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Dissertation
The associations between psychosocial stress and coronary heart disease in two cohorts of U.S. women
Doctor of Philosophy (Ph.D.), Drexel University
Jun 2018
DOI:
https://doi.org/10.17918/D8DM3G
Abstract
OBJECTIVE: This dissertation explores the effect of psychosocial stress on risk of coronary heart disease (CHD) and the underlying biobehavioral mechanisms between psychosocial stress and CHD in women. METHODS: Two cohort data were used: 1) Women's Health Initiative Observational Study (WHI-OS) participants aged 50-79 years (N= 80,825); 2) 5,089 adults (2,505 women and 2,584 men) without clinical cardiovascular disease, aged 45-84 years at baseline in Multi-Ethnic Study of Atherosclerosis (MESA). Job strain was constructed based on the Karasek's Job Demand-Control (JDC) model and imputed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain (WHI-OS only) were assessed via validated self-reported questionnaires. Various statistical modeling approaches were used: Cox proportional hazard models, generalized linear models, path analysis with covariance-based structure equation models. RESULTS: For WHI-OS participants with an average of 14.7 years of follow-up, high job strain was associated with 13% increased risk of CHD (HR=1.13, 95% CI:1.03,1.24). Women with the high life event scores had a 20% higher risk of CHD (HR=1.20, 95% CI: 1.09,1.31), and for women with high social strain, the CHD risk increased by 12% (HR=1.12, 95% CI: 1.04,1.22). There was a significant interaction between job strain and social strain (P value= 0.02). High job strain was associated with a 25% increased risk of CHD for women with high social strain (HR=1.25, 95% CI: 1.07,1.46) while no association between high job strain and CHD risk was found in women with low social strain. The results from MESA participants showed that extreme ongoing problems in life were associated with a 7% increase in CHD risk (AMR=1.07, 95% CI: 1.02, 1.13) while job strain was not independently associated with CHD risk. There is no interaction between gender and psychosocial stress in relation to CHD risk. Changes in CHD risks over a 2-year period were not associated with either job strain or ongoing problems in life. The results from path analysis suggested that leisure-time physical activity, alcohol consumption, hypertension, and diabetes explained more than 50% of the associations between each psychosocial stressors and CHD. CONCLUSIONS: In women, psychosocial stress in different domains has a disparate impact on CHD risks, and part of the association between psychosocial stress and CHD risks is explained by biobehavioral factors. Future work for impacting other domains of psychosocial stress and interventions emphasizing specific needs of women are needed.
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Details
- Title
- The associations between psychosocial stress and coronary heart disease in two cohorts of U.S. women
- Creators
- Conglong Wang - DU
- Contributors
- Yvonne L. Michael (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- ix, 109 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Epidemiology and Biostatistics; Drexel University
- Other Identifier
- 8093; 991014632572104721