Is the effect of work stress on cardiovascular mortality confounded by socioeconomic factors in the Valmet study?

Respective Mediating Effects of Social Position and Work Environment on the Incidence of Common Cardiovascular Risk Factors

Background

Social position and work environment are highly interrelated and their respective contribution to cardiovascular risk is still debated.

Methods and Results

In a cohort of 20 625 French workers followed for 25 years, discrete‐time survival analysis with reciprocal mediating effects, adjusted for sex, age, and parental history of early coronary heart disease, was performed using Bayesian structural equation modeling to simultaneously investigate the extent to which social position mediates the effect of work environment and, inversely, the extent to which work environment mediates the effect of social position on the incidence of common cardiovascular risk factors. Depending on the factor, social position mediates 2% to 53% of the effect of work environment and work environment mediates 9% to 87% of the effect of social position. The mediation by work environment is larger than that by social position for the incidence of obesity, hypertension, dyslipidemia, diabetes, sleep complaints, and depression (mediation ratios 1.32–41.5, 6.67 when modeling the 6 factors together). In contrast, the mediation by social position is larger than that by work environment for the incidence of nonmoderate alcohol consumption, smoking, and leisure‐time physical inactivity (mediation ratios 0.16–0.69, 0.26 when modeling the 3 factors together).

Conclusions

The incidence of behavioral risk factors seems strongly dependent on social position whereas that of clinical risk factors seems closely related to work environment, suggesting that preventive strategies should be based on education and general practice for the former and on work organization and occupational medicine for the latter.

Combined Effect of Lead Exposure and Allostatic Load on Cardiovascular Disease Mortality-A Preliminary Study

This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008 linked to 1999-2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

Analysis of factors contributing to occupational health inequality in Korea: a cross-sectional study using nationally representative survey data

Background

Despite the consensus that higher occupational classes tend to have better health and lower mortality rates, one study has reported reversed occupational gradients in mortality rates among Korean men after the economic crisis in the late 2000s. To examine these patterns of health inequality in more detail, we investigated the tendency of occupational gradients in socioeconomic position and multiple pathway indicators known to affect mortality in Korea.

Methods

We used data from 4176 men aged 35–64 in Korea derived from the 2007–2009 and 2013–2015 Korean National Health and Nutrition Examination Surveys. We compared the age-standardized prevalence and age-adjusted mean values of each contributing factor to health inequality among occupational groups, which are divided into upper non-manual workers, lower non-manual workers, manual workers, and others. Contributing factors included childhood and adulthood socioeconomic position indicators, biological risk factors, health behaviors, psychosocial factors, and work environment.

Results

Upper non-manual workers had prominently higher levels of education, income, parental education, and economic activity than lower non-manual and manual workers. The rates of smoking and high-risk alcohol consumption were lower, and the rate of weight control activities was higher, in the non-manual classes. Further, the rates of depression and suicidal ideation were lower, and perceptions of the work environment were more favorable, among non-manual workers than among their manual counterparts.

Conclusions

We detected occupational inequality in a wide range of socioeconomic positions and pathway indicators in Korea with consistently favorable patterns for upper non-manual workers. These occupational gradients do not support the previously reported reversed pattern of higher mortality rates in non-manual groups versus in the manual job class in Korea.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00638-9.

The relative contributions of behavioral, biological, and psychological risk factors in the association between psychosocial stress and all-cause mortality among middle- and older-aged adults in the USA

