American Journal of Epidemiology Advance Access published online on July 8, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn157
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Original Contribution |
Perceived Stress and Cause-specific Mortality among Men and Women: Results from a Prospective Cohort Study
1 National Institute of Public Health, Copenhagen, Denmark
2 National Research Centre for the Working Environment, Copenhagen, Denmark
3 The Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
Correspondence to Dr. Naja Rod Nielsen, National Institute of Public Health, Øster Farimagsgade 5A, 1399 Copenhagen K, Denmark (e-mail: nrn{at}niph.dk).
Received for publication August 21, 2007. Accepted for publication December 13, 2007.
The authors assessed the effect of psychological stress on total and cause-specific mortality among men and women. In 1981–1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry until 2004, with <0.1% loss to follow-up. Sex differences were found in the relations between stress and mortality (p = 0.02). After adjustments, men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52). This finding was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16). High stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease mortality for younger, but not older, men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women, except among younger women with high stress, who experienced lower cancer mortality (HR = 0.51, 95% CI: 0.28, 0.92). Future preventive strategies may be targeted toward stress as a risk factor for premature death among middle-aged, presumably healthy men.
cause of death; mortality; prospective studies; stress, psychological
Abbreviations: CI, confidence interval; HR, hazard ratio; ICD-8, International Classification of Diseases, Eighth Revision; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision
Editor's note: An invited commentary on this article appears on page 000, and the authors' response is published on page 000.
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