(13-10-12) Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data

Prof Mika Kivim?ki PhD et al

Background
Published work assessing psychosocial stress (job strain) as a risk factor for
coronary heart disease is inconsistent and subject to publication bias and
reverse causation bias. We analysed the relation between job strain and
coronary heart disease with a meta-analysis of published and unpublished
studies.
Methods
We used individual records from 13 European cohort studies (1985?2006) of men
and women without coronary heart disease who were employed at time of baseline
assessment. We measured job strain with questions from validated job-content
and demand-control questionnaires. We extracted data in two stages such that
acquisition and harmonisation of job strain measure and covariables occurred
before linkage to records for coronary heart disease. We defined incident
coronary heart disease as the first non-fatal myocardial infarction or coronary
death.
Findings
30 214 (15%) of 197 473 participants reported job strain. In 1?49 million
person-years at risk (mean follow-up 7?5 years [SD 1?7]), we recorded 2358
events of incident coronary heart disease. After adjustment for sex and age,
the hazard ratio for job strain versus no job strain was 1?23 (95% CI 1?10?
1?37). This effect estimate was higher in published (1?43, 1?15?1?77) than
unpublished (1?16, 1?02?1?32) studies. Hazard ratios were likewise raised in
analyses addressing reverse causality by exclusion of events of coronary heart
disease that occurred in the first 3 years (1?31, 1?15?1?48) and 5 years (1?30,
1?13?1?50) of follow-up. We noted an association between job strain and
coronary heart disease for sex, age groups, socioeconomic strata, and region,
and after adjustments for socioeconomic status, and lifestyle and conventional
risk factors. The population attributable risk for job strain was 3?4%.
Interpretation
Our findings suggest that prevention of workplace stress might decrease
disease incidence; however, this strategy would have a much smaller effect than
would tackling of standard risk factors, such as smoking.
Funding
Finnish Work Environment Fund, the Academy of Finland, the Swedish Research
Council for Working Life and Social Research, the German Social Accident
Insurance, the Danish National Research Centre for the Working Environment, the
BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical
Research Council, the Wellcome Trust, and the US National Institutes of Health.

Source: he Lancet, Early Online Publication, 14 September 2012
doi:10.1016/S0140-6736(12)60994-5Cite or Link Using DOI

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