Women, Employment Status, and Hypertension: Cross-Sectional and Prospective Findings from the Atherosclerosis Risk in Communities (ARIC) Study

PURPOSE: This study examined the cross-sectional and prospective associations between employment status and hypertension among middle-aged, African-American (AA) and European-American (EA) women participating in the Atherosclerosis Risk in Communities Study. METHODS: Employed women and homemakers from the baseline examination (1987–89) were included in the cross-sectional study (n = 7351). Associations between employment and the incidence of hypertension ascertained at visit 2 (1990–92) were determined among those who at baseline, had low-normal blood pressure (not hypertensive and systolic blood pressure (SBP) less-than-or-equals, slant 120 mm Hg systolic and diastolic blood pressure (DBP) less-than-or-equals, slant 80 mm Hg (n = 3194). Logistic regression analysis was used to examine the association between employment status and hypertension by ethnicity, taking into account covariates. RESULTS: At baseline, employed women were less likely to be hypertensive (SBP greater-or-equal, slanted 140 mm Hg or DBP greater-or-equal, slanted 90 mm Hg or current use of antihypertensive drugs) than were homemakers (prevalence odds ratio (POR) = 0.70; 95% confidence interval (CI) = 0.62–0.79), controlling for age, body mass index, and education. Among the subgroup who had low-normal blood pressure at baseline, employed women were less likely to develop hypertension during the three-year time period than were homemakers (odds ratio (OR) = 0.68; 95% CI = 0.44–1.05). The inverse association was stronger among AA (RR = 0.37; 95% CI = 0.16–0.88) than EA (OR = 0.83; 95% CI = 0.50–1.38) women. CONCLUSIONS: These findings suggest that the inverse association between hypertension and employment status is not due to a healthy worker effect, and that employment may confer protection against incident hypertension in women.