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• W2939734346 abstract "To the Editor: In analyses of longitudinal data from 7 to 14 cohort studies, the Individual Participant Data Meta-analysis in Working Populations (IPD-Work) consortium has demonstrated associations of job strain with an increased risk of coronary heart disease (CHD),1 ischemic stroke,2 type 2 diabetes,3 and depression.4 Moreover, among men who already had cardiometabolic disease, job strain carried a 1.6-fold increased risk of death.5 In contrast, no association was evident with other health outcomes, such as cancer, chronic obstructive pulmonary disease, asthma, Crohn’s disease or ulcerative colitis (eAppendix, p. 2; https://links.lww.com/EDE/B507). In all those analyses, job strain was defined by the combination of high occupational demands with low control,6 and was selected for investigation because, based on psychological theory,7,8 it was expected a priori to trigger harmful stress responses that might cause or promote chronic disease. Some commentators, however, have challenged this predefined approach and questioned the extent to which the observed associations with cardiometabolic outcomes and depression reflect effects specific to job strain, or whether they might be driven by independent effects of high occupational demands or low job control.9 Here we address that concern by presenting further analyses of the IPD-Work datasets. We report separate risk estimates for each combination of occupational demands and control, taking the combination of “neither high demands nor low control” as the reference. A description of the study populations and assessment of outcomes (i.e., CHD,1 ischemic stroke,2 type 2 diabetes,3 depression4, and, among men with cardiometabolic disease, total mortality)5 has been published previously and is summarized in the eAppendix (p. 1–5; https://links.lww.com/EDE/B507). The Table shows the results of previous IPD-Work studies on job strain as a binary exposure (part A) and those of the present analysis on job strain components (parts B and C). For each outcome, the summary risk estimates for job strain in the current component-specific analysis (part B) were similar in direction and magnitude to those previously published for the binary job strain variable (part A). In addition, age-, sex-, and socioeconomic status-adjusted hazard ratios for high demands with low control (i.e., job strain) were substantially higher than those for high demands in the absence of low control and low control in the absence of high demands (part B).TABLE.: Adjusted hazard ratios for the association of binary job strain variable with morbidity and mortality in previous IPD-Work studies (A) and age-, sex-, and socioeconomic status-adjusted hazard ratios for the associations of job strain components with these outcomes (B and C)Study-specific analyses for incident CHD, ischemic stroke, type 2 diabetes, and clinical depression showed that 38 (83%) of the 46 hazard ratios for job strain versus neither high demands nor low control favored risk factor status (part C). According to I2-statistics, heterogeneity in the study-specific hazard ratios was 0% for all outcomes (eAppendix, p. 5–10; https://links.lww.com/EDE/B507). Consistency of study-specific findings was poorer for high demands in the absence of low control (24/46 [52%], max I2 = 19%) and low control in the absence of high demands (30/46 [65%], max I2 = 53%). Small sample size precluded study-level comparisons for mortality in men with cardiometabolic disease. In conclusion, findings of cohort studies from the United Kingdom, France, Belgium, Denmark, Sweden, and Finland indicate that for each of CHD, ischemic stroke, type 2 diabetes, depression and (among men with cardiometabolic disease) mortality, risks are highest in individuals with job strain, whereas any effects of high occupational demands in the absence of low control, and of low job control in the absence of high demands, were weaker. Job strain defined as the combination of high job demands and low control is consistent with more general definitions of psychological stress which suggest that stress occurs when demands from external situations are perceived to be beyond coping capacities.7 As such, our results support the psychological stress theory underpinning our a priori decision to examine job strain as a binary risk factor for morbidity and mortality. Mika KivimäkiDepartment of Epidemiology and Public HealthUniversity College LondonLondon, United KingdomClinicum, Faculty of MedicineUniversity of HelsinkiHelsinki, FinlandFinnish Institute of Occupational HealthHelsinki, Finland[email protected] Solja T. NybergClinicum, Faculty of MedicineUniversity of HelsinkiHelsinki, Finland Jaana PenttiClinicum, Faculty of MedicineUniversity of HelsinkiHelsinki, FinlandDepartment of Public HealthUniversity of TurkuTurku, Finland Ida E. H. MadsenNational Research Centre for the Working EnvironmentCopenhagen, Denmark Linda L. Magnusson HansonStress Research InstituteStockholm UniversityStockholm, Sweden Reiner RuguliesNational Research Centre for the Working EnvironmentCopenhagen, DenmarkDepartment of Public HealthUniversity of CopenhagenCopenhagen, DenmarkDepartment of PsychologyUniversity of CopenhagenCopenhagen, Denmark Jussi VahteraDepartment of Public HealthTurku University HospitalUniversity of TurkuTurku, Finland David CoggonMRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthampton, United Kingdomon behalf of the IPD-Work consortium*" @default.
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• W2939734346 date "2019-07-01" @default.
• W2939734346 modified "2023-10-13" @default.
• W2939734346 title "Individual and Combined Effects of Job Strain Components on Subsequent Morbidity and Mortality" @default.
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• W2939734346 doi "https://doi.org/10.1097/ede.0000000000001020" @default.
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