Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort studyClinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / School of Health and Welfare, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
Department of Public Health, University of Helsinki, Helsinki, Finland.
Finnish Institute of Occupational Health, Helsinki, Finland.
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland / Division of Health Psychology, SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland / Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
Finnish Institute of Occupational Health, Helsinki, Finland.
National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm UMR 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
Stress Research Institute, Stockholm University, Stockholm, Sweden.
Finnish Institute of Occupational Health, Helsinki, Finland.
Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Stress Research Institute, Stockholm University, Stockholm, Sweden.
Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland / Center for Life Course Health Research, University of Oulu, Oulu, Finland.
Department of Epidemiology and Public Health, University College London, London, United Kingdom.
National Centre for Cardiovascular Prevention and Outcomes, University College London, London, United Kingdom.
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2018 (English)In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713, article id S2213-8587(18)30140-2Article in journal (Refereed) Published
Abstract [en]
BACKGROUND: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.
METHODS: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.
RESULTS: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41).
INTERPRETATION: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.
FUNDING: NordForsk, UK Medical Research Council, and Academy of Finland.
Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 6, no 9, p. 705-713, article id S2213-8587(18)30140-2
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
URN: urn:nbn:se:his:diva-16181DOI: 10.1016/S2213-8587(18)30140-2ISI: 000442438000017PubMedID: 29884468Scopus ID: 2-s2.0-85048552925OAI: oai:DiVA.org:his-16181DiVA, id: diva2:1247167
Note
CC BY 4.0
2018-09-112018-09-112020-11-26Bibliographically approved