Evidence of an association between psychosocial stress and mortality continues to accumulate. However, despite repeated calls in the literature for further examination into the physiological and behavioral pathways though which stress affects health and mortality, research on this topic remains limited. This study addresses this gap by employing a counterfactual-based mediation analysis of eight behavioral, biological, and psychological pathways often hypothesized to play a role in the association between stress and health. First, we calculated the survival rate of all-cause mortality associated with cumulative psychosocial stress (high vs. low/moderate) using random effects accelerated failure time models among a sample of 7108 adults from the Midlife in the United States panel study. Then, we conducted a multiple mediator mediation analysis utilizing a counterfactual regression framework to determine the relative contributions of each mediator and all mediators combined in the association between stress and mortality. Exposure to high psychosocial stress was associated with a 0.76 times reduced survival rate over the follow-up period 1995-2015, while adjusting for age, sex, race, income, education, baseline health, and study design effects. The mediators accounted for 49% of this association. In particular, smoking, sedentary behavior, obesity/BMI, and cardiovascular disease displayed significant indirect effects and accounted for the largest reductions in the total effect of stress on mortality, with natural indirect effects of 14%, 12%, 11%, and 4%, respectively. In conclusion, traditional behavioral and biological risk factors play a significant role in the association between psychosocial stress and mortality among middle and older adults in the US context. While eliminating stress and the socioeconomic disparities that so often deliver people into high-stress scenarios should be the ultimate goal, public health interventions addressing smoking cessation, physical activity promotion, and cardiovascular disease treatment may pay dividends for preventing premature mortality in the near-term.

Psychosocial information use for clinical decisions in diabetes care

OBJECTIVE

There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care.

MATERIALS AND METHODS

This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data.

RESULTS

Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions.

DISCUSSION

Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS.

CONCLUSION

Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.

Work stress on rise? Comparative analysis of trends in work stressors using the European working conditions survey

Objective

The rapid transformation of labor markets has been accompanied by the belief of rising stress at work. However, empirical evidence on such trends based on reliable survey data is scarce. This study analyzes long-term trends in well-established measures of work stressors across Europe, as well as potential occupational differences.

Methods

We use repeated cross-sectional data of 15 European countries from waves 1995, 2000, 2005, 2010, and 2015 of the European Working Conditions Surveys. We apply three-way multilevel regressions (with employees nested in country-years, which are in turn nested in countries) to analyze trends in work stressors measured according to the demand-control and effort-reward imbalance models. Trends by occupational groups are also assessed.

Results

Our findings suggest that work stress generally increased from 1995 to 2015, and that the increase was mostly driven by psychological demands. People working in lower-skilled occupations had generally higher levels of job strain and effort-reward imbalance, as well as they tend to have a steeper increase in job strain than people working in higher-skilled occupations. Most of the change occurred from 1995 to 2005.

Conclusion

Our results indicate that work stress has been on rise since 1995, specifically for people working in disadvantageous occupations. This directs the attention to the vulnerable position of the least skilled and also to the use of preventive measures to counteract some of the disadvantages experienced by this occupational group.

All-cause mortality and the time-varying effects of psychosocial work stressors: A retrospective cohort study using the HILDA survey

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn't clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality.

OBJECTIVE

We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships.

METHODS

Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality.

RESULTS

Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively.

CONCLUSIONS

Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality.

Psychosocial work exposures of the job strain model and cardiovascular mortality in France: results from the STRESSJEM prospective study

Objectives:

The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees.

Methods:

The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality.

Results:

Within the 1976–2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women.

Conclusions:

Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment.

Cross-sectional surveillance study to phenotype lorry drivers' sedentary behaviours, physical activity and cardio-metabolic health

OBJECTIVES

Elevated risk factors for a number of chronic diseases have been identified in lorry drivers. Unhealthy lifestyle behaviours such as a lack of physical activity (PA) and high levels of sedentary behaviour (sitting) likely contribute to this elevated risk. This study behaviourally phenotyped UK lorry drivers' sedentary and non-sedentary behaviours during workdays and non-workdays and examined markers of drivers cardio-metabolic health.

SETTING

A transport company from the East Midlands, UK.

PARTICIPANTS

A sample of 159 male heavy goods vehicle drivers (91% white European; (median (range)) age: 50 (24, 67) years) completed the health assessments. 87 (age: 50.0 (25.0, 65.0); body mass index (BMI): 27.7 (19.6, 43.4) kg/m²) provided objective information on sedentary and non-sedentary time.

