral arterial disease. Low social position is associated with an increased prevalence of cervical and lung cancers (OR=1.73?and 1.95, p<0.002?and p<0.03) and a decreased prevalence of skin cancer (OR=0.70, p<0.0001) while a bad work environment is associated with an increased prevalence of breast, skin, prostate and colon cancers (OR=1.31?to 2.91, p<0.0002?to p<0.0001). Unemployment exposure is not associated with the prevalence of any type of cancers. Conclusions Social position, work environment and unemployment are associated with distinct cardiovascular and cancerous diseases that could add up during lifetime, they should therefore be considered all together in any preventive strategy.
Introduction:
Social position is a powerful determinant of health, influencing the risk of cardiovascular diseases and cancers in particular. 1–4 The reasons why individuals with low social position usually have higher cardiovascular and cancer risks are many, including material deprivation, limited educational and cultural attainment, easy adoption of unhealthy behaviours, low importance given to the care of one’s own health, inability to cope with illness and to access healthcare. For example, individuals with low social…
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