Job stress and glycated hemoglobin levels: the role of educational attainment. Baseline data from the Longitudinal Study of Adult Health (ELSA-Brasil)

Santos, Raíla de Souza; Griep, Rosane Harter; Fonseca, Maria de Jesus Mendes da; Chor, Dóra; Santos, Itamar Souza; Melo, Enirtes Caetano Prates

doi:10.1590/2317-6369/24319PT2022v47e5

Brasil

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Research article • Rev. bras. saúde ocup. 47 • 2022 • https://doi.org/10.1590/2317-6369/24319PT2022v47e5 linkcopy

Job stress and glycated hemoglobin levels: the role of educational attainment. Baseline data from the Longitudinal Study of Adult Health (ELSA-Brasil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: stressful work conditions are associated to increased glycemic levels, but little is known about the role of educational attainment in this association.

Objectives: to analyze the association between psychosocial stress at work, levels of glycated hemoglobin (HbA1c), and the role of educational attainment as an effect modifier.

Methods: a cross-sectional study with baseline data from 11,922 active workers who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Psychosocial stress at work was measured via the Demand-Control model. Multinomial logistic regression and multiplicative interactions were performed.

Results: among female workers with low educational attainment, there was an association of low skill discretion and elevated HbA1c (OR 1.56; 95% CI 1.09-2.24). Low decision authority was associated to borderline (OR 1.21; 95% CI 1.01-1.45) and high (OR 1.73; 95% CI 1.19-2.51) HbA1c. Among male workers with low educational attainment, high strain (OR 1.94; 95% CI 1.18-3.21), low skill discretion (OR 2.0; 95% CI 1.41-2.83), and low decision authority (OR 1.58; 95% CI 1.13-2.21) were associated to high HbA1c.

Conclusion: Stress at work was associated to high and borderline levels of HbAlc in workers from both genders with low educational attainment. Actions to modify work relations and to prevent chronic diseases should be prioritized for this group.

Keywords: glycated hemoglobin A; occupational stress; educational status; cross-sectional studies; occupational health

WOMEN	HbA1c ^§
	Total	Normal	Borderline	High
	n = 6,229	n = 4,546	n = 1,297	n = 386
Age	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
	48.8 (7.0)	48.0 (6.9)	50.7 (7.0)	52.9 (6.5)
	n (%)	n (%)	n (%)	n (%)
Educational attainment
Up to complete high school	2,762 (44.3)	1,834 (66.4)**	674 (24.4)**	254 (9.2)**
Complete under-graduation	3,467 (55.7)	2,711 (78.2)	624 (18.0)	132 (3.8)
Weekly workload
Up to 40 hours a week	4,477 (71.9)	3,192 (71.3)**	976 (21.8)**	309 (6.9)**
More than 40 hours a week	1,752 (28.1)	1,354 (77.3)	323 (18.4)	75 (4.3)
Shiftwork
Daytime	3,911 (62.8)	2,945 (75.3)**	763 (19.5)**	203 (5.2)**
Nighttime	1,117 (17.9)	765 (68.5)	266 (23.8)	86 (7.7)
Ex-nighttime	1,201 (19.3)	836 (69.6)	267 (22.2)	98 (8.2)
Smoking habit
Never smoked	3,926 (63.0)	2,964 (75.5)**	754 (19.2)**	204 (5.2)**
Ex-smoker	1,520 (24.4)	1,076 (70.8)	336 (22.1)	108 (7.1)
Smoker	783 (12.6)	504 (64.4)	207 (26.4)	72 (9.2)
Physical activities
Strong	322 (5.3)	262 (81.4)**	52 (16.1)**	8 (2.5)**
Moderate	805 (13.1)	593 (73.7)	162 (20.1)	50 (6.2)
Weak	5,003 (81.6)	3,612 (72.2)	1,066 (21.3)	325 (6.5)
Body mass index
Underweight/normal	2,553 (41.0)	2,064 (80.8)**	417 (16.3)**	72 (2.8)**
Overweight	2,183 (35.0)	1,589 (72.8)	463 (21.2)	131 (6.0)
Obese	1,493 (24.0)	891 (59.7)	418 (28.0)	184 (12.3)
Job Strain†
Low strain ‡	1,453 (23.3)	1,090 (75.0)**	292 (20.1)**	71 (4.9)**
Active	1,204 (19.3)	926 (76.9)	226 (18.8)	52 (4.3)
Passive	2,252 (36.2)	1,576 (70.1)	491 (21.8)	185 (8.2)
High strain	1,320 (21.2)	952 (72.1)	289 (21.9)	79 (6.0)
Psychological Demands
Low ‡	3,705 (59.5)	2,667 (72.0)*	782 (21.1)*	256 (6.9)*
High	2,524 (40.5)	1,878 (74.4)	515 (20.4)	131 (5.2)
Skill Discretion
High ‡	2,846 (45.7)	2,148 (75.5)**	561 (19.7)**	137 (4.8)**
Low	3,383 (54.3)	2,399 (70.9)	737 (21.8)	247 (7.3)
Decision Authority
High ‡	2,142 (34.4)	1,598 (74.6)*	433 (20.2)*	111 (5.2)*
Low	4,087 (65.6)	2,947 (72.1)	866 (21.2)	274 (6.7)