OUTCOMES

Participants self-reported their sociodemographic information. Primary outcomes: sedentary behaviour and PA, assessed over 7 days using an activPAL3 inclinometer. Cardio-metabolic markers included: blood pressure (BP), heart rate, waist circumference (WC), hip circumference, body composition and fasted capillary blood glucose, triglycerides, high-density lipopreotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels. These cardio-metabolic markers were treated as secondary outcomes.

RESULTS

Lorry drivers presented an unhealthy cardio-metabolic health profile (median (IQR) systolic BP: 129 (108.5, 164) mm Hg; diastolic BP: 81 (63, 104) mm Hg; BMI: 29 (20, 47) kg/m²; WC: 102 (77.5, 146.5) cm; LDL-C: 3 (1, 6) mmol/L; TC: 4.9 (3, 7.5) mmol/L). 84% were overweight or obese, 43% had type 2 diabetes or prediabetes and 34% had the metabolic syndrome. The subsample of lorry drivers with objective postural data (n=87) accumulated 13 hours/day and 8 hours/day of sedentary behaviour on workdays and non-workdays (p<0.001), respectively. On average, drivers accrued 12 min/day on workdays and 6 min/day on non-workdays of moderate-to-vigorous PA (MVPA).

CONCLUSION

Lorry drivers demonstrate a high-risk cardio-metabolic profile and are highly sedentary and physically inactive. Interventions to reduce sitting and increase MVPA during breaks and leisure time to improve cardio-metabolic health are urgently needed. Educational programmes to raise awareness about diet and exercise are recommended.

Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death

Background

Suicide rates among those employed in male-dominated professions such as construction are elevated compared to other occupational groups. Thus far, past research has been mainly quantitative and has been unable to identify the complex range of risk and protective factors that surround these suicides.

Methods

We used a national coronial database to qualitatively study work and non-work related influences on male suicide occurring in construction workers in Australia. We randomly selected 34 cases according to specific sampling framework. Thematic analysis was used to develop a coding structure on the basis of pre-existing theories in job stress research.

Results

The following themes were established on the basis of mutual consensus: mental health issues prior to death, transient working experiences (i.e., the inability to obtain steady employment), workplace injury and chronic illness, work colleagues as a source of social support, financial and legal problems, relationship breakdown and child custody issues, and substance abuse.

Conclusion

Work and non-work factors were often interrelated pressures prior to death. Suicide prevention for construction workers needs to take a systematic approach, addressing work-level factors as well as helping those at-risk of suicide

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4500-8) contains supplementary material, which is available to authorized users.

The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers

BACKGROUND

Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk.

PROCEDURES

We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination.

RESULTS

Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95% CI 1.38,2.63).

PRACTICAL IMPLICATIONS

Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks.

Work Content and Serious Mental Illness among Middle-Aged Men: Results from a 6-Year Longitudinal Study in Japan

Objective

The present study aimed to determine prospective associations between work content after a working life of more than 20 years and serious mental illness among Japanese men aged 50 to 59 years, using a nationwide population-based survey.

Methods

Data were extracted from a national longitudinal survey of middle-aged and elderly persons previously conducted by the Ministry of Health, Labour and Welfare in Japan. We analyzed data across 10 work content categories for Japanese men who had been working in the same job type or industry for over 20 years. As part pf the survey, participants completed the Kessler (K)6 scale each year to determine their level of psychological distress (with scores ≥13 indicating serious mental illness). Cox discrete time proposal hazard regression analysis was used to examine potential associations between work content and serious mental illness from 2005 to 2010. Further adjustments were made for other sociodemographic characteristics and lifestyle factors.

Results

The current study involved a total of 11,942 participants with a mean (± standard deviation [SD]) of follow-up was 3.4 (± 2.0) years, during which time 892 participants (7.5%) had been classified as having a new-onset serious mental illness. Men who had worked in service jobs and in manufacturing jobs at baseline were more likely to develop serious mental illness than those in managerial jobs (hazard ratio 1.37, 1.30, 95% confidence intervals 1.04–1.80, 1.02–1.65) after adjustment for confounding variables.

