APH 2003, 61, 33-51:

Do regional differences in psychosocial variables contribute to regional differences in cardiovascular mortality in Belgium ?

P. De Smet, M. Moreau, E. Pelfrene, E. Clays, F. Leynen, F. Kittel, G. De Backer, M. Kornitzer

Keywords: Belgium, coronary heart disease mortality, psychosocial variables, work environment

Background: Since the end of the sixties the southern French speaking part of Belgium has shown an excess coronary and cardiovascular mortality as compared to the northern Dutch speaking region. The main hypothesis formulated 25 years ago related this excess mortality to less favourable nutritional patterns. In this paper we look in this paper at regional differences in psychosocial variables related to coronary heart disease as reported in the epidemiological literature. The hypothesis is that French speaking working subjects present a less favourable psychosocial profile as compared to Dutch speaking subjects.

Methods: Study 1 concerns 3092 working subjects of both genders from the BIRNH study who answered the Jenkins Activity Survey; a self administered questionnaire related to the Type A behaviour pattern and the JobStress Questionnaire wich is a home made questionnaire. Study 2 concerns 21,419 subjects of the BELSTRESS study who answered self administered questionnaires concerning the Karasek model on Demand/ Control/Social Support at work, depression, self-perceived health, exhaustion, social support outside work, aggression, sleep disturbances and anxiety. Univariate results in both genders stratified by level of education are presented in this paper.

Results: Study 1: French speaking subjects present the type A behaviour pattern more frequently and score significantly higher on the home made job-stress questionnaire. Study 2: French speaking subjects present higher average ratios of Demand/Control (job strain direction) as well as higher scores on depression, anxiety, agressivity, current health index (self-perceived health), vital exhaustion and lower prevalences of a high social support network outside work as well as higher prevalences of sleep problems.

Conclusions: Besides less favourable nutritional patterns French speaking subjects present less favourable profiles on a host of psycho-social variables related to coronary heart disease. Hence part of the excess coronary heart disease mortality, incidence and prevalence observed in the southern part of Belgium could be related to these psy-chosocial variables. This hypothesis should be tested in a large prospective study concerning both Belgian linguistic communities.