title: Self-reported stress and subsequent hospital admissions as a result of hypertension, varicose veins and haemorrhoids.
abstract: BACKGROUND
  This study examines a cohort in which individuals of privileged socio-economic position report greater psychological stress. We have previously shown in this cohort that stress is unrelated to coronary heart disease as measured by hospital discharge diagnosis and cause-specific death. In contrast, stress and hospitalization for cardiovascular conditions not requiring mandatory admission were associated. We hypothesized that psychosocial factors, in particular reporting tendency, are the likely mediator of this association, and the present study considers this further.
  
  
  METHODS
  A total of 5,596 men underwent a health screening during which they completed the Reeder Stress Inventory. Details of hospital admissions were retrieved from the Scottish Morbidity Records over a 21 year follow-up. Relationships between stress and admission were evaluated using proportional hazards regression.
  
  
  RESULTS
  Compared with low stress, reported high stress was found to be associated with increased numbers of admissions for each of three most common cardiovascular causes of non-mandatory admission: adjusted hazard ratios were 3.43 for essential hypertension (95 per cent confidence interval (CI) 1.36-8.65), 1.91 for lower limb varicose veins (95 per cent CI 1.12-3.24), and 2.01 for haemorrhoids (95 per cent CI 1.16-3.51). Stress and blood pressure at baseline were not associated.
  
  
  CONCLUSIONS
  The association between stress and admissions as a result of hypertension appears unlikely to be mediated by blood pressure. More likely is a mechanism based upon the reporting of symptoms, or the recording of discharge diagnoses. There is no obvious medical explanation for associations between stress and hospitalization as a result of varicose veins or haemorrhoids, and again it is likely that psychosocial factors provide the mechanism.
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR. chris.metcalfe@mrc-bsu.cam.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Metcalfe
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: John
authors.initials: J
authors.lastname: Macleod
authors.forename: Pauline
authors.initials: P
authors.lastname: Heslop
authors.forename: Carole
authors.initials: C
authors.lastname: Hart
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006484:Hemorrhoids / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012606:Scotland / Q000453:epidemiology; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology*; D014648:Varicose Veins / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy