Self-rated literacy level does not explain educational differences in health and disease

Background

Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.

Methods

Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals’ self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.

Results

People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.

Conclusion

Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.     

Socioeconomic and Ethnic Inequalities in the Progress of Multimorbidity and the Role of Health Behaviors

ObjectivesTo assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans.DesignHealth and Retirement Study, a longitudinal survey of older American adults.Setting and ParticipantsData pooled from 2006 to 2018 (waves 8–14), which include 38,061 participants.MethodsWe used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education.ResultsAfrican American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18–1.23 and 1.11; 95% CI 1.17–1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44–1.51) and 1.31 (95% CI 1.26–1.36) after accounting for behaviors.Conclusion and implicationsEthnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.     

Health-related behaviours mediate the relation between ethnicity and (mental) health in the Netherlands

Objective: Ethnic minorities in the Netherlands experience worse (mental) health than Dutch natives. So far, socioeconomic factors, discrimination, and the migration process have been identified as underlying factors, neglecting the potential role of health-related behaviours. This study investigates the mediating effect of lack of physical activity, smoking and alcohol consumption on ethnic inequalities in (mental) health in the Netherlands.

Design: Data from a municipal health survey (2012) in the four largest cities in the Netherlands, including 15,633 Dutch natives, 1,297 Surinamese, 850 Turks and 779 Moroccans were analysed. Mediation analyses were performed on the associations between ethnicity and psychological distress (range 10–50) and self-rated health (range 1–5).

Results: Being from an ethnic minority was associated with higher distress and poorer self-rated health, especially for Turks (higher distress 4.69, 95%CI 4.22–5.16; poorer health 0.35, 95%CI 0.30–0.40). Moroccans and Turks were the least physically active, Turks smoked the most, and Dutch natives drank the most. Lack of physical activity partially mediated the association between Turks (6% respectively 11%) and Moroccans (13% respectively 9%) for psychological distress and self-rated health. Smoking played a mediating role (3%) in Turks.

Conclusion: Lower physical activity and smoking more cigarettes partly explained ethnic health inequalities in the Netherlands. The current findings suggest that intervening and facilitating certain ethnic groups in engaging in health behaviours could contribute to improving their health and reduce ethnic health inequalities.     

Safety incidents associated with extended working hours. A systematic review and meta-analysis

Objective:We performed a systematic review to assess potential consequences of extended working hours on accidents, near-accidents, safety incidents and injuries (hereafter ’incidents’) by considering the overall certainty of evidence.Methods:We searched five databases systematically (Medline, Embase, PsycINFO, Web of Science, and Proquest Health and Safety Science Abstracts) and identified 10 072 studies published up to December 2020, 22 of which met the inclusion criteria. We followed a systematic approach to evaluate risk of bias and synthesize results in a meta-analysis. The certainty of evidence was determined by a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results:Our analyses indicated an association between working >12 hours/day [relative risk (RR) 1.24, 95% confidence interval (CI) 1.11–1.40], or working >55 hours/week (RR 1.24, 95% I 0.98–1.57), and elevated risk of incidents. The certainty of evidence evaluated as low. Weak or no associations were observed for other exposure contrasts: working >8 hours/day (RR 0.93, 95% CI 0.72–1.19), or working overtime (RR 1.08, 95% CI 0.75–1.55), working 41–48 hours/week (RR 1.02, 95% CI 0.92–1.13) or 49–54 hours/week (RR 1.02, 95% CI 0.97–1.07). The certainty of evidence was evaluated as low (very low for 41–48 hours/week).Conclusions:Daily working hours >12 hours and weekly working hours >55 hours was associated with an increased risk of incidents. The certainty of evidence was low. Hence, further high-quality research is warranted to elucidate these associations.     

Widening Socioeconomic Inequalities in Smoking in Japan, 2001–2016

BackgroundJapan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.MethodsWe analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.ResultsOverall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.ConclusionsSocioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.Key words: epidemiology, smoking, socioeconomic factors, Japan, trends     

Social class inequalities in self-rated health and their gender and age group differences in Japan