Conclusion

These findings suggest that Japanese men aged 50 to 59 years who have worked in service and manufacturing jobs after a working life of over 20 years have an increased risk of serious mental illness during follow-up. Identifying the most at-risk work content category after a working life of over 20 years would be an essential part of providing more effective interventions for psychological distress among Japanese men in this age group.

The association between education and work stress: does the policy context matter?

OBJECTIVES

Several studies report socioeconomic differences in work stress, where people in lower socioeconomic positions (SEP) are more likely to experience this burden. In the current study, we analyse associations between education and work stress in a large sample of workers from 16 European countries. In addition we explore whether distinct national labour market policies are related to smaller inequalities in work stress according to educational attainment.

METHODS

We use data collected in 2010/11 in two comparative studies ('Survey of Health, Ageing and Retirement in Europe' and the 'English Longitudinal Study of Ageing'; N = 13695), with samples of men and women aged 50 to 64 from 16 European countries. We measure highest educational degree according to the international standard classification of education (ISCED) and assess work stress in terms of the demand-control and the effort-reward imbalance model. National labour market policies are measured on the basis of policy indicators which are divided into (1) 'protective' policies offering financial compensation to those excluded from the labour market (e.g. replacement rate), and (2) 'integrative' policies supporting disadvantaged individuals on the labour market (e.g. investments into active labour market policies or possibilities for further qualification in later life). In addition to country-specific analyses, we estimate multilevel models and test for interactions between the indicators of national policies and individual education.

RESULTS

Main findings demonstrate consistent associations between lower education and higher levels of work stress in all countries. The strength of this association, however, varies across countries and is comparatively small in countries offering pronounced 'integrative' policies, in terms of high investments into measures of an active labor market policy and high participation rates in lifelong learning activities.

CONCLUSIONS

Our results point to different types of policies that may help to reduce educational differences in work stress, in particular policies supporting those who are disadvantaged on the labour market.

Longitudinal measurement invariance of the effort-reward imbalance scales in the Young Finns study

OBJECTIVES

In order to make valid conclusions about individual change in work-related risk factors it is important to examine whether these factors are measurement invariant over time. We tested the measurement invariance of the effort-reward imbalance (ERI) scales using the ERI Questionnaire (ERI-Q). Additionally, we examined the criterion validity of the ERI scales.

METHODS

The sample used in this study was population-based and comprised 2128 participants (56.6% women) in full-time employment. Data on effort, reward and self-reported general stress were collected in 2007 and 2012. Measurement invariance was assessed separately for the effort and reward scales, with reward treated as a first-order and as a second-order variable. Criterion validity of the ERI scales was also examined using a single-item measure of general stress.

RESULTS

Effort and reward were found to be measurement invariant over time, that is, they measured the same latent variable across both time points. Furthermore, ERI and its components showed adequate criterion validity, and effort was additionally found to prospectively predict general stress 5 years later (β=0.072, 95% CI 0.013 to 0.131).

CONCLUSIONS

Our results indicate that changes in the scores of the ERI scales are more likely caused by changes in perceptions of work characteristics than by changes in the construct of the scales. Additionally, the results support the criterion validity of ERI and its components.

Effects of recreational aerobics on adaptation of female first-year students from urban area and rural area to conditions of higher school education

Experiments proved beneficial effects of additional classes for recreational aerobics on the realization of morphophysiological mechanisms of adaptation to the education in Higher School in female first-year students.

Where does work stress come from? A generalizability analysis of stress in police officers

Differences among workers and workplace stressors both contribute to perceiving work as stressful. However, the relative importance of these sources to work stress is not well delineated. Moreover, the extent to which work stress additionally reflects unique matches between specific workers and particular job stressors is also unclear. In this study, we use generalizability theory to specify and compare sources of variance in stress associated with police work. US police officers (N = 115) provided ratings of 60 stressors commonly associated with policing duties. Primary and secondary stress appraisal ratings reflected differences among officers in tendencies to generally perceive work stressors as stressful (14-15% officer effect), and also agreement among officers in viewing some stressors as more stressful than others (18-19% stressor effect). However, ratings especially reflected distinct pairings of officers and stressors (38-41% interaction effect). Additional analyses revealed individual differences and stressor characteristics associated with each variance component, including an officer × stressor interaction - compared to officers low in neuroticism, highly neurotic officers provided lower primary appraisal ratings of stressors generally seen as not serious, and also higher primary appraisal ratings of stressors that were seen as serious. We discuss implications of the current approach for the continued study of stress at work.

