Introduction
Healthcare workers often work extended hours under heightened stress, which is exacerbated by prolonged periods of inactivity and inadequate physical exercise. Such factors are linked to an increased risk of cardiovascular diseases (CVD). A compelling study conducted in Malaysia by Hazmi et al. revealed that 42% of the 330 surveyed healthcare workers suffered from at least one medical condition, including dyslipidemia (30.8%), hypertension (14.3%), or diabetes mellitus (10.4%). Another investigation led by Mohd Ghazali et al. indicated that a significant majority (68.4%) of healthcare workers had at least three identifiable risk factors for CVD, with hypercholesterolemia and obesity being the most prevalent among them. In a contrasting study from Taiwan, medical technicians exhibited a notably higher prevalence of hypertension compared to their non-medical counterparts, with an odds ratio of 1.74.
Despite the criticality of this issue, the prevalence of cardiovascular-kidney-metabolic (CKM) syndrome remains ambiguous within the Chinese population. Recognizing the vulnerabilities of healthcare workers—identified as a high-risk group for CVD—this study set out to quantify the prevalence of CKM syndrome and to pinpoint associated risk factors, particularly female-specific risk enhancers, among healthcare professionals in tertiary hospitals across China.
Methods Study Design and Population
This cross-sectional study was carried out in tertiary hospitals throughout China. Participants were specifically recruited at the Affiliated Taizhou People’s Hospital of Nanjing Medical University from April to May 2024. The recruitment process was facilitated through head nurses across all clinical departments. The Ethics Research Committee of Taizhou People’s Hospital approved the study, which adhered to ethical standards delineated in the Declaration of Helsinki.
Study Questionnaires
We collected updated annual health examination reports for all 1,110 participants. These reports detailed critical measurements, including weight, height, glycosylated hemoglobin (HbA1c), triglycerides (TG), and fasting plasma glucose (FPG). The Body Mass Index (BMI) was determined by dividing weight (in kilograms) by the square of height (in meters). We calculated the triglyceride glucose product (TyG) index using the formula: ln[TG (mg/dL) × FBG (mg/dL) / 2].
Statistical Analysis
For statistical analysis, we utilized SPSS Statistics Version 25.0 (IBM Corporation, Chicago, IL, USA) and the R Programming Language (Version 4.2.0). Continuous variables were represented as mean ± standard deviation and subjected to t-tests, while categorical data were expressed as frequency and percentage and analyzed using chi-square tests. The American Heart Association’s criteria defined the stages of CKM Syndrome: Stage 0 indicated no CKM risk factors, Stage 1 identified excess or dysfunctional adiposity, Stage 2 encompassed hypertriglyceridemia, hypertension, diabetes, metabolic syndrome, or chronic kidney disease (CKD), Stage 3 indicated subclinical CVD, and Stage 4 represented clinical CVD. Initial investigations into CKM syndrome predictors and gender-specific risk enhancers utilized univariate logistic regression analysis, which was subsequently followed by multivariate analyses aimed at identifying independent predictors along with their predictive power. The predictive abilities of BMI, TG, FPG, HbA1c, and the TyG index for CKM syndrome were assessed using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values. A P-value of less than 0.05 was deemed statistically significant.
Results Characteristics of Study Population
A total of 1,110 healthcare workers participated in the study, comprising 197 males (with a mean age of 37.4 ± 9.3 years) and 913 females (mean age 34.3 ± 7.4 years). A notable majority of participants were nursing staff (N = 798, or 71.89%). Among them, 227 participants obtained postgraduate or higher academic qualifications, while the remaining individuals held associate or bachelor degrees. Most healthcare workers clocked in between 40 to 60 hours weekly (N = 943, accounting for 84.95%). A significant proportion of participants (N = 570, or 51.26%) had less than a decade of work experience, while 355 individuals (31.92%) had accrued 10–20 years of service. The data demonstrated that 94.87% of participants did not smoke (N = 1,053), and 84.78% abstained from alcohol (N = 941). Merely 1.89% were regular smokers, while 2.79% indicated excessive drinking habits. A striking 81.08% of participants did not engage in exercise, with more than half logging sedentary periods of less than five hours daily, in stark contrast to 7.48% reporting more than eight hours of inactivity. Furthermore, 63.87% of participants averaged fewer than seven hours of sleep nightly.
