Several studies have associated heart disease with job strain, defined as low job control and high job demands. We have studied incident heart disease (519 cases) and job strain among 3,575 males in NHANES1 survey who were currently employed at baseline in the early 1970s, and followed through 1987. Scores for job control and job demands were assigned to each subject based on current occupation at baseline. Controlling for conventional risk factors, we found no excess risk for those with the highest strain (lowest control and highest demands, rate ratio 1.08). Those with highest job control did have significantly decreased risk (rate ratio 0.71, 95% CI 0.54–0.93). In blue‐collar workers (58% of subjects) there was a significant inverse trend in risk with increasing job demands. Control for level of physical activity did not change this finding. A combination of high control and demand was protective among blue‐collar workers (odds ratio 0.69, 0.48–0.99). Our findings suggest that class‐specific analyses are needed in studying job stress, and that “active” blue–collar workers with high control and high demand are protected against heart disease. The “job demand” variable may measure whether work is challenging rather than fast‐paced. Our findings are limited by the use of assigned job scores based on job title. Am. J. Ind. Med. 31:256–259, 1997. © 1997 Wiley‐Liss, Inc.

Improved data collection is needed for OHSN to realize its full potential. Workplace violence is a serious, increasingly common problem in OHSN-participating hospitals. Nursing assistants and nurses have the highest injury risk.

For the entire cohort, there was no increase in mortality from hematopoietic cancer. There was a slight but significant increase among men, however. Among men and women combined, there was a trend toward an increased risk of death from hematopoietic cancer with increasing lengths of time since the first exposure to ethylene oxide.

The authors have created US mortality rates (age, sex, race, and calendar-time specific) and proportions, using multiple cause-of-death data, for the years 1960-1989. Multiple cause-of-death data include the usual underlying cause of death from the death certificate as well as contributory causes and other significant conditions. US multiple-cause rates and proportions enable the user to calculate the expected occurrences of disease on the death certificates of a cohort under study. There is an average of 2.66 causes and/or contributory conditions listed on US death certificates, increasing over time from 2.54 in the 1960s to 2.76 in the 1980s. The ratio of multiple-cause listings to underlying cause listings varies by disease, from low ratios for cancers to high ratios for diseases such as diabetes, arthritis, prostate disease, hypertension, pneumoconiosis, and renal disease. Use of these data is illustrated with two cohorts. Multiple-cause analysis (but not underlying cause analysis) revealed twofold significant excesses of renal disease and arthritis among granite cutters. For workers exposed to dioxin, neither multiple-cause nor underlying cause analysis indicated any excess of diabetes, an outcome of a priori interest. Good candidates for multiple-cause analysis are diseases that are of long duration, not necessarily fatal, yet serious enough to be listed on the death certificate.