BACKGROUND: Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive.METHODS: The data derived from interviews with 2987 randomly selected Japanese adults in four prefectures in Japan who completed the cross-national World Mental Health survey from 2002 through 2005. We calculated odds ratios (ORs) of having poor self-rated physical and mental health by two social class indicators independently with multivariate logistic regression models, adjusted for age, gender, marital status, and area. Stratified analyses by gender and age group were also conducted. RESULTS: The adjusted ORs of the lowest educational attainment category having poor self-rated physical and mental health were 1.42 (95% confidence interval [CI]: 1.15-1.76) and 1.37 (95% CI: 1.10-1.70), respectively. Among females, educational attainment had significant linear associations with self-rated physical and mental health. Adjusted household income was also significantly associated with self-rated physical health among female respondents. No associations were found among males. While educational attainment was associated with self-rated health among the young age group, adjusted household income was associated with self-rated physical health in the middle and old age group. CONCLUSION: These results indicated social inequalities in self-rated health and prominent social inequalities in self-rated health among females in Japan. Social inequalities in self-rated health seemed to exist across age groups. However, the mechanism of social inequalities in self-rated health could be different depending on the age group.     

La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña

ObjectiveTo show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale.MethodA cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender.ResultsThe prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health.ConclusionsPrecarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities.     

How leadership behaviors influence the effects of job predictability and perceived employability on employee mental health – a multilevel,prospective study

ObjectivesThis study aimed to elucidate the potential moderating effect of fair-, empowering-, and supportive-leadership behaviors on the relationship between job predictability, future employability, and subsequent clinically relevant mental distress.MethodThe study had a full panel, prospective design, utilizing online, self-administered questionnaire data collected at two time points, two years apart. Fair-, empowering-, and supportive-leadership behaviors, job predictability and future employability were measured by the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS_Nordic). Mental health was measured using the 10-item Hopkins Symptom Checklist (HSCL-10), with cut-off set to >1.85 to identify clinically relevant cases. As data were nested within work units, a multilevel analytic approach was chosen.ResultsIndividual-level direct effects: (i) higher levels of job predictability [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.70–0.98], (ii) future employability (OR 0.83, 95% CI 0.74–0.93), (iii) fair- (OR 0.78, 95% CI 0.68–0.91), empowering- (OR 0.77, 95% CI 0.67–0.87), and supportive- (OR 0.71, 95% CI 0.61–0.81) leadership behavior, and (iv) the combination “quality of leadership” (OR 0.69, 95% CI 0.59–0.81) were significantly associated with a lower risk of reporting subsequent mental distress. Work-unit level direct effects: higher work-unit levels of fair- (OR 0.52, 95% CI 0.34–0.80) and empowering- (OR 0.61, 95% CI 0.40–0.94) leadership behaviors and quality of leadership (OR 0.54, 95% CI 0.34–0.87) were significantly associated with a lowered risk of subsequent mental distress. Cross-level interactions: No cross-level interaction effects were shown.ConclusionsLeadership behaviors did not moderate the effects of job predictability and future employability on mental health. However, employees embedded within work-units characterized by fair, empowering and supportive leadership behaviors had a lower risk of subsequent mental distress.     

Sexual and gender harassment in Swedish workplaces: A prospective cohort study on implications for long-term sickness absence

Objectives:This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, ≥21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association.Methods:Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999–2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression.Results:Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02–1.05] and men (RR 1.07, 95% CI 1.04–1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01–1.10) and men (RR 1.07, 95% CI 1.02–1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA.Conclusions:Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.     

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention

ObjectivesTo explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction.DesignQuasi-experimental before–after study.SettingFive low-income neighbourhoods of Barcelona during 2010–15.Participants147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months.InterventionPrimary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers.MeasurementsWe assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models.ResultsAt 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10.ConclusionThis community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.     

Self-Rated Health and Long-Term Prognosis of Depression

PURPOSE

Indicators of prognosis should be considered to fully inform clinical decision making in the treatment of depression. This study examines whether self-rated health predicts long-term depression outcomes in primary care.

METHODS

Our analysis was based on the first 5 years of a prospective 10-year cohort study underway since January 2005 conducted in 30 randomly selected Australian primary care practices. Participants were 789 adult patients with a history of depressive symptoms. Main outcome measures include risks, risk differences, and risk ratios of major depressive syndrome (MDS) on the Patient Health Questionnaire.