MEN	HbA1c ^§
	Total	Normal	Borderline	High
	n = 5,693	n = 4,051	n = 1,138	n = 504
Age	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
	49.5 (7.4)	49.1 (7.5)	50.1 (7.2)	52.1 (6.7)
	n (%)	n (%)	n (%)	n (%)
Educational attainment
Up to complete high school	2,872 (50.4)	1,884 (65.6)**	643 (22.4)**	345 (12.0)**
Complete under-graduation	2,821 (49.6)	2,167 (76.8)	496 (17.6)	158 (5.6)
Weekly workload
Up to 40 hours a week	3,529 (62.0)	2,446 (69.3)**	731 (20.7)**	352 (10.0)**
More than 40 hours a week	2,164 (38.0)	1,604 (74.1)	409 (18.9)	151 (7.0)
Shiftwork
Daytime	3,652 (64.1)	2,650 (72.6)**	714 (19.6)**	288 (7.9)**
Nighttime	714 (12.5)	504 (70.6)	131 (18.3)	79 (11.1)
Ex-nighttime	1,327 (23.3)	897 (67.6)	292 (22.0)	138 (10.4)
Smoking habit
Never smoked	2,981(52.4)	2,250 (75.5)**	540 (18.1)**	191 (6.4)**
Ex-smoker	1,868 (32.8)	1,262 (67.6)	387 (20.7)	219 (11.7)
Smoker	844 (14.8)	536 (63.5)	213 (25.2)	95 (11.3)
Physical activities
Strong	521 (9.3)	401 (77.0)*	90 (17.3)*	30 (5.8)*
Moderate	887 (15.8)	633 (71.4)	179 (20.2)	75 (8.5)
Weak	4,197 (74.9)	2,946 (70.2)	852 (20.3)	399 (9.5)
Body mass index
Underweight/normal	1,952 (34.3)	1,495 (76.6)**	359 (18.4)**	98 (5.0)**
Overweight	2,567 (45.1)	1,843 (71.8)	501 (19.5)	223 (8.7)
Obese	1,174 (20.6)	711 (60.6)	279 (23.8)	183 (15.6)
Job Strain †
Low strain ‡	1,736 (30.5)	1,257 (72.4)**	356 (20.5)**	123 (7.1)**
Active	1,047 (18.4)	792 (75.6)	183 (17.5)	72 (6.9)
Passive	2,081 (36.6)	1,442 (69.3)	416 (20.0)	223 (10.7)
High strain	829 (14.6)	560 (67.6)	183 (22.1)	86 (10.4)
Psychological Demands
Low ‡	3,817 (67.0)	2,699 (70.7)	771 (20.2)	347 (9.1)
High	1,876 (33.0)	1,352 (72.1)	366 (19.5)	158 (8.4)
Skill Discretion
High ‡	3,030 (53.2)	2,206 (72.8)**	609 (20.1)**	215 (7.1)**
Low	2,663 (46.8)	1,845 (69.3)	527 (19.8)	291 (10.9)
Decision Authority
High ‡	2,124 (37.3)	1,559 (73.4)**	399 (18.8)**	166 (7.7)**
Low	3,569 (62.7)	2,491 (69.8)	739 (20.7)	339 (9.5)

