title: Occupation and risk of sudden death in a United States community: a case-control analysis.
abstract: OBJECTIVE
  Work environment is said to influence cardiovascular risk. We assessed whether nature of occupation affects risk of sudden cardiac death (SCD) in the general population.
  
  
  METHODS
  In the ongoing, prospective Oregon Sudden Unexpected Death Study (catchment population 1 million), working-age SCD cases (18-65 years) were compared with controls who died from any cause. Usual occupation obtained from death certificates was classified using the US Census Bureau standard occupational classification descriptions and categorised as white collar, blue collar or homemaker. Odds ratio (OR) for SCD by occupation category was obtained and clinical profile of SCD cases was compared by occupation type.
  
  
  RESULTS
  Among SCD cases (n=646; 74% male) compared to controls (n=622; 73.6% male), the proportion of white collar workers was higher among male SCD cases (52.7% vs 43.7%; p=0.01); the difference in females was smaller (59.5% vs 55%; p=0.62). Adjusting for race and smoking status, male white collar workers had a higher risk of SCD compared to blue collar workers (OR=1.67, (1.26 to 2.23), p<0.001). A similar, non-significant trend was observed among females (OR 1.49 (0.81 to 2.75); p=0.20). White collar SCD cases were less likely to be current smokers (34.7% vs 45.3%, p=0.008), drug misusers (13.1% vs 18.5%) or have diabetes (21.4% vs 28.2%, both p=0.07) compared to blue collar workers. Other cardiac risk factors were similar.
  
  
  CONCLUSIONS
  A white collar occupation was associated with increased risk of SCD, when compared to blue collar occupations. Since differences in conventional risk factors did not explain this elevated risk, work-related behavioural and psychosocial stressors warrant a closer evaluation.
authors.affiliation: Shanghai Jiaotong University School of Public Health, Shanghai, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Vallabh
authors.initials: V
authors.lastname: Suryadevara
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Harpriya
authors.initials: H
authors.lastname: Chugh
authors.affiliation: Shanghai Jiaotong University School of Public Health, Shanghai, China.
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Zheng
authors.affiliation: Department of Pathology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification; D016017:Odds Ratio; D009922:Oregon / Q000453:epidemiology; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013315:Stress, Psychological; D019966:Substance-Related Disorders / Q000453:epidemiology; D014937:Work
keywords: CARDIOLOGY; EPIDEMIOLOGY; occupation; sudden cardiac death