TY - JOUR

T1 - Effort-Reward Imbalance at Work and Incident Coronary Heart Disease

T2 - A Multicohort Study of 90,164 Individuals

AU - Dragano, Nico

AU - Siegrist, Johannes

AU - Nyberg, Solja T.

AU - Lunau, Thorsten

AU - Fransson, Eleonor I.

AU - Alfredsson, Lars

AU - Bjorner, Jakob B.

AU - Borritz, Marianne

AU - Burr, Hermann

AU - Erbel, Raimund

AU - Fahlen, Goran

AU - Goldberg, Marcel

AU - Hamer, Mark

AU - Heikkila, Katriina

AU - Joeckel, Karl-Heinz

AU - Knutsson, Anders

AU - Madsen, Ida E. H.

AU - Nielsen, Martin L.

AU - Nordin, Maria

AU - Oksanen, Tuula

AU - Pejtersen, Jan H.

AU - Pentti, Jaana

AU - Rugulies, Reiner

AU - Salo, Paula

AU - Schupp, Juergen

AU - Singh-Manoux, Archana

AU - Steptoe, Andrew

AU - Theorell, Tores

AU - Vahtera, Jussi

AU - Westerholm, Peter J. M.

AU - Westerlund, Hugo

AU - Virtanen, Marianna

AU - Zins, Marie

AU - Batty, G. David

AU - Kivimaki, Mika

PY - 2017/7

Y1 - 2017/7

N2 - Background: Epidemiologic 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.Methods: This 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.Results: At 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.Conclusions: Individuals 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.

AB - Background: Epidemiologic 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.Methods: This 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.Results: At 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.Conclusions: Individuals 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.

U2 - 10.1097/EDE.0000000000000666

DO - 10.1097/EDE.0000000000000666

M3 - Journal article

C2 - 28570388

VL - 28

SP - 619

EP - 626

JO - Epidemiology

JF - Epidemiology

SN - 1044-3983

IS - 4

ER -