Social determinants of leisure time physical activity, body mass index, and acute myocardial infarction
Sammanfattning: There are substantial socioeconomic differences in cardiovascular morbidity and mortality in most western countries. Socioeconomic differences in cardiovascular risk factors (obesity/overweight, tobacco smoking, leisure time physical activity, dietary habits) are correspondingly large. The main aim of this study is to investigate the influence of psychosocial work conditions and social capital on cardiovascular risk factors at different levels: health locus of control, leisure time physical activity, body mass index (BMI) and acute myocardial infarction (AMI). The 2000 public health survey in Scania is a cross-sectional postal questionnaire study of a randomly selected sample of people born 1919-1981 from the population registers, conducted in November 1999 to February 2000. A total of 13,715 persons, 59% of the random sample, responded, In papers I and II, 5,180 persons aged 18?64 years that belonged to the work force or were unemployed were included. In paper III, 1,967 females, aged 18-34, were investigated. Paper IV is a prospective cohort study using the 2000 survey as baseline, linked to AMI morbidity/mortality data for January 2000-December 2002. Logistic regression models were used in papers I, II and III, to investigate associations between psychosocial factors at work and unemployment, and lack of belief in the possibility to influence one's own health (paper I), and low leisure time physical activity (paper II), and to investigate the association between the socio-economic, psychosocial, health behaviour, self reported global and psychological health and locus of control, and BMI in paper III. In paper IV, hazard rate ratios for first time AMI (fatal and non-fatal) were analysed ccording to social participation, trust and their combinations. In paper I significantly higher odds ratios of lack of internal locus of control were observed in the passive, jobstrain and unemployed categories, compared to the relaxed reference category. These patterns remained in the multivariate models, with the exception of the passive and unemployed categories among men in which the significant differences disappeared. The control dimension seems to be of greatest importance. In paper II significantly higher odds ratios of low leisure-time physical activity among both men and women were observed in the jobstrain and unemployed categories compared to the relaxed reference category. However, these significant differences disappeared after adjustment for education. In paper III adjustments were only made for age in the analyses, but the results show important socioeconomic, psychosocial and lifestyle differences between underweight compared to overweight/obese young women. Young women with underweight had significantly higher odds ratios of working overtime, being students, having low emotional support, having poor self reported global as well as poor psychological health, while women with overweight/obesity were unemployed, daily smokers, had low education, low social participation, low emotional and instrumental support, sedentary lifestyle, poor self reported global health and external locus of control compared to normal weight women. In paper IV, particularly low social participation and the social participation/trust categories traditionalism (low social participation/high trust) and low social capital (low social participation/low trust) were significantly associated with an increased risk of AMI. After adjustments for age, sex, education, economic stress, physical activity, daily smoking, BMI and self reported health only the significantly increased risk of first ever AMI remains in the low social participation/high trust category.
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