This cross-sectional study investigates the relationship between the psychosocial work environment and cardiovascular disease (CVD) prevalence in a randomly selected, representative sample of 13,779 Swedish male and female workers. It was found that self-reported psychological job demands, work control, and coworker social support combined greater then multiplicatively in relation to CVD prevalence. An age-adjusted prevalence ratio (PR) of 2.17 (95% CI-1.32, 3.56) was observed among workers with high demands, low control, and low social support compared to a low IntroductionThe role of a stressful work environment in the devel-

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OBJECTIVES. This study examined the effect of cumulative exposure to work organization--psychological demands, work control, and social support on prospectively measured cardiovascular disease mortality risk. METHODS. The source population was a national sample of 12517 subjects selected from the Swedish male population by Statistics Sweden in annual surveys between 1977 and 1981. Over a 14-year follow-up period, 521 deaths from cardiovascular disease were identified. A nested case-control design was used. Work environment exposure scores were assigned to cases and controls by linking lifetime job histories with a job exposure matrix. RESULTS. Conditional logistic regression analysis was used in examining cardiovascular mortality risk in relation to work exposure after adjustment for age, year last employed, smoking, exercise, education, social class, nationality, and physical job demands. In the final multi-variable analysis, workers with low work control had a relative risk of 1.83 (95% confidence interval [CI] = 1.19, 2.82) for cardiovascular mortality. Workers with combined exposure to low control and low support had a relative risk of 2.62 (95% CI=1.22, 5.61). CONCLUSIONS. These results indicate that long-term exposure to low work control is a risk factor for cardiovascular disease mortality.

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This study investigates the relative distribution of home responsibilities and psychosocial work environment characteristics and their associations with psychosomatic strain in a random sample of the female and male working population of Sweden (N = 12,772). Occupational variables investigated were psychological and physical demands, job control, social support, and job hazards. Home characteristics included measures of household work, number and age of children, and child care resources. A sex-pooled logistic regression analysis was performed to detect sex differences in the effects of the variables upon strain. Gender was no longer associated with psychosomatic strain after adjusting for work and home characteristics and their interactions, and while there were some similarities between the sexes with respect to the main effects of the home and work characteristics, in 52 of 60 combined effect comparisons women had a greater combined odds ratio for strain than men.