Age, job characteristics and coronary health (original) (raw)
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Job strain and cardiovascular risk factors: a cross sectional study of employed Danish men and women
British journal of industrial medicine, 1991
As part of the World Health Organisation initiated MONICA project, 2000 men and women aged 30, 40, 50, and 60 from the general population were invited to undergo a medical examination with special emphasis on cardiovascular disease. A total of 1504 (75%) participated, 1209 of whom were employed. The participants answered a questionnaire on working, social, and health conditions and underwent clinical examinations that included the measurement of blood pressure and serum cholesterol, triglyceride, high density lipoprotein, fibrinogen, and glycated haemoglobin (HbA1C) concentrations. Using the demand-control model for measuring job strain suggested by Karasek, the employed people were classified according to those who had suffered job strain and those who had not in two different ways. The subjective classification was based on the participants' statements regarding demand and control in their jobs whereas the objective classification was based on job title and mode of payment. Mo...
American Journal of Epidemiology, 2004
Conflicting findings in the literature have made the relation between job strain and coronary heart disease (CHD) controversial. The effect of high job strain on the 10-year incidence of CHD and total mortality was examined in men and women participating in the Framingham Offspring Study; 3,039 participants, 1,711 men and 1,328 women, aged 18-77 years, were examined between 1984 and 1987 and followed for 10 years. Measures of job strain, occupational characteristics, and risk factors for CHD were collected at the baseline examination. Before and after controlling for systolic blood pressure, body mass index, cigarette smoking, diabetes, and the total/high density lipoprotein cholesterol ratio in Cox proportional hazards models, the authors found that high job strain was not associated with mortality or incident CHD in either men or women over the follow-up period. Contrary to expectation, women with active job strain (high demands-high control) had a 2.8fold increased risk of CHD (95% confidence interval: 1.1, 7.2) compared with women with high job strain (high demands-low control). For men, higher education, personal income, and occupational prestige were related to decreased risk of total mortality and CHD. These findings do not support high job strain as a significant risk factor for CHD or death in men or women. cohort studies; coronary disease; occupations; psychology; stress Abbreviations: CHD, coronary heart disease; CI, confidence interval; RR, relative risk.
A prospective study of job strain and coronary heart disease in US women
International Journal of Epidemiology, 2002
More US women than ever before are in paid employment. According to data from the US Bureau of Labor Statistics, 61% of women over age 20 are in paid employment. 1 Exposure to adverse job conditions and other occupational factors are therefore increasingly important considerations in the aetiology of coronary heart disease (CHD) in women. Among psychosocial risk factors for CHD, studies in men have established that a particular form of job stress, job strain, is predictive of CHD risk. The job strain model, developed by Karasek, posits that a combination of high psychological demands and low control increases the risk of CHD. 2 With few exceptions, 3-7 the majority of more than a dozen case-control and cohort studies in men have established an association between job strain and cardiovascular disease, across a variety of occupations and settings. [8][9] This association seems to be mediated in part through a more adverse profile of cardiovascular risk factors, such as smoking, 24 higher body mass index (BMI), 24 risk of hypertension, 25 and negative emotions such as hostility and depression. 26 However, the association between job strain and cardiovascular disease in men has also been found to be independent of these risk factors.
Job strain and symptoms of angina pectoris among British and Finnish middle-aged employees
2009
Background: High job strain has been linked with cardiovascular outcomes. This study aimed to examine whether job strain is associated with angina pectoris symptoms among British and Finnish non-manual employees. Methods: Postal questionnaire survey data among 40 to 60 year-old employees of the British Whitehall II Study (n=4551, 27% women) and the Finnish Helsinki Health Study (n=7605, 83% women) cohort were analyzed. Angina pectoris symptoms were the outcome in logistic regression analysis. Karasek's job strain was examined. Models were adjusted first for age, secondly for occupational class, and finally for smoking, heavy drinking, physical inactivity, unhealthy food habits, and obesity. Results: Angina pectoris symptoms were reported by 5% of women and 3% of men in Britain, and by 6% of women and 4% of men in Finland. High job strain was associated with angina pectoris symptoms among men in Britain (OR 2.08; CI 95% 1.07-4.02) and women in Finland (OR 1.90; CI 95% 1.36-2.63) independent of age, occupational class, and behavioral risk factors. However, similar associations between job strain and angina pectoris symptoms were not observed among men in Finland or women in Britain. Conclusion: The results yielded partial support for the association between job strain and angina pectoris symptoms across national contexts.
Psychosomatic Medicine, 2006
Evidence regarding the status of job strain as a risk factor for coronary heart disease (CHD) is mixed, including both results supporting the risk status and null findings. However, previous studies have typically assessed job strain at one point in time only. We examined whether the failure of such measurement to reflect long-term job strain could contribute to false null findings. Methods: Job strain and its components, as stress indicators, were assessed twice (3-year time lag) for 5043 men and 2210 women who were free of apparent CHD at baseline. Incident CHD after the stress measurement comprised CHD death, a first nonfatal myocardial infarction, or definite angina (mean follow-up, 10.4 years). The data analysis was based on Cox proportional-hazard models adjusted for age, sex, and employment grade and corrected using regression dilution ratios calculated from short-term repeat data in a random subsample. Results: In the total cohort, incidence of new CHD was higher for higher levels of job strain and demands. For these stress indicators, the corrected excess CHD risk was 30% and 29% higher than the corresponding uncorrected estimates, whereas the corresponding increase for job control was only 13%. Effects of job strain and work demands, but not job control, were stronger for a subgroup, with consistent exposure measurements over time than for the total cohort. Conclusion: This evidence suggests that use of single-time exposure measures may underestimate the status of long-term job strain as a CHD risk factor.
Is job strain a major source of cardiovascular disease risk?
Scandinavian Journal of Work, Environment & Health, 2004
Empirical studies on job strain and cardiovascular disease (CVD), their internal validity, and the likely direction of biases were examined. The 17 longitudinal studies had the highest validity ratings. In all but two, biases towards the null dominated. Eight, including several of the largest, showed significant positive results; three had positive, nonsignificant findings. Six of nine case-control studies had significant positive findings; recall bias leading to overestimation appears to be fairly minimal. Four of eight cross-sectional studies had significant positive results. Men showed strong, consistent evidence of an association between exposure to job strain and CVD. The data of the women were more sparse and less consistent, but, as for the men, most of the studies probably underestimated existing effects. Other elements of causal inference, particularly biological plausibility, corroborated that job strain is a major CVD risk factor. Additional intervention studies are needed to examine the impact of ameliorating job strain upon CVD-related outcomes.