Stages of CKM Syndrome and Risk Enhancement Factors by Gender
The data on CKM syndrome stages differentiated between male and female demographics, as depicted in Figure 1. Limitations in the data made it unfeasible to differentiate between Stage 2 and Stage 3, resulting in the consolidation of the two for thorough analysis. A statistically significant difference was observed in the distribution of CKM stages across male and female healthcare workers (P < 0.05).
Data representing the risk-enhancing factors associated with CKM syndrome by gender is illustrated in Figure 2. A noteworthy uptick in obstructive sleep apnea prevalence was found in males compared to females (5.08% vs 0.55%, P < 0.05), as well as mental health disorders (2.03% vs 0.88%, P = 0.155). Additionally, 6.46% of females experienced female-specific enhancement factors, such as premature ovarian insufficiency and polycystic ovary syndrome.
Clinical and Biochemical Characteristics by CKM Syndrome
Participants exhibiting CKM syndrome compared to those without it tended to be older, had a greater percentage of postgraduate degrees, were predominantly physicians, and reported longer work experiences exceeding 20 years. They demonstrated sedentary behaviors, fewer night shifts, and higher proportions of smokers and drinkers, alongside elevated levels of BMI, FPG, TG, HbA1c, and the TyG index (P < 0.05).
Univariate and Multivariate Analyses of Factors Associated with CKM Syndrome
Univariate logistic regression analysis unveiled that male gender, being a physician, possessing a postgraduate or higher degree, engaging in sedentary behavior, smoking, drinking, age, BMI, TG, HbA1c, FPG, and TyG index emerged as significant risk factors. Conversely, shorter work durations (below ten years) and the presence of night shifts acted as protective factors (P < 0.05).
The multivariate logistic regression analysis, adjusting for age and sex, underscored key findings. When contrasting individuals with over twenty years of work experience as the control group, a work duration of fewer than ten years was identified as a protective factor (OR = 0.676, 95% CI 0.459–0.995, P < 0.05).
ROC Analyses of BMI, TG, HbA1c, FPG, and TyG Index
Summarized results from the ROC analysis of BMI, TG, HbA1c, FPG, and TyG index are presented in Table 3 and Figure 3. The data indicated BMI as the most effective predictor of CKM Syndrome, outperforming FPG, HbA1c, TG, and the TyG index [0.884 (0.864, 0.904) vs 0.638 (0.604,0.672) vs 0.708 (0.677, 0.739) vs 0.745 (0.715, 0.774) vs.0.761 (0.733, 0.790); P < 0.05].
Clinical and Biochemical Characteristics by Female-Specific Risk Enhancers
Participants exhibiting female-specific risk enhancers demonstrated a distinct lack of physical exercise, alongside higher levels of BMI, TG, and TyG index compared to their counterparts (P < 0.05).
Univariate and Multivariate Analyses of Factors Associated with Female-Specific Risk Enhancers
Univariate logistic regression analysis of female-specific risk enhancers revealed that BMI, TG, and the TyG index constituted risk factors (P < 0.05). Multivariate logistic regression analysis, incorporating TG and TyG index, established that BMI (OR = 1.112, 95% CI 1.025–1.207) represents an independent predictor.
Discussion
Cardiovascular, kidney, and metabolic diseases are interconnected in their pathophysiology. The prevalence of CKM syndrome nearly reached alarming figures, with almost 90% of male healthcare workers and 60% of female healthcare workers qualifying for at least Stage 1 of the syndrome. Stages 2 to 3 were notably more common among male patients (53.81%), while most female CKM syndrome patients predominantly fell into Stage 1 (35.82%).
