Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC14710.15690/vramn.v68i9.777WORK-RELATED DISEASES: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПРОФЕССИОНАЛЬНЫХ ЗАБОЛЕВАНИЙIMPORTANCE OF OCCUPATIONAL SELECTION IN PREVALENCE OF HYPERTENSION: EFFECTS OF HEALTHY AND UNHEALTHY WORKERРОЛЬ ПРОФЕССИОНАЛЬНОГО ОТБОРА В РАСПРОСТРАНЕННОСТИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ: «ЭФФЕКТ ЗДОРОВОГО» И «НЕЗДОРОВОГО РАБОЧЕГО»MaksimovS. A.МаксимовС. А.
Russian Federation

MD, senior research scientist of the laboratory of epidemiology of cardiovascular diseases, associate professor of the Scientific Research Institute for Complex Issues of Cardiovascular Diseases under the Siberian Branch of RAMS. Address: 6, Sosnovy Blvd., Kemerovo, 650002; tel.: (3842) 64-42-40

m1979sa@yandex.ruArtamonovaG. V.АртамоноваГ. В.
Russian Federation

PhD, professor, Deputy Director for Science, Head of the department of medical services optimization of the Scientific Research Institute for Complex Issues of Cardiovascular Diseases under the Siberian Branch of RAMS. Address: 6, Sosnovy Blvd., Kemerovo, 650002; tel.: (3842) 64-45-73

artamonova@cardio.kem.ruResearch Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Kemerovo, Russian FederationНИИ комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово, Российская Федерация10092013689Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук374107082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/147

The importance of occupational selection in prevalence of arterial hypertension in researches of professional cohorts is considered in the article. Because arterial hypertension represents not only the independent disease, but also one of the most important indexes of the functional status of a human body, prevalence of arterial hypertension in professional groups can be substantially caused by occupational selection. As an epidemiological phenomenon of occupational selection "healthy worker effect", known of scientific literature from the middle of last century is considered. Besides, it is offered to consider the regularities of professional selection opposite to "healthy worker effect", as "unhealthy worker effect". The professional conditionality of arterial hypertension considered from epidemiological line items can be distorted by occupational selection. Thus existence of "healthy worker effect" makes impression of absence of direct link between level of occupational influence and frequency of arterial hypertension. At the same time, the increase in prevalence of arterial hypertension not always testifies to its professional conditionality, and can be connected to "unhealthy worker effect". Possible solutions of problems associated with identification of relationships between occupational factors and prevalence of hypertension in the presence of «effects of the healthy» and «unhealthy worker» are discussed. The challenge of considered problem in occupational medicine despite the numerous offered methodological approaches of elimination or decrease in influence of occupational selection is noted.

Рассматривается роль профессионального отбора в распространенности артериальной гипертензии в исследованиях профессиональных когорт. В связи с тем, что артериальная гипертензия представляет собой не только самостоятельное заболевание, но и один из важнейших показателей функционального состояния организма человека, распространенность артериальной гипертензии в профессиональных группах может быть в значительной степени обусловлена профессиональным отбором. В качестве эпидемиологического феномена профессионального отбора рассматривается «эффект здорового рабочего», известный из научной литературы с середины прошлого столетия. Кроме того, предлагается учитывать закономерности профессионального отбора, противоположные «эффекту здорового рабочего», как «эффект нездорового рабочего». Рассматриваемая с эпидемиологических позиций профессиональная обусловленность артериальной гипертензии может искажаться профессиональным отбором. При этом наличие «эффекта здорового рабочего» создает впечатление отсутствия прямой связи между уровнем профессионального воздействия и частотой артериальной гипертензии. В то же время, увеличение распространенности артериальной гипертензии не всегда свидетельствует о ее профессиональной обусловленности, а может быть связано с «эффектом нездорового рабочего». Обсуждаются возможные пути решения проблемы идентификации причинно-следственных связей между профессиональными факторами и распространенностью артериальной гипертензии при наличии «эффекта здорового» и «нездорового рабочего». Отмечается нерешенность рассматриваемой проблемы в медицине труда, несмотря на многочисленные предложенные методологические подходы устранения или снижения влияния профессионального отбора.