RESULTS

Retention rates during the 5 years were 660 (84%), 586 (74%), 560 (71%), 533 (68%), and 517 (66%). At baseline, MDS was present in 27% (95% CI, 23%–30%). Cross-sectional analysis of baseline data showed participants reporting poor or fair self-rated health had greater odds of chronic illness, MDS, and lower socioeconomic status than those reporting good to excellent self-rated health. For participants rating their health as poor to fair compared with those rating it good to excellent, risk ratios of MDS were 2.10 (95% CI, 1.60–2.76), 2.38 (95% CI, 1.77–3.20), 2.22 (95% CI, 1.70–2.89), 1.73 (95% CI, 1.30–2.28), and 2.15 (95% CI, 1.59–2.90) at 1, 2, 3, 4, and 5 years, after accounting for missing data using multiple imputation. After adjusting for age, sex, multimorbidity, and depression status and severity, self-rated health remained a predictor of MDS up to 5 years.

CONCLUSIONS

Self-rated health offers family physicians an efficient and simple way to identify patients at risk of poor long-term depression outcomes and to inform therapeutic decision making.     

Gender-specific trends in educational attainment and self-rated health, 1972-2002

Objectives. We tested whether self-rated health has improved over time (1972–2002) for women and men. We also considered the degree to which historical gains in educational attainment help to explain any observed trends.

Methods. Using 21 years of repeated cross-sectional data from the General Social Survey, we estimated a series of ordered logistic regression models predicting self-rated health.

Results. Our results show that women’s health status has steadily improved over the 30-year period under study, and these improvements are largely explained by gains in educational attainment. We also found that the health trend for men is nonlinear, suggesting significant fluctuations in health status over time.

Conclusions. Based on the linear health status trend and strong mediation pattern for women, and the nonlinear health status trend for men, women have benefited more than men, in terms of self-rated health, from increased educational attainment.

     

Association of long working hours with accidents and suicide mortality in Korea

Objectives:The deleterious health effects of long working hours have been previously investigated, but there is a dearth of studies on mortality resulting from accidents or suicide. This prospective study aims to examine the association between working hours and external-cause mortality (accidents and suicide) in Korea, a country with some of the longest working hours in the world.Methods:Employed workers (N=14 484) participating in the Korean National Health and Nutrition Examination Survey (KNHANES) were matched with the Korea National Statistical Office’s death registry from 2007–2016 (person-years = 81 927.5 years, mean weighted follow-up duration = 5.7 years). Hazard ratios (HR) for accident (N=25) and suicide (N=27) mortality were estimated according to weekly working hours, with 35–44 hours per week as the reference.Results:Individuals working 45–52 hours per week had higher risk of total external cause mortality compared to those working 35–44 hours per week [HR 2.79, 95% confidence interval (CI) 1.22–6.40], adjusting for sex, age, household income, education, occupation, and depressive symptoms. Among the external causes of death, suicide risk was higher (HR 3.89, 95% CI 1.06–14.29) for working 45–52 hours per week compared to working 35–44 hours per week. Working >52 hours per week also showed increased risk for suicide (HR 3.74, 95% CI 1.03–13.64). No statistically significant associations were found for accident mortality.Conclusions:Long working hours are associated with higher suicide mortality rates in Korea.     

Deindustrialisation and the long term decline in fatal occupational injuries

Aims: To examine the extent to which deindustrialisation accounts for long term trends in occupational injury risk in the United States.

Methods: Rates of fatal unintentional occupational injury were computed using data from death certificates and the population census. Trends were estimated using Poisson regression. Standardisation and regression methods were used to adjust for the potential effect of structural change in the labour market.

Results: The fatal occupational injury rate for all industries declined 45% from 1980 to 1996 (RR (rate ratio) 0.55, 95% CI 0.52 to 0.57). Adjustment for structural changes in the workforce shifted the RR to 0.62 (95% CI 0.60 to 0.65). Expanding industries enjoyed more rapid reduction in risk (–3.43% per year, 95% CI –3.62 to –3.24) than those that contracted (–2.65% per year, 95% CI –2.88 to –2.42).

Conclusions: Deindustrialisation contributed to the decline of fatal occupational injury rates in the United States, but explained only 10–15% of the total change.

     

Trends in mental health inequalities in urban Canada

ObjectivesCanadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada’s largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time.MethodsSelf-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored.ResultsAt the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011–2015. Inequalities were present in 2001–2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001–2005 and decreased over time.ConclusionThe large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.     

