Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.
BACKGROUNDEpidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.
METHODSThis multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.
RESULTSAt baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.
CONCLUSIONSIndividuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.
From the aInstitute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany; bClinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; cInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; dSchool of Health Sciences, Jönköping University, Jönköping, Sweden; eStress Research Institute, Stockholm University, Stockholm, Sweden; fCentre for Occupational and Environmental Medicine, Stockholm County Council, Sweden; gNational Research Centre for the Working Environment, Copenhagen, Denmark; hUnit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark; iFederal Institute for Occupational Safety and Health (BAuA), Berlin, Germany; jInstitute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany; kThe National Agency for Special Needs Education and Schools, Härnösand, Sweden; lParis Descartes University, Paris, France; mInserm U1018, University Paris Saclay, France; nDepartment of Epidemiology and Public Health, University College London, London, United Kingdom; oSchool of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, United Kingdom; pDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; qClinical Effectiveness Unit, The Royal College of Surgeons, London, United Kingdom; rDepartment of Health Sciences, Mid Sweden University, Sundsvall, Sweden; sAS3 Employment, AS3 Companies, Viby J, Denmark; tDepartment of Psychology, Umeå University, Umeå, Sweden; uFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland; vThe Danish National Centre for Social Research, Copenhagen, Denmark; wDepartment of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark; xDepartment of Psychology, University of Turku, Turku, Finland; yGerman Institute for Economic Research, Berlin, Germany; zDepartment of Public Health, University of Turku, Turku, Finland; aaTurku University Hospital, Turku, Finland; bbOccupational and Environmental Medicine, Uppsala University, Uppsala, Sweden., , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Proportional Hazards Models
Severity of Illness Index
Pub Type(s)Journal Article
Research Support, Non-U.S. Gov't