This study extensively scrutinized various risk factors for CKM syndrome. Besides gender and age, smoking, alcohol consumption, and sedentary behavior for over eight hours were identified as risk factors. Prior studies corroborate that long sedentary periods heighten the risks of CVD, diabetes, and obesity. The analysis also found that shorter work durations signified a protective factor against CKM syndrome due to reduced exposure to occupational risk factors associated with job strain and long-term night shifts.
A majority of participants worked between 40 to 60 hours weekly. Past research correlates long working hours with heightened risks of coronary heart disease and stroke incidents. Notably, night shift work appeared as a protective factor but lost significance after adjusting for age and gender. This incongruity may stem from only assessing recent night shifts, neglecting the potential cumulative effects of sustained night shift work.
The comparative predictive power of various health indicators for CKM syndrome revealed BMI as the standout performer among predictors.
Additionally, the prevalence of risk-enhancing factors such as obstructive sleep apnea was markedly higher among males, exceeding general population rates by 1% to 4%. Although female-specific risk enhancers were documented, all affected female healthcare workers reported a complete lack of physical exercise. BMI, TG, and the TyG index were identified as significant risk factors for female-specific enhancement factors. Existing literature further supports that elevated BMI influences conditions like premature ovarian insufficiency and polycystic ovary syndrome, with lifestyle interventions showing positive impacts on these same conditions.
This research is not without limitations. Self-reported assessments of established CVD and associated risk factors may introduce bias or misdiagnosis. Additionally, critical data necessary for the evaluation of advanced CKM syndrome stages—including cardiac biomarkers and imaging studies—were not collected, potentially underestimating more severe disease stages. The cross-sectional nature of the study confines the analysis to a singular data moment, limiting predictive capabilities for CKM and female-specific risk enhancers.
Conclusion
Healthcare personnel in Chinese tertiary hospitals exhibit widespread non-ideal CKM health, particularly among males. This underscores the urgent need for equitable healthcare strategies that emphasize and prioritize CKM health.
Data Sharing Statement
The data supporting this study’s findings can be made available through the corresponding author upon reasonable request.
Acknowledgment
We express our gratitude to all study participants. Qingqing Zhang and Jing Zheng contributed equally as co-first authors.
Funding
Funding for this work was provided by the Taizhou People’s Hospital Doctoral Research Project (XingWei Ding), the Taizhou People’s Hospital Scientific Research Start-Up Fund Project (QDJJ202113), and the Nanjing Medical University Taizhou School of Clinical Medicine Research Project (TZKY20220203).
Disclosure
The authors declare no conflicts of interest concerning this publication.
References
1. Association TCDSot CM. The Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 edition). Chinese J Diabetes. 2021;13(4):315–409.
2. Group CCHaDRW. Summary of the 2022 Chinese cardiovascular health and disease report. Chin Circulation J. 2023;38(6):583–612.
3. Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol. 2023;22(1):195. doi:10.1186/s12933-023-01937-x
4. Arnold SV, Lipska KJ, Li Y, et al. Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction. Am Heart J. 2014;168(4):466–470e461. doi:10.1016/j.ahj.2014.06.023
5. Kadowaki T, Maegawa H, Watada H, et al. Interconnection between cardiovascular, renal and metabolic disorders: a narrative review with a focus on Japan. Diabetes Obes Metab. 2022;24(12):2283–2296. doi:10.1111/dom.14829
6. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606–1635. doi:10.1161/CIR.0000000000001184
7. Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148(24):1982–2004. doi:10.1161/CIR.0000000000001191
8. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016;91(4):422–431. doi:10.1016/j.mayocp.2016.02.001
9. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385. doi:10.1001/archinternmed.2012.3199
10. Hazmi H, Ishak WR, Jalil RA, et al. Traditional cardiovascular risk-factors among healthcare workers in Kelantan, Malaysia. Southeast Asian J Trop Med Public Health. 2015;46(3):504–511.