Invited commentary: Structure and context matters--the need to emphasize "social" in "psychosocial epidemiology"

A high level of influence on core aspects of life in general and at the workplace in particular is believed to reduce the risk of ill health. In this issue of the Journal, Joensuu et al. (Am J Epidemiol. 2012;175(7):609-619) shake this belief by presenting prospective associations between high decision authority at work and increased all-cause, cardiovascular, and alcohol-related mortality among Finnish forest company employees followed through 2005. In this invited commentary, the author welcomes these findings as a much needed inspiration for reflections on the current state of psychosocial epidemiology and how it can be advanced in the future. Although it is important to investigate possible harmful effects of too high decision authority, the author argues that it is even more important to be aware that psychosocial factors originate from societal structures and social contexts. Understanding these structures and contexts, their changes over time, and their relation to psychosocial factors is key for understanding the effect of psychosocial factors on health and illness. Joensuu et al. have presented thought-provoking findings. It is the hope of the author that this will push the research community to emphasize the "social" in "psychosocial epidemiology."

Long-term effects of poor health on employment: the significance of life stage and educational level

Previous research has found the employment consequences of poor health to be of increased magnitude in low qualified groups. The purpose of this study is to investigate if this relationship varies within different stages of the life course when focusing on long term associations with non-employment. An expectation of the article is that stronger effects of poor health may be found in young adults compared to middle aged people. The article considers two possible explanations: normative change and life stage resources. Using three-wave panel data from the Norwegian county of Nord-Trøndelag, the HUNT study allows the study of respondents over two decades. Two narrow cohorts have been selected for comparison, and health was measured by self-reported longstanding limiting illness. For the analyses, cross tabulations, logistic regression, and fixed effects logistic regression techniques are used. The article concludes in favour of the resource explanation; young adulthood is a critical period in relation to long term employment consequences of poor health, and especially so among people with fewer educational resources. Cohort differences in the employment consequences of poor health are not likely to be caused by poorer work ethics among younger cohorts.

Exploring the interplay between work stress and socioeconomic position in relation to common health complaints: the role of interaction

BACKGROUND

This study explored the interplay between work stress and socioeconomic position and investigated if the interaction of work stress and low socioeconomic position is associated with poorer health.

METHODS

A representative sample of the Swedish working population, including 2,613 employees (48.7% women) aged 19-64 years, was analyzed. The health outcomes were poor self-rated health, psychological distress, and musculoskeletal pain. Work stress was operationalized as job strain and effort-reward imbalance, and socioeconomic position as occupational class. Interaction analysis was based on departure from additivity as criterion, and a synergy index (SI) was applied, using odds ratios (ORs) from logistic regressions for women and men.

RESULTS/CONCLUSIONS

In fully adjusted models, work stress, and in a lesser extent also socioeconomic position, was associated with higher odds for the three health complaints. The prevalence of poorer health was highest among those individuals jointly exposed to high work stress and low occupational class, with ORs ranging from 1.94 to 6.77 (95%CI 1.01-18.65) for poor self-rated health, 2.42-8.44 (95%CI 1.28-27.06) for psychological distress and 1.93-3.93 (95%CI 1.11-6.78) for musculoskeletal pain. The joint influence of work stress and low socioeconomic position on health was additive rather than multiplicative.

The Magnitude of Mortality from Ischemic Heart Disease Attributed to Occupational Factors in Korea - Attributable Fraction Estimation Using Meta-analysis

Objectives

Ischemic heart disease (IHD) is a major cause of death in Korea and known to result from several occupational factors. This study attempted to estimate the current magnitude of IHD mortality due to occupational factors in Korea.

