A longitudinal general population-based study of job strain and risk for coronary heart disease and stroke in Swedish men.

BMJ Open (Impact Factor: 2.06). 03/2014; 4(3):e004355. DOI: 10.1136/bmjopen-2013-004355
Source: PubMed

ABSTRACT The aim was to investigate whether psychosocial stress based on the job-demand-control (JDC) model increased the risk for coronary heart disease (CHD) and stroke.
Swedish men.
The Primary Prevention Study (PPS) comprises 6070 men born between 1915 and 1925 free from previous history of CHD and stroke at baseline (1974-1977). Psychosocial workplace exposure was assessed using a job-exposure matrix (JEM) for the JDC model based on occupation at baseline. The participants were followed from baseline examination, until death, until hospital discharge or until 75 years of age, whichever occurred first, using the Swedish national register on cause of death and the Swedish hospital discharge register for non-fatal and fatal stroke and CHD events. Cox regression models were used with stroke or CHD as the outcome, using JDC model and age as explanatory variables, as well as stratified models with regard to smoking, self-reported stress, socioeconomic status, obesity, hypertension and diabetes.
Risk for stroke and CHD.
There was an increased risk (HR) for CHD in relation to high strain (HR 1.31, 95% CI 1.01 to 1.70). The risk was further increased among ever-smokers and among blue-collar workers. There was a relation between low control and increased risk for CHD (HR 1.19, 95% CI 1.06 to 1.35). There was no increased risk for stroke in any of the JDC categories.
Exposure to occupational psychosocial stress defined as job strain or low control increased the risk for CHD, especially among smokers and blue-collar workers. There was no increased risk for stroke in any of the JDC categories.

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    ABSTRACT: This study aimed to evaluate the contribution of work, non-work and individual factors to obesity with regard to gender-related differences, and to clarify the mediating role that psychological distress plays in these dynamics in Canada from 1994 to 2008 using the Canadian National Population Health Survey (NPHS). Longitudinal. The NPHS is a randomised longitudinal cohort study with biennial interviews of the Canadian adult population from 18 to 64. 5925 non-obese workers in cycle 1 (49% were women). Obesity was measured using the body mass index (BMI), with a threshold of BMI >30 kg/m(2). BMI was corrected in accordance with the recommendations of Connor Gorber et al to adjust for gender bias in responses. Of the work characteristics evaluated, only decision authority was associated with obesity for women but not for men. Living as a couple, child-related strains, psychotropic drug use, hypertension, being physically inactive and low psychological distress were obesity risk factors but were not moderated by gender. Overall, psychological distress did not mediate the associations that work factors have on obesity. Our study suggests that men and women differ little in the extent to which work, non-work and individual factors predict obesity. However, for women, the level of decision authority is associated with a lower obesity risk. In addition, psychological distress did not mediate the contribution of work factors and actually seems, contrary to expectations, to decrease the obesity risk when work, non-work and individual factors are taken into account. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 01/2015; 5(3):e006285. DOI:10.1136/bmjopen-2014-006285 · 2.06 Impact Factor
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    ABSTRACT: The overall aims of this thesis were to improve our understanding of (1) associations between adverse psychosocial work conditions and less explored cardiovascular outcomes, and (2) workers’ perceptions and reactive behaviour when exposed to such conditions. Psychosocial job environment was evaluated with the job demand-control and effort-reward imbalance models. In the former construct, demand captures psychological work load, while control measures the employee’s influence over work tasks. Conceptually, effort is similar to job demand in measuring work intensity, while reward measures salary, esteem from colleagues and management, and job security. Examined subjects were drawn from three cohorts: randomly selected residents from Greater Gothenburg, patients with new onset acute coronary syndrome from the West county of Sweden and Swedish male construction workers. Results in paper I illustrated that a combination of high demands-low control, commonly referred to as high strain, and imbalance between effort and reward was related to adverse values in intermediate cardiovascular heart disease risk factors, foremost blood pressure and blood lipids. Surprisingly, findings in paper II showed that work conditions characterized by high demands-high control were more strongly associated to increased ischemic stroke, than high strain. Furthermore, high strained and effort-reward imbalanced jobs predicted job mobility in a general population sample (Paper III) and were related to delayed return to work and fear-avoidance perceptions towards the workplace, among patients with new onset acute coronary syndrome (Paper IV). Fear-avoidance attributions, in turn, mediated the relationship between poor psychosocial conditions and expected work resumption. The results partly concur with previous evidence on links between psychosocial job factors and cardiovascular outcomes. The results also indicate that workers are not passive receptors to impairing job conditions, but both react to and actively try to improve or avoid detrimental work environment, and consequently protect their health. In the gender stratified analyses (paper I, III, IV) notable differences were detected, as psychosocial job dimensions were not related to blood pressure, job mobility, expected return to work or fear-avoidance attributions among women. These differences could be due to a gender segregated labour market or lack of precision in reflecting female dominated work cultures. Further explanations might be that for women, private life stressors, e.g. child care or household work, deflate relationships between the psychosocial factors and outcomes used in this thesis.
    12/2014, Degree: Doctoral, Supervisor: Kjell Torén, Annika Rosengren, Annika Härenstam
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    ABSTRACT: The present study aimed to investigate whether different dimensions of psychosocial stress, as measured by the job demand-control model (JDC), were associated with increased risks of ischemic stroke and coronary heart disease (CHD). A cohort of 75 236 male construction workers was followed from 1989-2004. Exposure to psychosocial stress was determined by a questionnaire answered in 1989-1993. Events of ischemic stroke and CHD were found by linkage to the Swedish Causes of Death and National Patient registers. Hazard ratios (HR) were obtained from Cox regression models, adjusted for age, smoking habits, body mass index and systolic blood pressure. There were 1884 cases of CHD and 739 cases of ischemic stroke. Regarding ischemic stroke, no association was found between job demands [HR 1.12, 95% confidence interval (95% CI) 0.89-1.40, highest versus lowest quintile] or job control (HR 1.04, 95% CI 0.82-1.32, lowest versus highest quintile). Regarding CHD, job demands were associated to CHD (HR 1.18, 95% CI 1.02-1.37, highest vs. lowest quintile), but no consistent trend was seen among quintiles. The results were inconsistent in relation to job control. The division of JDC into four categories showed no significant associations with either ischemic stroke or CHD. This exploratory study showed no significant associations between psychosocial work environment and ischemic stroke, and the associations between job demands and control and CHD were inconsistent and weak. The combination of job control and job demand showed no significant associations with either ischemic stroke or CHD.
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