occupational selection«healthy worker effect»hypertensionoccupationally related diseasesпрофессиональный отбор«эффект здорового рабочего»артериальная гипертензияпрофессионально обусловленные заболевания1. Denisov E.I., Chesalin P.V. Professionally caused morbidity: the basics methodology. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology. 2006; 8: 5–10.2. Rukovodstvo po otsenke professionalnogo riska dlya zdorovya rabotnikov. Organizatsionno-metodicheskiye osnovy, printsipy i kriterii otsenki. Rukovodstvo [Guidelines on Occupational Risk Assessment for Workers’ Health. Organizational and Methodological Aspects, Principles and Criteria. Guideline]. Мoscow, 2004.3. Izmerov N.F., Denisov E.I., Prokopenko L.V., Sivochalova O.V., Stepanyan I.V., Chelishcheva M.Yu., Chesalin P.V. Methodology for detection and prevention of diseases associated with the work. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology. 2010; 9: 1–7.4. McGeoghegan D., Binks K., Gillies M., Jones S., Whaley S. The non-cancer mortality experience of male workers at British Nuclear Fuels plc, 1946-2005. Int. J. Epidemiol. 2008; 37 (3): 506–518.5. Burns C.J., Bodner K.M., Jammer B.L., Collins J.J., Swaen J.M.H. The healthy worker effect in US chemical industry workers. Occup. Med. (London). 2011; 61: 40–44.6. Bashkireva A.S., Artamonova V.G., Khavinson V.Kh. Productive aging or "healthy worker effect"? A retrospective analysis of the incidence of automobile drivers. Uspekhi gerontologii = Advances in Gerontology. 2009; 22(4): 539–547.7. McMichael A.J. Standardized mortality ratios and the «healthy worker effect»: scratching beneath the surface. J. Occup. Med. 1976; 18 (3): 165–168.8. Enterline P.E. Comments on the «healthy worker effect» in occupational epidemiology. In: Reports to the Workers’ Compensation Board on the Healthy Worker Effect. Toronto, Canada: Ministry of Labour of the Government of Ontario. ISDP Report No 3. 1988. Available at: http://www.canoshweb.org/odp/html/JUL1988.htm9. Fox A.J., Collier P.F. Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Brit. J. Prev. Soc. Med. 1976; 30 (4): 225–230.10. Pearce N., Checkoway H., Kriebel D. Bias in occupational epidemiology studies. Occup. Environ. Med. 2007; 64: 562–568.11. Arrighi H.M., Hertz-Picciotto I. The evolving concept of the healthy worker survivor effect. Epidemiology. 1994; 5 (2): 189–196.12. Doll R. Healthy worker effect. In: Reports to the Workers’ Compensation Board on the Healthy Worker Effect. Toronto, Canada: Ministry of Labour of the Government of Ontario. ISDP Report No 3. 1988. Available at: http://www.canoshweb.org/odp/html/JUL1988.htm13. McMichael A.J. Assigning handicaps in the mortality stakes: an evaluation of the «healthy worker effect». In: Reports to the Workers’ Compensation Board on the Healthy Worker Effect. Toronto, Canada: Ministry of Labour of the Government of Ontario. ISDP Report No 3. 1988. Available at: http://www.canoshweb.org/odp/html/JUL1988.htm14. Nicholson W.J. Comments on the healthy worker effect. In: Reports to the Workers’ Compensation Board on the Healthy Worker Effect. Toronto, Canada: Ministry of Labour of the Government of Ontario. ISDP Report No 3. 1988. http://www.canoshweb.org/odp/html/JUL1988.htm15. Kocharov A.M., Britov V.M., Ivanov V.M. Blood pressure, physical activity and physical performance. Terapevticheskii Arkhiv = Therapeutic Archive. 1993; 65(12): 12–16.16. Jonsson B.G., Astrand I. Physical work capacity in men and women aged 18 to 65. Scand. J. Public Health. 1979; 7 (3): 131–142.17. Skrobonja A., Kontosic I. Arterial hypertension in correlation with age and body mass index in some occupational groups in the harbour of Rijeka, Croatia. Ind. Health. 1998; 36 (4): 312–317.18. Kalinina A.M., Kontsevaya A.V., Belonosova S.V., Yeganyan R.A., Pozdnyakov Yu.M., Kiseleva N.V. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2010; 9(3): 90–97.19. Rezultaty vtorogo etapa monitoringa epidemiologicheskoy situatsii po arterialnoy gipertonii v Rossiyskoy Federatsii (2005–2007 gg.), provedennogo v ramkakh federalnoy tselevoy programmy “Profilaktika i lecheniye arterialnoygipertonii v Rossiyskoy Federatsii”. Informatsionno-statisticheskiy sbornik. [Results of the Second Stage of Monitoring the Epidemiological Situation of Arterial Hypertension in Russia (2005 to 2007), Conducted under the Federal Target Program “Prevention and Treatment of Hypertension in the Russian Federation”. Information and Statistical Compilation]. Мoscow, 2008. 224 p.20. Maksimov S.A., Skripchenko A.E., Artamonova G.V. Vestnik RAMN = Annals of the RAMS. 2012; 12: 54–59.21. Maksimov S.A., Skripchenko A.E., Indukayeva Ye.V., Shapovalova E.B., Yankin M.Yu., Mulerova T.A. and others. Uspekhi gerontologii = Advances in Gerontology. 