Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

Abstract

SummaryBackgroundAlthough 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.MethodsIn 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.ResultsWe 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).InterpretationIn men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and in...

Individual and Combined Effects of Job Strain Components on Subsequent Morbidity and Mortality

“…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, http://links.lww.com/EDE/B507).…”

Changes in work characteristics over 12 years: Findings from the 2002‐2014 US National NIOSH Quality of Work Life Surveys

“…and other countries . Job strain, a combination of high levels of job demands and low levels of control over one's work, is a risk factor for adverse health effects, including cardiovascular disease . The job strain (job demands and control) model was introduced in 1979 by Robert Karasek and explains how the risk of adverse health outcomes, including cardiovascular disease and its risk factors, can be increased by high work demands and low job control or job decision latitude.…”

Sociomedical problems of overwork-related deaths and disorders in Japan

“…For the Stress Check Program mentioned above, an important question remains as to how the data obtained should be used to improve the psychosocial work environment . The latest findings for workers in EU countries indicate that occupational stress, measured as job strain, elevates the mortality risk even among individuals with favorable health conditions, such as no lifestyle risk factors, normotensive, and better adherence to pharmacological treatment . This association highlights the need for managing work stress to avoid any damage in terms of both physical and mental health.…”

“…6 Furthermore, long working hours and other stress factors at work have been targeted as critical hazards to workers' health and well-being in the European countries and the United States. [7][8][9][10] A dramatic change occurred in Japan in November 2014 when the Government enforced the law targeting at preventing overwork-related deaths and disorders. 11 This progress clearly indicated the vesting of management and prevention of unfavorable events among workers exposed to long working hours and poor psychosocial factors at work as a national responsibility.…”