Abstract
ObjectivesDistinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks.DesignA cross-sectional and retrospective observational study.SettingA population-based French cohort (CONSTANCES).Participants130 197 adults enrolled between 2012 and 2021 without missing values.Primary outcome measuresThe 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.ResultsWhile 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.ConclusionsSocial 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.
Funder
Institut National de la Santé et de la Recherche Médicale
Institut National Du Cancer
Caisse nationale de l'Assurance Maladie
Institut pour la recherche en santé publique
Agence Nationale de la Recherche
Reference64 articles.
1. Social Determinants of Risk and Outcomes for Cardiovascular Disease
2. Socioeconomic factors and cardiovascular disease: a review of the literature.
3. Kogevinas M , Pearce N , Susser M . Social inequalities and cancer. International Agency for Research on Cancer Scientific Publications, 1997.
4. Vaccarella S , Lortet-Tieulent J , Saracci R . Reducing Social Inequalities in Cancer: Setting Priorities for Research. International Agency for Research on Cancer Scientific Publications, 2019.
5. Beenackers MA , Kamphuis CBM , Giskes K , et al . Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 2012;9:116. doi:10.1186/1479-5868-9-116