Methods

After selecting occupational risk factors by literature investigation, we calculated attributable fractions (AFs) from relative risks and exposure data for each factor. Relative risks were estimated using meta-analysis based on published research. Exposure data were collected from the 2006 Survey of Korean Working Conditions. Finally, we estimated 2006 occupation-related IHD mortality.

Results

For the factors considered, we estimated the following relative risks: noise 1.06, environmental tobacco smoke 1.19 (men) and 1.22 (women), shift work 1.12, and low job control 1.15 (men) and 1.08 (women). Combined AFs of those factors in the IHD were estimated at 9.29% (0.3-18.51%) in men and 5.78% (-7.05-19.15%) in women. Based on these fractions, Korea's 2006 death toll from occupational IHD between the age of 15 and 69 was calculated at 353 in men (total 3,804) and 72 in women (total 1,246).

Conclusion

We estimated occupational IHD mortality of Korea with updated data and more relevant evidence. Despite the efforts to obtain reliable estimates, there were many assumptions and limitations that must be overcome. Future research based on more precise design and reliable evidence is required for more accurate estimates.

Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings

An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

Assessing the contribution of working conditions to socioeconomic disparities in health: a commentary

INTRODUCTION

Occupational health researchers can play a pivotal role in increasing our understanding of the role of physical and psychosocial working conditions in producing socioeconomic health disparities and trends of increasing socioeconomic health disparities, contributing to interventions to reduce such disparities, and helping to improve public education materials on this subject. However, a number of methodological challenges in this field need to be considered.

METHODS

Commentary, including a review of selected studies.

RESULTS/CONCLUSION

Research needs to be guided by models of the associations between social (socioeconomic position (SEP), race/ethnicity, immigration status, and gender) and occupational variables and health, to avoid inappropriate control for confounding, and to specify causal pathways (mediation) and interaction effects. Different approaches to the theory and measurement of SEP also need to be tested.

Association of workplace chronic and acute stressors with employee weight status: data from worksites in turmoil

OBJECTIVES

To examine the independent and joint effects of psychosocial chronic and acute stressors with weight status and to report the intraclass correlation coefficient for body mass index (BMI).

METHODS

Baseline data on 2782 employees from a group-randomized weight gain prevention intervention were examined to investigate the effect of high job strain and job insecurity on BMI and on the odds of overweight/obesity including potential confounders and mediating variables. Data were analyzed using mixed models.

RESULTS

The mediating variables removed the effect of high job strain on weight (beta = 0.68, P = 0.07; odds ratios = 1.34, confidence interval = 1.00 to 1.80) whereas job insecurity was never significant. Intraclass correlation coefficient for BMI is 0.0195, 0.0193, and 0.0346 overall, for men and women, respectively.

CONCLUSION

Worksite wellness should target health enhancing behaviors to minimize the health effects of psychosocial work conditions.

Do pre-employment influences explain the association between psychosocial factors at work and coronary heart disease? The Whitehall II study

OBJECTIVES

To examine whether the association between psychosocial factors at work and incident coronary heart disease (CHD) is explained by pre-employment factors, such as family history of CHD, education, paternal education and social class, number of siblings and height.

METHODS

A prospective cohort study of 6435 British men aged 35-55 years at phase 1 (1985-1988) and free from prevalent CHD at phase 2 (1989-1990) was conducted. Psychosocial factors at work were assessed at phases 1 and 2 and mean scores across the two phases were used to determine long-term exposure. Selected pre-employment factors were assessed at phase 1. Follow-up for coronary death, first non-fatal myocardial infarction or definite angina between phase 2 and 1999 was based on clinical records (250 events, follow-up 8.7 years).

RESULTS

The selected pre-employment factors were associated with risk for CHD: HRs (95% CI) were 1.33 (1.03 to 1.73) for family history of CHD, 1.18 (1.05 to 1.32) for each quartile decrease in height and 1.16 (0.99 to 1.35) for each category increase in number of siblings. Psychosocial work factors also predicted CHD: 1.72 (1.08 to 2.74) for low job control and 1.72 (1.10 to 2.67) for low organisational justice. Adjustment for pre-employment factors changed these associations by 4.1% or less.

