French Psychosocial Stress Research Projects

The Center for Social Epidemiology received the following abstract from Dr. Regis de Guademaris regarding his research project in France. The results were presented at the 1998 International Society for Hypertension meeting. “I am working on the incidence of hypertension in France and environmental factors. I manage a national survey supported by the French Society of Hypertension. This is the abstract on my present work that I submitted to the International Society of Hypertension in Amsterdam, as well as to next year’s ICOH meeting in Tel-Aviv.”

Aim of the study: This prospective study is designed to assess, in France, the prevalence of hypertension, the one-year incidence of hypertension (unknown today) and the relationship between incidence of hypertension and environmental, occupational and social factors.

Subjects and Methods: Every worker in France, whatever his/her occupation, is affiliated with an occupational medical center and has a systematic clinical check-up every year. In order to ensure a good representation of our sample, we therefore selected from a list of occupational physicians a sample of 50 physicians according to their age and to the typology and location in France, of their occupational center. Each physician then selected randomly 800 workers among his/her assigned population. During the usual systematic annual visit, blood pressure was recorded with a validated semi-automatic device (Omron® > 705 CP) at the 5^th, 6^th and 7^th of rest in the sitting position. When the average of these 3 measurements was 140 / 90 mmHg, a second visit was scheduled one month later for a repeat BP measurement under the same conditions. At each visit, a specifically designed questionnaire was used to record height, body weight, drug treatment, socio-economic status, the level of cardiovascular risks factors as reported by the patient, and an estimation of his/her medical drug consumption over the last year. We anticipated a representative sample of 30,000 French workers. During the second year of the study, a case-control study will be conducted among the cohort of newly identified hypertensive patients and an appropriate cohort of control subjects to assess relationship between psychosocial and occupational factors (Karasek questionnaire) and blood pressure modifications

Results : The study started on January 1^st, 1997. On September 1^st, 20188 subjects (mean age 38.9 ± 9.4 years, proportion of males 56.9%) have been enrolled.. Among the untreated patients, 10% had at the first visit, a mean BP ³ 140 / 90 mmHg, and 90% of them could be seen at the one-month visit.

Conclusion: The inclusion rate is respected in this study and the prevalence data will be available for the ISH meeting.

Next, we are planing a nested case control on professional (occupational) risks factors whose protocol is the following :

Goal of the study: The main goal is to identify professional and non professional risk factors for hypertension. Psycho-social aspects of the work environment will be particularly analyzed. New cases of hypertension will be recruited from a cohort study.

Methods: The study design is a nested case-control study. The new cases of arterial hypertension, identified in the cohort study after one year of follow-up will be the cases of this study. Sample of non hypertensive workers will constitute the control group.

Subjects: The work site physicians, on a voluntary basis, will include all the incident cases of hypertension after one year of follow up. Two controls will be included by the same physicians for each hypertensive subject. The two controls will be recruited by the same way: for example, the following employees provided that they have the same sex and their age is in the same decade. If an incidence of 1% per year is hypothesised, the number of subjects of the work site physicians will be approximately 10.

Inclusion criteria

The cases will be the employees without hypertension and no antihypertensive treatment at the beginning of the study, who will be hypertensive after one year of follow-up and confirmed as such during the control visit. The controls will be the normotensive employees at inclusion who will be still normotensive after one year of follow-up.

Exclusion Criteria

Control: blood pressure < 140-90 mm Hg and no treatment at t0. Same criteria at T1.

Cases: blood pressure < 140-90 mm Hg and no treatment at T0 and blood pressure >140/90 mm Hg and/or hypertensive treatment at T1. During the control visit at one month, the final group of incidence hypertensive subjects will be the employees in whom the blood pressure will be still over 140/90 mm Hg. The other employees will constitute an intermediate group which will be analysed separately.

Number of subjects

Three hundred hypertensive subjects are expected. If about one half of the work site physicians accept to participate in the study, 160 cases and 320 controls could be included. In this condition, if we suppose that > the risk factor among normotensive subjects has a prevalence of 10%, with > a risk at 5%, the power of the study to detect an odd ratio equal to 1.3 is 80%.

Collection of data

The data are basically collected through self-questionnaires. During the one-year follow up visit, in addition to the questionnaire which is given to any participant, one short questionnaire will be filled out by the work site physician with a few questions on noise exposure, job constraints as described by the worksite physician. A self questionnaire will be filled out by the employee. The following information will be collected:

• Social support (SSQT, 23 items).
• Depression (questionnaire CES-D, 20 items)
• Life-events (derived from the French GAZEL questionnaire)
• Karasek JCQ

Among questionnaires we need to use the French version of Karasek that has been translated and validated in French by Chantal Brisson in Canada. We will also use the French validated version of Social support (SSQT, 23 items), the depression questionnaire (CES-D, > 20 items) and the life-event derived from a French product.”

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