Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data

Abstract

SummaryBackgroundPublished 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 We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies.MethodsWe used individual records from 13 European cohort studies (1985–2006) of men and women without coronary heart disease who were employed at time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.Findings30 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 This effect estimate was higher in published (1·43, 1·15–1·77) than unpublished (1·16, 1·02–1·32) studies.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%.InterpretationOur 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.FundingFinnish 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.

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

“…This latter finding is consistent with a recently proposed psychosocial “perfect storm13” model 13 of CVD risk that suggests an underlying vulnerability (eg, depression) is associated with greater risk of cardiac events and mortality, particularly in the presence of perceived stress. Although examinations of the association between depressive symptoms or stress and CVD are increasingly common,4, 6, 7, 8, 9, 14, 15, 16, 17, 18, 19 fewer studies have examined the combined effects of depressive symptoms and stress 10, 11. The perfect storm model emphasizes the importance of considering the convergence of a variety of factors that contribute to CVD risk rather than focusing on 1 risk factor in isolation.…”

Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data

“…However, although several reviews of this field exist (5,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), the few systematic quantifications of the evidence have been based on published cross-sectional (18,19,25) or published longitudinal studies (26). Given the potential publication bias in studies based on published data (27), an individual-participant metaanalysis of unpublished data would provide important complementary evidence to evaluate the effect of long working hours on mental health. Furthermore, long working hours are more common in Asia and North America than in Europe and the risk of mental health problems is higher among women and individuals with low socioeconomic position than men and those with high socioeconomic status.…”

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

“…Individuals who report excessive work demands coupled with low decisional latitude are deemed to be experiencing "job strain" [55]. However a recent meta-analysis found only a small increase in incident CHD associated with job strain (HR 1·23; 95% CI 1·10-1·37) [56]. Similarly, the perception of an imbalance between the effort of work (e.g.…”