Models	Women (n = 6,229)		Men (n = 5,693)
	HbA1c*		HbA1c*
	Borderline	High	Borderline	High
Job Strain †	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Crude model 1 ^a
Low strain	1.00	1.00	1.00	1.00
Active	0.91 (0.75-1.11)	0.86 (0.60-1.25)	0.82 (0.67-0.99)	0.92 (0.68-1.25)
Passive	1.16 (0.98-1.37)	1.79 (1.35-2.38)	1.02 (0.87-1.19)	1.56 (1.24-1.97)
High strain	1.13 (0.94-1.36)	1.27 (0.91-1.77)	1.15 (0.94-1.41)	1.56 (1.16-2.08)
Model 2 ^b
Low strain	1.00	1.00	1.00	1.00
Active	0.91 (0.75-1.11)	0.87 (0.60-1.26)	0.83 (0.68-1.01)	0.98 (0.72-1.33)
Passive	1.17 (0.99-1.38)	1.83 (1.37-2.45)	1.04 (0.88-1.22)	1.67 (1.32-2.11)
High strain	1.22 (1.02-1.48)	1.50 (1.07-2.11)	1.19 (0.97-1.46)	1.72 (1.28-2.31)
Model 3 ^c
Low strain	1.00	1.00	1.00	1.00
Active	0.93 (0.77-1.14)	0.92 (0.64-1.34)	0.85 (0.70-1.04)	1.04 (0.76-1.41)
Passive	1.00 (0.84-1.19)	1.28 (0.95-1.74)	0.87 (0.73-1.03)	1.14 (0.88-1.46)
High strain	1.07 (0.88-1.30)	1.12 (0.79-1.59)	1.02 (0.82-1.26)	1.23 (0.90-1.67)
Model 4 ^d
Low strain	1.00	1.00	1.00	1.00
Active	0.91 (0.74-1.11)	0.85 (0.58-1.24)	0.86 (0.70-1.05)	1.05 (0.77-1.44)
Passive	0.99 (0.83-1.18)	1.27 (0.94-1.73)	0.88 (0.74-1.05)	1.15 (0.89-1.49)
High strain	1.02 (0.84-1.24)	1.05 (0.73-1.49)	1.01 (0.82-1.26)	1.19 (0.87-1.62)
educational attainment interactions	p = 0.4273		p = 0.0231
*Dimensions*
High Psychological Demands
Crude model 1^a	0.94 (0.82-1.06)	0.73(0.59-0.91)	0.95 (0.82-1.09)	0.91 (0.75-1.11)
Model 2^b	0.97 (0.85-1.10)	0.79(0.63-0.98)	0.96 (0.83-1.10)	0.95 (0.77-1.16)
Model 3^c	1.01 (0.89-1.15)	0.88 (0.70-1.10)	1.00 (0.87-1.15)	1.05 (0.85-1.28)
Model 4^d	0.97 (0.85-1.11)	0.81 (0.65-1.03)	0.99 (0.86-1.15)	1.03 (0.84-1.26)
educational attainment interactions	p = 0.745		p = 0.579
Low Skill Discretion
Crude model 1^a	1.18 (1.04-1.33)	1.61 (1.30-2.00)	1.03 (0.91-1.18)	1.62 (1.34-1.95)
Model 2^b	1.19 (1.05-1.35)	1.65 (1.32-2.05)	1.05 (0.92-1.19)	1.69 (1.40-2.04)
Model 3^c	1.01 (0.89-1.16)	1.15 (0.90-1.46)	0.86 (0.74-0.99)	1.15 (0.93-1.42)
Model 4^d	1.01 (0.88-1.16)	1.15 (0.90-1.46)	0.86 (0.74-1.00)	1.16 (0.93-1.43)
educational attainment interactions	p = 0.058		p < 0.00001
Low Decision Authority
Crude model 1^a	1.09 (0.95-1.24)	1.33 (1.06-1.67)	1.16 (1.01-1.33)	1.30 (1.07-1.58)
Model 2^b	1.18 (1.04-1.35)	1.56 (1.23-1.97)	1.18 (1.03-1.36)	1.40 (1.15-1.71)
Model 3^c	1.08 (0.94-1.24)	1.25 (0.99-1.59)	1.06 (0.92-1.22)	1.07 (0.87-1.32)
Model 4^d	1.07 (0.93-1.23)	1.27 (1.00-1.63)	1.06 (0.92-1.22)	1.04 (0.84-1.28)
educational attainment interactions	p = 0.019		p = 0.004

Models Interaction Schooling	Women (n = 3,467)		Men(n = 2,821)		Women (n = 2,762)		Men (n = 2,872)
	HbA1c*				HbA1c*
	Borderline	High	Borderline	High	Borderline	High	Borderline	High
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
	LOW EDUCATIONAL ATTAINMENT				HIGH EDUCATIONAL ATTAINMENT
†Job Strain ‡
Low strain			1.00	1.00			1.00	1.00
Active			0.87 (0.68-1.11)	0.83 (0.54-1.28)			0.87 (0.60-1.26)	1.45 (0.92-2.31)
Passive			1.04 (0.80-1.36)	1.35 (0.87-2.10)			0.77 (0.61-0.98)	1.06 (0.76-1.47)
High strain			1.14 (0.80-1.61)	1.94 (1.18-3.21)			0.90 (0.68-1.20)	0.97 (0.65-1.44)
Control Dimensions ‡
High Skill Discretion	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Low Skill Discretion	0.97 (0.81-1.17)	1.56 (1.09-2.24)	0.98 (0.77-1.23)	2.00 (1.41-2.83)	1.06 (0.86-1.30)	0.92 (0.67-1.25)	0.78 (0.65-0.95)	0.87 (0.68-1.12)

High Decision Authority	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Low Decision Authority	1.21 (1.01-1.45)	1.73 (1.19-2.51)	1.13 (0.92-1.37)	1.58 (1.13-2.21)	0.91 (0.73-1.12)	0.98 (0.71-1.35)	0.97 (0.79-1.20)	0.78 (0.60-1.02)

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[TFN6] ^§HbA1c: normal HbA1c <5.7% (< 39 mmol/mol), borderline HbA1c 5.7% - 6.4% (39 mmol/mol - 47 mmol/mol), and high HbA1c ≥ 6.5% (≥ 48 mmol/mol); †Job Strain: low strain work (low demand and high control); active work (high demand and high control); passive work (low demand and low control); and high strain work (high demand and low control); ‡Reference categories; *p < 0.05; **p < 0.01 in Pearson chi-squared test with Yates’ correction for glycemic level. SD: Standard Deviantion.