Occupational risk factors for ischaemic heart disease : differences among males and females in the Māori and general populations of New Zealand : a thesis with publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health (Epidemiology) at Massey University, Wellington, New Zealand
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Date
2021
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Massey University
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Abstract
Occupation is a poorly characterised risk factor for cardiovascular disease, a leading cause of death worldwide, with females and indigenous peoples underrepresented in research. This thesis assessed associations between occupation/occupational exposures and cardiovascular risk factors and ischaemic heart disease (IHD), for males and females of the Māori and general populations of New Zealand.
Two previous New Zealand Workforce Surveys (NZWS) in the general (NZWS; n=3003; 2004-2006) and Māori (Māori NZWS; n=2107; 2009-2011) populations were linked to Ministry of Health data in Statistics New Zealand’s Integrated Data Infrastructure. Age-adjusted logistic regression was used to assess associations between occupational groups and cardiovascular risk factors (high blood pressure, high deprivation, high cholesterol, diabetes, smoking and obesity). Cox proportional hazard regression, adjusted for age, deprivation and smoking, was used to assess associations between ever working in an occupational group and incident IHD, over a 7-14 year follow-up period. Associations with occupational exposures were also assessed.
Cardiovascular risk factors were disproportionately experienced by blue-collar workers, particularly plant and machine operators and assemblers and elementary workers. In contrast, professionals were less likely to experience risk factors. Similarly, having ever worked as a plant and machine operator and assembler or elementary worker was positively associated with IHD for Māori females. Having ever worked as a technician and associate professional was inversely associated with IHD. Associations were not consistent between Māori and the general population or between males and females, with differences observed for clerks, agriculture and fishery workers and sales and service workers.
Occupational exposure to dust, tools that vibrate, smoke or fumes, oils and solvents, and high frequency exposure to repetitive tasks, loud noise, working at high speeds and awkward grip or hand movements, common in blue-collar occupations, was positively associated with IHD. Associations were not consistent across all populations, with no positive associations observed among Māori males.
In conclusion, this thesis shows a role of occupation in IHD risk, presenting an opportunity for IHD interventions, particularly for blue-collar occupations. However, findings suggest that occupational risk factors cannot be generalised across all populations and future research and intervention development therefore requires consideration of sex and ethnicity.
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Keywords
Coronary heart disease, Risk factors, Occupational diseases, Epidemiology, New Zealand