CONCLUSIONS

In this occupational cohort of British men, the association between psychosocial factors at work and CHD was largely independent of family history of CHD, education, paternal educational attainment and social class, number of siblings and height.

Occupation as socioeconomic status or environmental exposure? A survey of practice among population-based cardiovascular studies in the United States

Decisions about how occupation is used in epidemiologic research can affect conclusions about the importance of socioeconomic and environmental factors in explaining disparities for outcomes such as cardiovascular disease. A review of practices in the collection and use of occupational data was conducted among population-based cardiovascular studies in the United States. Studies were identified for review from the National Heart, Lung, and Blood Institute website and the biomedical database, Computer Retrieval of Information on Scientific Projects, by use of selected criteria. Data collection instruments and study publications were retrieved and reviewed for 30 of 33 studies (91%). Most of the studies (83%) collected at least descriptive occupational data, and more than half (60%) collected data on workplace hazards. The reviewed studies produced 80 publications in which occupational data were used in analyses, most often as an indicator of socioeconomic status. Authors rarely acknowledged known conceptual and empirical links among socioeconomic status, employment stability, and working conditions. Underutilization of data on workplace conditions was found. Existing data could be used more effectively to examine the contribution of work-related social and environmental conditions to the development of modifiable cardiovascular disease through multiple pathways.

Is the impact of job control on stroke independent from socioeconomic status?: a large-scale study of the Swedish working population

BACKGROUND AND PURPOSE

The main purpose of this study was to test whether the impact of job control on stroke mortality is independent of socioeconomic factors.

METHODS

This was a register-based cohort study of nearly 3.5 million working people (25 to 64 years of age in the 1990 Swedish Census) with a 5-year follow-up for stroke mortality. Job control was aggregated to the data from a secondary data source (job exposure matrix). Gender-specific Poisson regressions were performed.

RESULTS

Compared with high job control occupations, low job control was significantly related to hemorrhagic (relative risk, 1.54; 95% CI, 1.10 to 2.17) and all-stroke mortality (relative risk, 1.50; 95% CI, 1.11 to 2.03) in women but not in men. The significance of job control in women was independent of all confounders included (marital status, education level, and occupational class). Class-specific analyses indicated a consistent effect of job control for most classes (significant for female lower nonmanuals). However, low job control did not increase the risk of stroke mortality in upper nonmanuals.

CONCLUSIONS

Job control was significantly related to hemorrhagic and all-stroke mortality in women but not in men.

Preemployment Family Factors as Predictors of Effort/Reward Imbalance in Adulthood: A Prospective 18-year Follow-Up in the Cardiovascular Risk in Young Finns Study

OBJECTIVE

We prospectively examined whether preemployment family factors predict adulthood work stress manifested as effort-reward imbalance (ERI).

METHODS

The study sample comprised 746 participants from the Cardiovascular Risk in Young Finns Study. Data were collected by questionnaires. The parents reported their socioeconomic position and life satisfaction in 1983 when the participants were at age 6 to 21. The participants reported ERI in 2001 at age 24 to 39.

RESULTS

High rewards were predicted by high parental life satisfaction in men and by high parental socioeconomic position in women. The association between higher parental socioeconomic position and higher efforts was mediated by participant's education. Preemployment family factors were not associated with the total ERI.

CONCLUSIONS

Although preemployment family factors were associated with the reward and effort components, they seemed to have little effect on the total ERI.

A life-course approach to measuring socioeconomic position in population health surveillance systems

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

Parental socioeconomic position and parental life satisfaction as predictors of job strain in adulthood: 18-year follow-up of the Cardiovascular Risk in Young Finns Study

OBJECTIVE

The objective of this study was to prospectively examine whether parental socioeconomic position (SEP) and parental life satisfaction predict job strain in adulthood.

METHODS

The cohort comprised 755 participants from the ongoing Cardiovascular Risk in Young Finns Study. The parents reported their SEP and life satisfaction when the participants were aged 6-21 years. Eighteen years later at ages 24-39 years, the participants responded to a survey on job strain and its components, job control and job demands.

