"In contrast, the employment status of white women was not significantly related to heart disease," says lead investigator April L. Perry, M.S.P.H., a doctoral candidate in the Department of Epidemiology at the University of North Carolina at Chapel Hill.
Women's participation in the work place is increasing at a faster pace than that for men, with women projected to compose just under half of the total labor force by 2010, says Perry. However, there is no conclusive research linking women's employment status to heart disease, she adds.
"There has been the expectation that women in the paid labor force would have higher rates of coronary heart disease due to the extra demands and additional stress associated with employment plus overseeing a household," Perry explains. "This expectation is primarily due to findings of higher rates of coronary heart disease among men, which historically were partially attributed to stressors encountered in the workplace environment."
Perry and her colleagues evaluated the relationship between employment status and risk of heart disease among middle-aged white and African-American women in the Atherosclerosis Risk in Communities (ARIC) study. The ARIC study is a prospective study of 16,000 middle-aged persons (ages 45–64 at start of the study) in the United States. It is designed to investigate the progression of atherosclerosis ("hardening of the arteries"), which is the disease process that underlies heart disease.
Perry's study is composed of 6,855 women, of whom 1,788 (26 percent) were homemakers and 5,067 (74 percent) were employed outside the home at the baseline examination from 1987–1989. The ARIC study has information available for these participants concerning various socio-demographic characteristics such as age, income, and education; health-related behaviors, such as smoking history; and body mass index (BMI), cholesterol levels, and hypertension status; and the incidence of coronary heart disease, including fatal and non-fatal heart attacks as well as revascularization procedures like angioplasty.
During an 11-year follow-up, 302 coronary events occurred. After adjusting for age, employed African-American women were almost two times less likely to have a coronary event than were African-American homemakers. There was no statistically significant difference in heart disease rates among white women who worked outside the home and those who were homemakers.
The differences in cardiovascular disease risk factors – hypertension, diabetes, body mass index, HDL cholesterol, smoking, and alcohol use – partially accounted for the association of heart disease with employment status in African-American women. However, even after considering these factors, African-American women employed outside the home still had 33 percent less risk of a coronary event compared to African-American homemakers.
"The labor force experiences of African-American and white women have been vastly different. Historically, more African-American women were consistently employed outside of the home during adulthood compared to white women due to the necessity to provide additional household income," Perry says.
Based on research of the potential negative health consequences of the workplace, Perry notes that the better health of the employed African-American women may seem paradoxical. "However," she adds, "given that African-American women have been more reliant on the economic contributions from a job outside of the home, they may have benefited both economically and socially from it."
A limitation of this study was the lack of information available about duration and extent of employment, says Perry. Historically, women have entered and exited the labor force, particularly during child-bearing ages, and this study was not able to evaluate changes in jobs during life and other employment variations, such as full-time versus part-time status and total years employed.
Even so, Perry adds, "These findings should encourage additional research into the labor force experience of women and how these experiences may affect their cardiovascular health, particularly for African-American women."
Co-authors are Kathryn M. Rose, Ph.D.; Diane Catellier, Ph.D.; Ana Diez-Roux, Ph.D.; Carles Muntaner, M.D., Ph.D.; Herman A. Tyroler, M.D.; and Sharon B. Wyatt, Ph.D.
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