Psychosocial determinants of premature cardiovascular mortality differences within Hungary

Abstract

Objectives: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. Design: Cross sectional, ecological analyses. Setting: 150 sub-regions of Hungary. Participants and methods: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. Main outcome measures: Gender specific standardised premature (45-64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. Results: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. Conclusion: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions. T he gap in life expectancy between Central-Eastern European (CEE) and Western Europe (WE) continues to be an important public health problem.1 2 This gap increased most dramatically over the past three decades and it is largely attributable to excess cardiovascular (CV) mortality in midlife, and particularly among men. Up to the end of the 1970s, mortality rates in Hungary were lower than those found in Great Britain or Austria. Subsequently, mortality rates declined in WE. But in Hungary and in other CEE countries this trend was reversed, especially among middle aged men. In the 1990, the mortality rates among 45-64 year old men in Hungary rose to and remained at levels that were higher than they were in the 1930s.2 In 1999 the standardised death rates attributable to diseases of the circulatory system were three times higher among Hungarian men and women that the European average, but were 2.8 times higher among men than among women.

Analysis of job stress in workers employed by three public organizations in Serbia

“…The overview of published data indicated that majority of studies have analyzed the impact of job stress on the incidence of cardiovascular diseases and associated mortality. Many studies confirmed that job stress increased the risk of cardiovascular diseases [25][26][27][28][29]. These studies highlight the adverse effects of low control at work, low social support, high job strain and also, job insecurity and effort-reward imbalance resulting in cardiovascular diseases.…”

Short and Long Term Effects of Psychosocial Factors on the Outcome of Coronary Artery Bypass Surgery

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