11. Ghazali SM, Seman Z, Cheong KC, et al. Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults. BMC Public Health. 2015;15:68. doi:10.1186/s12889-015-1432-z
12. Lin CM, Li CY. Prevalence of cardiovascular risk factors in Taiwanese healthcare workers. Ind Health. 2009;47(4):411–418. doi:10.2486/indhealth.47.411
13. Ostrominski JW, Arnold SV, Butler J, et al. Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999–2020. JAMA Cardiol. 2023;8(11):1050–1060. doi:10.1001/jamacardio.2023.3241
14. Xu J, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2021. NCHS Data Brief. 2022;(456):1–8.
15. Aggarwal R, Ostrominski JW, Vaduganathan M. Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011–2020. JAMA. 2024;331(21):1858–1860. doi:10.1001/jama.2024.6892
16. Collaboration NCDRF. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027–1050. doi:10.1016/S0140-6736(23)02750-2
17. Connelly PJ, Azizi Z, Alipour P, Delles C, Pilote L, Raparelli V. The importance of gender to understand sex differences in cardiovascular disease. Can J Cardiol. 2021;37(5):699–710. doi:10.1016/j.cjca.2021.02.005
18. Hutchens MP, Fujiyoshi T, Komers R, Herson PS, Anderson S. Estrogen protects renal endothelial barrier function from ischemia-reperfusion in vitro and in vivo. Am J Physiol Renal Physiol. 2012;303(3):F377–385. doi:10.1152/ajprenal.00354.2011
19. Lizcano F, Guzman G. Estrogen deficiency and the origin of obesity during menopause. Biomed Res Int. 2014;2014:757461. doi:10.1155/2014/757461
20. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012;172(6):494–500. doi:10.1001/archinternmed.2011.2174
21. Patterson R, McNamara E, Tainio M, et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. 2018;33(9):811–829. doi:10.1007/s10654-018-0380-1
22. Yuan F, Gong W, Ding C, et al. Association of physical activity and sitting time with overweight/obesity in Chinese occupational populations. Obes Facts. 2021;14(1):141–147. doi:10.1159/000512834
23. Wang N, Sun Y, Zhang H, et al. Long-term night shift work is associated with the risk of atrial fibrillation and coronary heart disease. Eur Heart J. 2021;42(40):4180–4188. doi:10.1093/eurheartj/ehab505
24. Kivimaki M, Jokela M, Nyberg ST, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015;386(10005):1739–1746. doi:10.1016/S0140-6736(15)60295-1
25. Szegda KL, Whitcomb BW, Purdue-Smithe AC, et al. Adult adiposity and risk of early menopause. Hum Reprod. 2017;32(12):2522–2531. doi:10.1093/humrep/dex304
26. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618–637. doi:10.1093/humupd/dms030
27. Jiskoot G, Dietz de Loos A, Timman R, Beerthuizen A, Laven J, Busschbach J. Lifestyle treatment in women with polycystic ovary syndrome: predictors of weight loss and dropout. Brain Behav. 2022;12(7):e2621. doi:10.1002/brb3.2621
Why Healthcare Workers Might Need a Gym Membership
Ah, the life of a healthcare worker! They’re the unsung heroes of our society, or as I like to call them, the *glorified superheroes in scrubs* – minus the capes and with a serious lack of sleep! You know, it’s not just the patients who need medical attention. Turns out, our beloved healthcare workers are also facing some alarming health risks. Grab your popcorn; we’re diving into a study that reads like a horror story for healthcare professionals!
