Yukiko Inoue, M.O.H., Graduate School of Medicine, International University of Health and Welfare; Institutional Research Center, University of Occupational and Environmental Health, Japan Akinori Nakata, Ph.D., Graduate School of Medicine, International University of Health and Welfare Akiomi Inoue, Ph.D., Institutional Research Center, University of Occupational and Environmental Health, Japan Seiichiro Tateishi, M.D., Ph.D., Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan Hisashi Eguchi, M.D., M.B.A., Ph.D., Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan Mayumi Tsuji, M.D., Ph.D., Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan Akira Ogami, M.D., Ph.D., Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan Tomohisa Nagata, M.D., Ph.D., Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan Shinya Matsuda, M.D., Ph.D., Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan Yoshihisa Fujino, M.D., M.P.H., Ph.D., Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
The purpose of this study was to clarify whether workplace infection-control against COVID-19 and clustering of unhealthy lifestyle behaviors exert an interactive effect on self-rated health.
More than one year has passed since the global pandemic of coronavirus disease 2019 (COVID-19). The spread of this infections and deterioration of health brought about by COVID-19 are widespread. It is necessary to understand long-term health effect in those potentially exposed to COVID-19 to protect population health. One such way is to rate one’s health by a single item, which is well-known as ?self-rated health (SRH).? As an overall health indicator, SRH is a robust predictor of all-cause mortality and future morbidity and therefore, may help understand long-term health. The pandemic has had a tremendous impact on work and life. Organizational factors such as infection control at the workplace may play a crucial role not only to protect workers from infection but also from developing mental health issues. Past studies showed an inverse relationship between a number of infection-control measures in the workplace and psychological distress among Japanese employees. Containment restrictions may lead to an increase in unhealthy lifestyle behaviors such as lack of exercise, poor sleep, unhealthy eating habits, increased alcohol consumption, and smoking, and the clustering of unhealthy lifestyle behaviors are reported in several studies to present an increased risk of poor SRH. Therefore, we examined the interaction of cluster of unhealthy lifestyle behaviors and workplace infection-control on SRH deterioration.
The data in this cross-sectional study were collected during the third wave of epidemic in Japan by an online survey during December 22 -26, 2020. After deleting missing responses, 27,036 survey participants were included. We excluded workers who worked alone, and those working under Small Office Home Office (SOHO) businesses, agriculture, forestry, and fishing (n=2,704). We divided participants into 12 groups based on infection control and the number of unhealthy lifestyle behaviors as shown in Table 1. We assessed SRH by asking, “In general, how is your health?” We divided responses into ?poor? (fair or poor) or ?good? (excellent, very good, or good). Workplace infection-control was assessed by asking, “Do you think your employer has taken sufficient infection-control measures for employees?” We dichotomized these responses into sufficient (?yes? or ?somewhat?) and insufficient (?somewhat no? or ?no?) infection-control groups. Those with sufficient infection-control with an absence of unhealthy lifestyle behaviors served as a reference, and multiple logistic regression analyses were conducted to estimate adjusted odds ratios (aORs) of poor SRH. We firstly adjusted for age and sex (Model 1), and additionally adjusted for marital status, education, annual household income, job type, number of employees in the workplace, hours of work, number of diseases, psychological distress (K6?5), body mass index, and COVID-19 incidence rate by prefecture (Model 2). The level of significance was set at p< 0.05 (two-tailed). We analyzed the data using SPSS 21.0 for Windows.
Overall, 26.1% responded that the employer did not sufficiently took an action to control infection. Compared to the counterparts, the respondents tended to have lower educational status, lower income, and longer working hours. Further, the insufficient infection-control group had 1.8-2.3 times higher ORs, even when the number of unhealthy lifestyle behaviors was identical as the sufficient infection-control group. This trend was similar even after controlling for additional confounders (Model 2). The ORs increased when the number of unhealthy lifestyle behaviors increased; those who had five unhealthy lifestyle behaviors (unhealthiest group) had 8.25 (95% CI: 5.78-11.8, p< .001) times more likely to rate their health poor. Model 2 had a similar trend but the ORs were attenuated relative to Model 1. Moreover, ORs were highest at 16.31 (95% CI: 9.93-26.8, p< .001) for those who had five unhealthy lifestyle behaviors (unhealthiest group) with insufficient infection control. After multivariate adjustment, ORs were 8.47 (95% CI: 4.99-14.37, p<.001).
This study showed that the odds of poor SRH was higher when workers were exposed to insufficient workplace infection-control and when the number of unhealthy lifestyle behaviors increased. The risk was highest when these factors were combined. Consequently, the workplace should sufficiently implement infection-control measures to maintain long-term health during the pandemic. Additionally, individuals should make an effort to reduce at least one unhealthy lifestyle behavior.
Workplaces with insufficient infection-control seems to have an additive effect on the relationship between unhealthy lifestyle behaviors and SRH.