The social determinants of health as predictors of adherence to public health preventive measures among parents and young children during the COVID-19 pandemic: a longitudinal cohort study

ObjectivesTo investigate whether social determinants of health (SDOH) are predictive of adherence to public health preventive measures and to describe changes in adherence over time among parents and children.MethodsA longitudinal study was conducted in children aged 0–10 years and their parents through the TARGet Kids! COVID-19 Study in the Greater Toronto Area, Canada (April–July 2020). This study included 335 parents (2108 observations) and 416 children (2632 observations). Parents completed weekly questionnaires on health, family functioning, socio-demographics, and public health practices. The outcome was adherence to public health preventive measures measured separately for parents and children. Marginal log-binomial models were fitted using repeated measures of the outcome and predictors.ResultsUnemployment (RR 0.67, 95% CI: 0.47, 0.97), apartment living (RR 0.72, 95% CI: 0.53, 0.99), and essential worker in the household (RR 0.74, 95% CI: 0.55, 1.00) were associated with decreased likelihood of adherence among parents; however, no associations were observed for other SDOH, including family income and ethnicity. Furthermore, there was no strong evidence that SDOH were associated with child adherence. The mean number of days/week that parents and children adhered at the start of the study was 6.45 (SD = 0.93) and 6.59 (SD = 0.86), respectively, and this decreased to 5.80 (SD = 1.12) and 5.84 (SD = 1.23) by study end. Children consistently had greater adherence than parents.ConclusionSDOH were predictive of adherence to public health preventive measures among parents but less so in children among our sample of relatively affluent urban families. Adherence was high among parents and children but decreased over time. Equitable approaches to support the implementation of public health guidelines may improve adherence.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00540-5.     

Metabolic syndrome – a risk factor for all-cause disability pension: a prospective study based on the Swedish WOLF cohort

ObjectiveThe aim was to study the impact of metabolic syndrome on the risk for disability pension among Swedish employees.MethodsA working population-based prospective cohort [Work, Lipids and Fibrinogen (WOLF) cohort, N=10 803], was linked to national registry records of all-cause disability pension for the period 1992–2013. Occupational health service data included 1992–2009 anthropometric measurements, blood samples, and questionnaires. Metabolic syndrome was defined according to International Diabetes Federation criteria, and risk for any all-cause disability pension was analyzed using Cox proportional hazard regression as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex and other covariates.ResultsOf the employees, 17.9% (men 21.5%, women 9.7%) met the criteria for metabolic syndrome. The prevalence of all-cause disability pension was 15.2% in men with metabolic syndrome and 7.5% in men without metabolic syndrome; for women, the corresponding results were 23.2% and 12.7%. After adjustment for socio-demographic factors, health behaviors, work-related factors, diabetes, and obesity, the risk for all-cause disability pension among subjects with metabolic syndrome displayed an HR of 1.37 (95% CI 1.18–1.60). Results were similar for men and women. In a subgroup, further adjustment for chronic diseases resulted in an HR of 1.32 (95% CI 1.04–1.68).ConclusionThis study demonstrates an increased risk for all-cause disability pension, even after adjustment for other risk factors, among Swedish employees with metabolic syndrome compared to those without at baseline.     

Occupational exposure to noise in relation to pregnancy-related hypertensive disorders and diabetes

Objectives:Exposure to environmental noise has been associated with an increased risk of cardiovascular diseases and diabetes, but evidence for occupational noise is limited and conflicting, especially related to pregnancy outcomes. This study aimed to evaluate the association of occupational noise exposure with hypertensive disorders of pregnancy (HDP) and gestational diabetes.Methods:Our population-based cohort study utilized data on 1 109 516 singletons born to working mothers in Sweden between 1994–2014 from the Medical Birth Register and the Longitudinal Integration Database for Health Insurance and Labor Market Studies. Noise exposure came from a job exposure matrix (JEM) in five categories <70, 70–74, 75–80, 80–85, >85 dB(A). Relative risks (RR), adjusted for confounders and other job exposures, were calculated by modified Poisson regressions for the full sample and a subsample of first-time mothers reporting full-time work.Results:Exposure to 80–85 dB(A) of noise was associated with an increased risk of all HDP [RR 1.12, 95% confidence interval (CI) 1.05–1.18] and preeclampsia alone (RR 1.14, 95% CI 1.07–1.22) in the full sample. Results were similar for first-pregnancy, full-time workers. Exposure to >85 dB(A) of noise was also associated with an increased risk of gestational diabetes (RR 1.57, 95% CI 1.10–2.24) in the analysis restricted to first-time mothers working full-time.Conclusion:In this study, exposure to noise was associated with an increased risk for HDP and gestational diabetes, particularly in first-time mothers who work full-time. Further research is needed to confirm findings and identify the role of hearing protection on this association so prevention policies can be implemented.