Job Strain as a Risk Factor for Type 2 Diabetes: A Pooled Analysis of 124,808 Men and Women

Abstract

OBJECTIVEThe status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as “job strain,” is associated with incident type 2 diabetes independent of lifestyle factors.RESEARCH DESIGN AND METHODSWe extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses.RESULTSThere were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06–1.25) with no difference between men and women (1.19 [1.06–1.34] and 1.13 [1.00–1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00–1.23).CONCLUSIONSFindings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.

High‐sensitivity CRP: Possible link between job stress and atherosclerosis

“…If smoking is a mediator, then control for it in our analyses as a confounder would represent overcontrol. In fact, there is also evidence that body mass index [Azagba and Sharaf, 2012], hypertension [Landsbergis et al, 2013], and diabetes mellitus [Nyberg et al, 2014] may be mediators in the relationship between job stress and cardiovascular disease. If they are mediators, then our adjusted results are conservative estimates of the associations between job stressors and hs-CRP.…”

Job Strain and the Risk of Stroke

“…reporting high job demands in combination with low control over the work situation) were compared to all others. [22][23][24][25] Socioeconomic status (SES; low, intermediate, high, other), defined on the basis of occupational title or education, served as a proxy marker of stroke risk factors. Data on standard stroke risk factors, such as diabetes, hypertension (systolic/diastolic blood pressure >140/90mmHg), smoking, and heavy alcohol consumption (>28 units of alcohol per week for men and >21 units for women), were available in 3 studies, Whitehall II, WOLF-Norrland and WOLF-Stockholm (due to small numbers, less than 20 per study, atrial fibrillation was not possible to include in as a risk factor in the analysis).…”

Disruption of multisystem responses to stress in type 2 diabetes: Investigating the dynamics of allostatic load

“…Stress-related factors may contribute to risk of type 2 diabetes through their impact on inflammatory, metabolic, cardiovascular, and neuroendocrine regulation (2). Socioeconomic adversity over the life course predicts type 2 diabetes in later life (3), whereas stress at work and more general indicators of perceived stress are associated with future diabetes (4,5). There appears to be a bidirectional relationship between type 2 diabetes and depressive symptoms (6), and people with type 2 diabetes may report greater social isolation and more limited social support (7).…”