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Gender and sex differences in job status and hypertension
  1. Jane E Clougherty1,
  2. Ellen A Eisen1,2,
  3. Martin D Slade3,
  4. Ichiro Kawachi4,
  5. Mark R Cullen5
  1. 1Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA
  2. 2University of California at Berkeley, School of Public Health, Berkeley, California, USA
  3. 3Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4Harvard School of Public Health, Department of Society, Human Development, and Health, Boston, Massachusetts, USA
  5. 5Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Jane E Clougherty, Harvard School of Public Health, Department of Environmental Health, Landmark Building, 401 Park Drive Room 404 West, Boston, MA 02115, USA; jcloughe{at}


Objectives Studies have shown greater health risks associated with blue-collar manufacturing employment for women than men. It remains challenging, however, to distinguish gendered job status (affected by family composition and other personal characteristics) from sex-linked biological differences influencing physiological response to workplace physical hazards.

Methods We examined the effects of hourly (blue-collar) status on incident hypertension among men and women, using health claims data for 14 618 white- and blue-collar aluminium manufacturing employees in eight US states. To explore gender differences in job status, we developed sex-stratified propensity score models identifying key socioeconomic predictors of hourly status for men and women. To examine the effects of hourly employment on hypertension risk, after adjusting for gender differences in job status, we applied time-weighted logistic regression models, stratified by propensity score, with additional adjustment for socioeconomic confounders.

Results Family structure (partnership, parity) influenced job status for both sexes; single mothers were more likely to hold hourly jobs (OR 2.02; 95% CI 1.37 to 2.97) and partnered men with children less likely (OR 0.68; 95% CI 0.56 to 0.83). Education, age at hire and race influenced job status for both sexes. The effect of hourly status on hypertension was significant only among women predicted to be hourly (OR 1.78; 95% CI 1.34 to 2.35).

Conclusions Our results indicate significant risks of hypertension associated with hourly status for women, possibly exacerbated by sociodemographic factors predicting hourly status (eg, single parenthood, low education). Greater attention to gender differences in job status, and finer exploration of sex-linked biological differences influencing responsivity to workplace exposures, is warranted.

  • Gender
  • sex
  • hourly status
  • hypertension
  • propensity scores
  • epidemiology
  • cardiovascular
  • gender

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  • Funding This study was funded by NIH (1RO1AG026291), by Alcoa Inc and by the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Yale University.

  • Provenance and peer review Not commissioned; externally peer reviewed.