Occupational disparities in physiologic stress among U.S. workers

Introduction: Occupational stress, associated with increased rates of morbidity and possibly mortality, has become a serious US worker health issue. As a conceptual framework for the cumulative wear and tear on the body caused by physiological responses to stressors, "Allostatic Load (AL)" may serve as an objective global stress measure. We examined US data for average AL scores and the proportion of high scores by employment type, 40 specific occupational groups, and four broad-based sectors; and describe the association between job type and AL.

Methods: We used data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) for adults (≥ 17 years old) participating in both a comprehensive medical examination and questionnaire that reported on their occupational status and job type (n=5,328). We developed an AL index guided by the literature that included 10 biomarkers. We further categorized participants by employment status into one of 40 specific occupational groups and by socio-demographic characteristics.

Results: Blue-collar workers had a higher proportion (39.1%) experiencing greater physiological stress (with AL index score of ≥3) than white-collar (37.4%), farm (36.8%) or service (33.6%) workers. Adults employed as construction laborers (47.0%) and protective service occupations (51.3%) had the two highest mean AL scores. After adjustment for socio-demographic indicators, blue-collar workers were significantly more likely to experience higher physiologic stress than white-collar workers (adjusted odds ratio= 1.44; 95%CI [1.09¨C1.91])

Discussion: Given that stress is a modifiable risk factor, workplace intervention efforts at preventing high stress levels among occupations at risk may be warranted.