The association between employment status and metabolic syndrome: Is education an effect modifier in women?

Introduction
Socioeconomic factors and employment status are important risk factors for coronary heart disease (CHD). However, most of the studies in this field performed in developed countries and on male working population. In developing countries, unlike in developed countries, most of the women are out of workforce and involved in childcare and houseworks. The aim of this study is to examine the effects of paid work and housework on metabolic syndrome (MS) and to explore effects of education on employment status and MS relationship among the 30-64 year old women living in Izmir, Turkey.

Methods
This is a population-based, cross sectional study. The study sample was derived from women who participated in baseline survey of Balçova’s Heart Project, in 2007. Data were collected by face to face interviews. In total 533 women (191 paid work and 342 housewives) were included in the current study. T-test, chi-square test, and logistic regression models were used to assess the associations between employment status, education and metabolic syndrome. The study was supported by The Scientific and Technological Research Council of Turkey (No:SBAG109S277).

Results
Workers had significantly higher education levels than housewives (p<0.001). Housewives were older than working women (p<0.001). After adjusting for age housewives had a higher risk for MS (OR:2.06,95%CI:1.21-3.53). When university degree set for the reference category age adjusted OR for primary school was 3.30(%95CI:1.34–8.11) and for secondary school was 3.02(95%CI:1.21–7.53). Among the women with high education level housewives had higher risk of MS than workers (age adjusted OR:2.41,95%CI:1.17-4.95). However, in the low education group the association between employment status and MS was disappeared (age adjusted OR:1.42 95%CI:0.56-3.37).

Discussion
Education level could be an important effect modifier in the relationship between employment and CHD in women. The higher the education the importance of employment would be substantial to prevent CHD in women.