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Job Strain and the Prevalence of Myocardial Infarction in HES and HANES


The odds of those in High Strain Jobs having had a Myocardial Infarction were: HES: 2.48 (p=.012) and HANES: 3.28 (p=.001)
times that of those Not in High Strain Jobs, controlling for age AJPH, 1988


The Health Examination Survey (HES) 1960-62 is based on an examination of a representative sample of 6,672 persons drawn from the civilian non-institutionalized population of the United States, ages 18 to 79. The detailed component of the Health and Nutrition Examination Survey (HANES), conducted between 1971 and 1975, is similar to the HES in that it is also representative of non institutionalized persons in the United States (6,913 subjects ages 25-74 were examined). Sample weights derived for these surveys are used as appropriate. Both the HES and HANES involve clinical examinations and follow very similar data collection procedures. Our analyses are restricted to males who report current occupation (approximately 17 per cent of the males in each sample are missing occupation data) which results in final sample sizes of 2,409 (2,088 Whites) in the HES, and 2,424 (2,136 Whites) in the HANES.

In the HES data, the presence of myocardial infarction was judged by a clinical panel of four doctors. Myocardial infarctions were classified as definite (93 per cent) or suspect (7 per cent) based on a review of the 12-lead electrocardiograms (EKG), chest X-rays, medical history, and blood chemistry during analyses. The presently available HANES data on coronary heart disease (CHD) are based on the diagnosis made by the field examining physicians after reviewing the medical history, the detailed cardiovascular questionnaire, and the complete physical examination. (Chest X-ray and EKG tracings may or may not have been available. An improved classification based on expert EKG evaluation is still in process.) These criteria have probably led to an underestimation of overall myocardial infarction on the HANES. Experience with examining physicians’ initial diagnosis compared to final diagnosis with the HES shows relatively few false positive CHD cases but a larger number of false negatives. To reduce the unreliability due to misclassification when angina is included, we decided to focus on that subset of CHD which is most reliably assessed, myocardial infarctions (ICD codes, 410-414). The number of cases in the HES is 39 (33 Whites) and 30 in the HANES (28 Whites).

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