Academic journal article Scandinavian Journal of Work, Environment & Health

Incidence of Myocardial Infarction among Cooks and Other Restaurant Workers in Sweden 1987-2005

Academic journal article Scandinavian Journal of Work, Environment & Health

Incidence of Myocardial Infarction among Cooks and Other Restaurant Workers in Sweden 1987-2005

Article excerpt

Objectives The aim of this study was to investigate the incidence of myocardial infarction (MI) among cooks and other restaurant workers.

Methods A prospective cohort study comprised manual workers in the service sector in the Swedish National Census of 1985, totaling 543 497 women and 233 999 men. Restaurant workers were identified by occupational codes. Information on first time MI during 1987-2005 was obtained from nation-wide registers. We used Cox proportional hazards modeling, with separate analyses for men and women, adjusting for age, hypertension, diabetes, and socioeconomic status.

Results Female cooks, restaurant and kitchen assistants, and wait staff all showed a statistically significant increase in risk of MI [hazard ratio (HR) 1.34, 95% confidence interval (95% CI) 1.21-1.48; HR 1.12, 95% CI 1.03-1.21; and HR 1.25, 95% CI 1.06-1.47, respectively]. No increased risk was found among female cold-buffet managers. Among men, there was no statistically significant increase in risk for any of these occupations. The association was not stronger for subjects working ≥5 years. Group level information on smoking habits showed a similar percentage of daily smokers among female cooks compared to female manual workers in general.

Conclusions We found an increased risk of MI among female but not male cooks, restaurant and kitchen assistants, and wait staff. The excess risk may be related to occupational factors, but the results do not clearly support the hypothesis of cooking fumes as a risk factor for MI. Job strain could be a potential explanation for the findings.

Key terms cardiovascular disease; cooking fume; epidemiology; occupational exposure; particle; restaurant.

Cooks and other kitchen workers are exposed to air pollution generated while cooking and frying, such as aerosol oil droplets, combustion products (including fine and ultrafine particles), and organic gaseous pollutants (1-3). The levels and the chemical composition of cooking emissions vary depending on the cooking oil used, the temperature, the kind of food cooked, and the cooking method (3-5).

Several earlier epidemiological studies have indicated an increased risk of myocardial infarction (MI) among cooks and other restaurant workers (6-10), although it is not known whether the excess risk is caused by occupational exposure to cooking fumes, cigarette smoking, passive smoking, or other causes. An increased mortality of MI or other ischemic heart disease (IHD) has been found among female cooks in England and Wales (6), female cooks and other kitchen workers in Finland (7), male British army cooks (8), and male and female cooks and restaurant workers in Sweden (9,10).

There is a well-established association between particulate urban air pollution and cardiovascular morbidity and mortality (11-14). A common hypothesis is that inhaled particles cause a systemic inflammatory response that increases the risk of cardiovascular disease (15-18). An elevated risk of MI has been found for some occupational groups with high exposure to particulate air pollution (19-22), as well as among those with occupational exposure to combustion particles (23).

Since cooks and other kitchen workers are occupationally exposed to particles and other air pollutants generated in the kitchen, inhalation of these air pollutants is a possible contributing factor to the increased risk of MI and other IHD previously noted in these occupations.

The aim of this study was to investigate the association between occupation as a cook or other restaurant worker and incidence of MI, using workers in the same socioeconomic group as reference, adjusting for individual information on diabetes and hypertension. The prevalence of daily smokers was compared on a group level.

Methods

Study base

The cohort comprised skilled and unskilled manual workers in the service sector in the Swedish National Census (with individual-level information on all people in Sweden, including demographic data and occupation) of 1985, who were alive on 1 January 1987, totaling 543 497 women and 233 999 men (table 1). …

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