RESULTS

According to structural equation modeling, lower parental SEP and higher parental life dissatisfaction independently predicted increased adulthood job strain. Lower parental SEP also predicted lower educational attainment, which in turn was linked with higher job strain and lower job control. We found no gender differences in these predictive relationships.

CONCLUSION

Parental SEP and parental life satisfaction are associated with job strain in adulthood, and the effect is partly mediated by education. These prospective data suggest that preemployment factors should be taken into account as potential confounders in future research on job strain-health associations.

Is incomplete recovery from work a risk marker of cardiovascular death? Prospective evidence from industrial employees

OBJECTIVE

A chronic lack of recovery from work during leisure time is hypothesized to indicate a health risk among employees. We examined whether incomplete recovery from work predicted cardiovascular mortality.

METHODS

This prospective cohort study involved 788 industrial employees (534 men, 254 women, mean age 37.3, SD = 12.0) who were initially free from cardiovascular diseases. The baseline examination in 1973 determined cases of cardiovascular disease, cardiovascular risk factors, and the extent of recovery from work. Data on mortality in 1973 to 2000 were derived from the national mortality register.

RESULTS

Sixty-seven cardiovascular deaths and 102 deaths from noncardiovascular causes occurred during the mean follow-up of 25.6 years. Employees who seldom recovered from work during free weekends had an elevated risk of cardiovascular death (p = .007) but not of other mortality (p = .82). The association between incomplete recovery and cardiovascular death remained after adjustment for age, sex, and 16 conventional risk factors, including occupational background, cholesterol, systolic pressure, body mass index, smoking, alcohol consumption, physical inactivity, depressive symptoms, fatigue, lack of energy, and job stress. The association was not explained by deaths that occurred close to the assessment of recovery from work.

CONCLUSIONS

This study suggests that incomplete recovery from work is an aspect of the overall risk profile of cardiovascular disease mortality among employees.

Associations between working conditions and angina pectoris symptoms among employed women

OBJECTIVE

This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women.

METHODS

Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek's job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work-home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded.

RESULTS

AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause.

CONCLUSIONS

Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women.

Is the association between low job control and coronary heart disease confounded by risk factors measured in childhood and adolescence among Swedish males 40–53 years of age?

OBJECTIVES

Low job control is associated with an increased relative risk of coronary heart disease (CHD). The increased risk seems to be most marked in men under 55 years of age. Adverse social circumstances in childhood have been related to an increased risk of CHD in adulthood. The aim of this study was to investigate the role of differences in CHD risk factors measured in childhood or late adolescence (indicators of social circumstances and negative behaviour), as well as social circumstances in adulthood, for the association between low job control and CHD among Swedish men 40-53 years of age.

METHODS

The study is based on a cohort of 49 323 young Swedish males, born 1949-51. For the study we have used information on childhood environment collected at the 1960 census (when the subjects were 9-11 years of age), negative behavioural factors collected at compulsory conscription for military training among young Swedish men in 1969/70 (when the subjects were 18-20 years of age), data on job control from 1990 (measured indirectly from occupational titles using a job exposure matrix, when the subjects were 39-41 years of age), and follow-up data on CHD hospitalization and mortality between the years 1991 and 2003.

RESULTS

An increased relative risk of CHD (HR = 1.55; 95% CI 1.31-1.84) was found among workers with low job control, compared with workers with high job control. Risk factors for CHD measured in different phases during the life course were strongly associated with level of job control in middle age. In multivariate analyses, taking the factors measured in childhood into consideration and also adjusting for lifestyle factors measured at age 18-20 (smoking, heavy alcohol consumption, and overweight) the increased relative risk of CHD in low control jobs was reduced by 85%. After also adjusting for adult income (according to the 1985 census) no increased relative risks remained.

CONCLUSION

Risk factors for CHD measured already in childhood and adolescence could explain a substantial part of the of the increased risk of CHD and mortality among males 40-53 years of age associated with the measure of low work control used in this study. The results suggest that low job control, measured as in this study, is not a risk factor for CHD among men in this age group.