2011; 24(4): 697–700.22. Karamnova N.S., Kalinina A.M., Grigoryan Ts.A., Oleynikova N.V., Vygodin V.A. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2009; 8(6): 54–58.23. Barbini N., Gorini G., Ferrucci L., Biggeri A. The role of professional activity in arterial hypertension. G. Ital. Med. Lav. Ergon. 2007; 29 (2): 174–181.24. Kirkutis A., Norkiene S., Griciene P., Gricius J., Yang S., Gintautas J. Prevalence of hypertension in Lithuanian mariners. Proc. West Pharmacol. Soc. 2004; 47: 71–75.25. Takashima Y., Yoshida M., Kokaze A., Orido Y., Tsuqane S., Ishikawa M. et al. Relationship of occupation to blood pressure among middle-aged Japanese men--the significance of the differences in body mass index and alcohol consumption. J. Epidemiol. 1998; 8 (4): 216–226.26. Schlussel Y.R., Schall P.L., Zimbler M., Waren K., Pickering T.G. The effect of work environments on blood pressure: evidence from seven New York organizations. J. Hypertens. 1990; 8 (7): 679–685.27. Helmert U., Shea S., Bammann K. The impact of occupation on self-reported cardiovascular morbidity in western Germany: gender differences. Rev. Environ. Health. 1997; 12 (1): 25–42.28. Idahosa P.E. Hypertension: an ongoing health hazard in Nigerian workers. Am. J. Epidemiol. 1987; 125 (1): 85–91.29. Popov A.I., Salamatina L.V., Prokopenko L.V., Buganov А.А. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology. 2007; 1: 16–22.30. Kerefova Z.Sh., Zhilova I.I., Elgarov А.А. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology.2007; 5: 18–23.31. Sibekova T.V., Elgarov A.A., Elgarov M.A. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology. 2007; 5: 13–18.32. Oliver R.M. Physique and serum lipids of young London busmen in relation to ischaemic heart disease. Brit. J. Ind. Med. 1967; 24 (3): 181–186.33. Le Moual N., Kauffmann F., Eisen E.A., Kennedy S.M. The healthy worker effect in asthma. Work may cause asthma, but asthma may also influence work. Am. J. Respir. Crit. Care Med. 2008; 177 (1): 4–10.34. Zinenko G.M., Petrichenko S.I., Miroshnikov M.P., Dasayeva A.A., Vermel A.Ye. Meditsina truda i promyshlennaya ekologiya = Home Occupational Medicine and Industrial Ecology. 2005; 1: 8–14.35. Nakanishi N., Yoshida H., Nagano K., Kawashimo H., Nakamura K., Tatara K. Long working hours and risk for hypertension in Japanese male white collar workers. J. Epidemiol. Community Health. 2001; 55: 316–322.36. Wada K., Katoh N., Aratake Y., Furukawa Y., Hayashi T., Satoh E. et al. Effect of overtime work on blood pressure and body mass index in Japanese male workers. Occup. Med. (London). 2006; 56 (8): 578–580.37. Frolkis V.V. Biologiya stareniya. [Biology of Aging]. Мoscow, Nauka, 1982. 616 p.38. Kishkun А.А. Biologicheskiy vozrast i stareniye: vozmozhnosti opredeleniya i puti korrektsii: Rukovodstvo dlya vrachey. [Biological Age and Aging: Possible Ways of Identifying and Correcting: Guidelines for Physicians]. Мoscow, GEOTAR-Меdiа, 2008. 976 p.39. Buzunov V.А. Gigiyena i sanitariya = Hygiene and Sanitation. 1983; 8: 20–22.40. Bakaleinikova V.L. Gigiyena i sanitariya = Hygiene and Sanitation. 1990; 7: 34–37.41. Reshetyuk A.L., Stezhenskaya E.I., Bugaev V.N., Silenko Yu.S., Kukalo N.P. Vestnik AMN SSSR = Annals of AMS of the USSR. 1986; 10: 53–57.42. Mikhailuts A.P., Artamonova G.V. Gigiyena truda i professionalnyye zabolevaniya = Labour Hygiene and Occupational Diseases. 1989; 3: 4–7.43. Salonen P., Arola H., Nygard C.-H., Huhtala H., Koivisto A.M. Factors associated with premature departure from working life among ageing food industry employees. Occup Med (Lond.). 2003; 53: 65–68.44. Siegrist J., Wahrendorf M., Knesebeck O., Jurges H., Borsch-Supan A. Quality of work, well-being, and intended early retirement of older employees – baseline results from the SHARE Study. Eur. J. Public Health. 2006; 17 (1): 62–68.45. Maksimova T.M., Belov V.B., Gavrilova N.N., Tokurov M.V., Khritova V.V. Problemy sotsialnoy gigiyeny, zdravookhraneniya i istorii meditsiny = Problems of Social Hygiene, Health Care and History of Medicine. 2001; 2: 4–9.46. Shestakov V.P., Dyskin А.А. Klinicheskaya gerontologiya = Clinical Gerontology.1998; 3: 67.47. Cherkasskaya E.А. Gigiyena truda i professionalnyye zabolevaniya = Labour Hygiene and Occupational Diseases. 1991; 5: 4–6.48. Lakatta E.G. Arterial pressure and aging. Int. J. Cardiol. 1989; 25 (Suppl. 1): 81–89.49. Applebaum K.M., Malloy E.J., Eisen E.A. Reducing healthy worker survivor bias by restricting date of hire in a cohort study of Vermont granite workers. Occup. Environ. Med. 2007; 64: 681–687.50. Robins J. A new approach to causal inference in mortality studies with a sustained exposure period: application to control of the healthy worker survivor effect. Math. Modeling. 1986; 7: 1393–1512.