Trajectories of family and employment stress associated with cerebrovascular accidents

Jerez, María Pilar; Madero-Cabib, Ignacio

doi:10.11606/s1518-8787.20210550033253

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.20210550033253 copy

Trajectories of family and employment stress associated with cerebrovascular accidents

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES:

Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age.

METHODS:

We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors.

RESULTS:

Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA.

CONCLUSIONS:

Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.

DESCRIPTORS:
Stroke; Risk Factors; Financial Stress; Burnout, Professional; Socioeconomic Factors

		%
CVA Diagnosis
	Absence	93.6
	Presence	6.4
Sex
	Man	43.3
	Woman	56.7
Educational level
	Secondary or higher	61.5
	Elementary	38.5
Health coverage
	Public	88.0
	Private	11.2
Dairy consumption
	Less than once a week	12.3
	One or more times per week	87.2
Consumption of meat, fish or poultry
	Less than once a week	1.7
	One or more times per week	98.3
Consumption of legumes, beans or eggs
	Less than once a week	3.7
	One or more times per week	96.2
Physical activity
	Once a month or less	56.6
	One or more times per week	43.4
Smoking
	Absence	81.1
	Presence	17.3
Hypertension
	Absence	66.0
	Presence	34.0
Body mass index
	Not obese	69.7
	Obese	30.3

		Odds ratios	95% confidence intervals	Odds ratios	95% confidence intervals	Odds ratios	95% confidence intervals
Type of employment and family stress trajectories
	Absence of family and employment stress
	Absence of family stress, persistent employment stress	2.42	0.77—7.56	3.16^d d p < 0.1. Note: Statistically significant effects marked in gray.	0.89–11.17	3.38^d d p < 0.1. Note: Statistically significant effects marked in gray.	1.00–11.50
	Absence of family stress, out of the labor market	9.18^b b p < 0.01.	2.16—39.00	8.54^b b p < 0.01.	1.80–40.50	8.28^b b p < 0.01.	1.86–36.93
	Persistent family stress, absence of employment stress	12.64^a a p < 0.001.	3.53—45.23	12.90^a a p < 0.001.	2.96–56.14	11.87^b b p < 0.01.	2.80–50.38
Sociodemographic variables
Age				1.09	0.87–1.36	1.11	0.90–1.37
Sex
	Man	–		–		–
	Woman			0.94	0.44–2.01	0.80	0.37–1.83
Educational level
	Secondary or higher	–		–		–
	Elementary			1.95^d d p < 0.1. Note: Statistically significant effects marked in gray.	0.93–4.11	1.50	0.79–2.84
Health coverage
	Public	–		–		–
	Private			0.00^a a p < 0.001.	0.00–0.00	0.00^a a p < 0.001.	0.00–0.00
Traditional CVA risk factors
Body mass index
	Not obese	–		–		–
	Obese					1.72	0.74–4.00
Physical activity
	Once a month or less	–		–		–
	One or more times per week					0.90	0.25–3.19
Dairy consumption
	Less than once a week	–		–		–
	One or more times per week					0.51	0.17–1.54
Consumption of legumes, beans or eggs
	Less than once a week	–		–		–
	One or more times per week					0.28^c c p < 0.05.	0.09–0.86
Consumption of meat, fish or poultry
	Less than once a week	–		–		–
	One or more times per week					0.76	0.09–6.40
Smoking
	Absence	–		–		–
	Presence					1.21	0.55–2.67
Hypertension
	Absence	–		–		–
	Presence					1.74	0.68–4.46
Intercept		0.02		0.00		0.00

		Odds ratios	95% confidence intervals	Odds ratios	95% confidence intervals	Odds ratios	95% confidence intervals
Type of employment and family stress trajectories
	Absence of family and employment stress	–		–		–
	Absence of family stress, persistent employment stress	1.31	0.23–7.35	1.94	0.28–13.18	2.27	0.33–15.58
	Absence of family stress, out of the labor market	7.50	0.59–95.57	7.71	0.47–125.29	8.98	0.59–95.57
	Persistent family stress, absence of employment stress	8.32^b b p < 0.05. Note: Statistically significant effects marked in gray.	1.52–45.64	9.15^b b p < 0.05. Note: Statistically significant effects marked in gray.	1.37–61.18	8.69^b b p < 0.05. Note: Statistically significant effects marked in gray.	1.22–61.83
Type of employment and family stress trajectories * Sex
	Absence of family stress, persistent employment stress * Woman	3.54	0.30–42.16	2.72	0.20–36.25	2.28	0.17–28.86
	Absence of family stress, out of labor market * Woman	2.27	0.09–46.06	1.64	0.06–44.34	1.27	0.04–36.28
	Persistent family stress, absence of employment stress * Woman	2.06	0.15–33.96	2.00	0.14–28.25	1.92	0.12–29.51
Sociodemographic variables
Age				1.09	0.88–1.36	1.12	0.92–1.37
Educational level
	Secondary or higher	–		–		–
	Elementary			1.87	0.85–4.01	1.44	0.74–2.80
Health coverage
	Public	–		–		–
	Private			0.00^a a p < 0.001.	0.00–0.00	0.00^a a p < 0.001.	0.00–0.00
Traditional CVA risk factors
Body mass index
	Not obese	–		–		–
	Obese					1.70	0.75–3.88
Physical activity
	Once a month or less	–		–		–
	One or more times per week					0.91	0.26–3.25
Dairy consumption
	Less than once a week	–		–		–
	One or more times per week					0.51	0.17–1.51
Consumption of legumes, beans or eggs
	Less than once a week	–		–		–
	One or more times per week					0.29^b b p < 0.05. Note: Statistically significant effects marked in gray.	0.09–0.88
Consumption of meat, fish or poultry
	Less than once a week	–		–		–
	One or more times per week					0.76	0.09–6.52
Smoking
	Absence	–		–		–
	Presence					1.25	0.58–2.69
Hypertension
	Absence	–		–		–
	Presence					1.73	0.68–4.40
Intercept		0.02		0.00		0.00

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[1] Correspondence: Ignacio Madero-Cabib, Avenida Vicuña Mackenna 4860 Casilla 306, Correo 22, Macul 7820436 Santiago, Chile E-mail: i.maderocabib@uc.cl