The Grim Reality: Sitting is the New Smoking
Based on a recent study from China, a staggering 42% of healthcare workers are juggling at least one medical condition. You heard that right! And with “conditions” such as hypertension and diabetes rearing their ugly heads, these folks are proving that long hours in a stressful environment, combined with a sedentary lifestyle, is the perfect recipe for cardiovascular diseases (CVD). Yes, folks, sitting for long hours isn’t just an inconvenience – it’s becoming an epic health crisis!
Did you know? A significant chunk of these healthcare workers (over 68%) have at least three CVD risk factors! Maybe we need to hand out personal trainers along with the scrubs!
The Study Breakdown: Crunching the Numbers
The study surveyed 1,110 healthcare warriors – 197 males and 913 females. They spent an average of 40 to 60 hours per week doing their jobs, and most of them, shockingly, don’t even participate in physical exercise. Come on, people! You’re not that busy! Well, according to the stats, 81.08% of them don’t exercise at all. They’re working hard and hardly working out!
Gender Differences: It’s a Man’s World… Sort Of
When gender enters the mix, things get even cheekier! Men seem to have a greater share of risk factors such as obstructive sleep apnea compared to women. And just when you thought women faced all the health challenges, 6.46% of the women reported issues like polycystic ovary syndrome. Talk about a plot twist!
Why Healthcare Workers Need to Prioritize Their Health
Let’s get real: healthcare workers need more than coffee and the occasional pizza slice. The study highlighted that healthcare workers with a long tenure (over 20 years) were more likely to have CKM (Cardiovascular-Kidney-Metabolic) syndrome. If you’ve been in the game for a while, congratulations! You might be one jackpot away from health complications!
Long Hours and No Exercise, Oh My!
Long working hours have been linked to an increased risk of coronary heart disease – and it’s no surprise! It’s like asking a cheetah to take a nap right after a sprint; it just doesn’t work! The doctors may cure others, but who is going to take care of them?
The Call to Action: Time to Move, Healthcare Heroes!
Here’s a cheeky thought: Instead of handing out scrubs as a uniform, why not give those fine folks a gym membership? Or maybe even host exercise classes right in the hospital? I mean, let’s face it – if you can handle a 14-hour shift with a smile, surely you can knock out a few jumping jacks during your lunch break! It’s time to see a need for equitable healthcare approaches that prioritize the CKM health of these everyday heroes.
Conclusion: Let’s Save the Superheroes!
To wrap things up in a can’t-miss bow, the study paints a rather concerning picture of poor CKM health among healthcare workers in China. There’s urgency here, folks! The takeaway? It’s time to take the health of our healthcare heroes seriously. When the doctors and nurses are healthy, they can continue to save lives, including their own!
Before I wrap up, let me leave you with this thought: If healthcare workers don’t take care of themselves, who’s going to take care of the rest of us? Food for thought, isn’t it?
Y from a serious health condition! The demands of the job, coupled with poor lifestyle choices, can lead to significant health consequences that not only affect the workers themselves but also their ability to provide care to patients.
Gym Memberships: A Vital Investment in Health
So, what’s the solution? A gym membership might just be the lifeline these healthcare heroes need! Regular exercise can combat many of the cardiovascular and metabolic risks documented in studies. Not only does physical activity help reduce stress, but it also plays a crucial role in maintaining a healthy weight, lowering blood pressure, and improving overall cardiovascular health. When healthcare workers prioritize their physical well-being, they not only protect themselves from long-term health issues but also enhance their ability to care for others.
Imagine this: a healthcare worker ready for action, not just in their scrubs but with the stamina and resilience that comes from regular exercise. A gym membership could empower these professionals to build healthier habits, improve their mental health, and set an example for their patients.
Conclusion: A Call to Action
If you’re a healthcare worker or know someone who is, it’s time to make health a priority. Investing in a gym membership isn’t just spending money; it’s investing in a happier, healthier, and more productive life. So let’s rally together: healthcare workers, put down the coffee and pick up those dumbbells! Your health is important, and you deserve a fighting chance against the temptations of sedentary living.
