Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data
- PMID: 22981903
- PMCID: PMC3486012
- DOI: 10.1016/S0140-6736(12)60994-5
Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data
Abstract
Background: Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies.
Methods: We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death.
Findings: 30,214 (15%) of 197,473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%.
Interpretation: Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.
Funding: Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.
Copyright © 2012 Elsevier Ltd. All rights reserved.
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Comment in
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Job strain as a measure of exposure to psychological strain.Lancet. 2012 Oct 27;380(9852):1455-6. doi: 10.1016/S0140-6736(12)61512-8. Epub 2012 Sep 14. Lancet. 2012. PMID: 22981902 No abstract available.
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Job strain is associated with an increased risk of coronary heart disease.Evid Based Ment Health. 2013 May;16(2):53. doi: 10.1136/eb-2012-101161. Epub 2013 Jan 7. Evid Based Ment Health. 2013. PMID: 23299055 No abstract available.
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Job strain and coronary heart disease - Authors' reply.Lancet. 2013 Feb 9;381(9865):448-9. doi: 10.1016/S0140-6736(13)60244-5. Lancet. 2013. PMID: 23399067 No abstract available.
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Job strain and coronary heart disease.Lancet. 2013 Feb 9;381(9865):448. doi: 10.1016/S0140-6736(13)60242-1. Lancet. 2013. PMID: 23399068 No abstract available.
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Job strain and coronary heart disease.Lancet. 2013 Feb 9;381(9865):448. doi: 10.1016/S0140-6736(13)60243-3. Lancet. 2013. PMID: 23399069 No abstract available.
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RE: "Need for more individual-level meta-analyses in social epidemiology: example of job strain and coronary heart disease".Am J Epidemiol. 2013 Sep 15;178(6):1007-8. doi: 10.1093/aje/kwt192. Epub 2013 Aug 15. Am J Epidemiol. 2013. PMID: 23956098 No abstract available.
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RE: "Need for more individual-level meta-analyses in social epidemiology: example of job strain and coronary heart Disease".Am J Epidemiol. 2013 Sep 15;178(6):1008-9. doi: 10.1093/aje/kwt193. Epub 2013 Aug 15. Am J Epidemiol. 2013. PMID: 23956099 No abstract available.
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The authors reply.Am J Epidemiol. 2013 Sep 15;178(6):1009-10. doi: 10.1093/aje/kwt194. Am J Epidemiol. 2013. PMID: 24171205 Free PMC article. No abstract available.
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Excuse me, but did the IPD-work consortium just "falsify" the job-strain model?Scand J Work Environ Health. 2015 Sep 1;41(5):504-5. doi: 10.5271/sjweh.3512. Epub 2015 Aug 6. Scand J Work Environ Health. 2015. PMID: 26247332 No abstract available.
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Authors' reply: Calculation of population attributable risk should to be based on robust estimates.Scand J Work Environ Health. 2015 Sep 1;41(5):506-7. doi: 10.5271/sjweh.3518. Epub 2015 Aug 6. Scand J Work Environ Health. 2015. PMID: 26247405 No abstract available.
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References
-
- Karasek R, Theorell T. Healthy work: stress, productivity, and the reconstruction of working life. Basic Books; New York: 1990.
-
- Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9:360–370. - PubMed
-
- Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet. 2007;370:1089–1100. - PubMed
-
- Netterstrom B, Kristensen TS, Sjol A. Psychological job demands increase the risk of ischaemic heart disease: a 14-year cohort study of employed Danish men. Eur J Cardiovasc Prev Rehabil. 2006;13:414–420. - PubMed
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