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Stroke. 2015 Feb;46(2):557-9. doi: 10.1161/STROKEAHA.114.008019. Epub 2015 Jan 6.

Job strain and the risk of stroke: an individual-participant data meta-analysis.

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From the Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping, Sweden (E.I.F.); Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (E.I.F., L.A.); Stress Research Institute, Stockholm University, Stockholm, Sweden (E.I.F., C.L., L.L.M.H., T.T., H.W.); Finnish Institute of Occupational Health, Tampere, Finland (S.T.N., K.H.); Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden (L.A.); National Research Centre for the Working Environment, Copenhagen, Denmark (J.B.B., I.E.H.M., R.R.); Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark (M.B., M.L.N.); Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany (H.B.); Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany (N.D., T.L.); Netherlands Organisation for Applied Scientific Research (TNO), Hoofddorp, Netherlands (G.A.G., W.E.H., I.L.H.); Versailles-Saint Quentin University, Versailles, France (M.G., M.Z.); Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France (M.G., M.Z.); Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France (A.S.-M.); Department of Epidemiology and Public Health, University College London, London, UK (M.H., M. Kumari, M.J.S., A.S., A.B., E.J.B., A.S.-M., G.D.B., M. Kivimäki); Finnish Institute of Occupational Health, Helsinki, Finland (M. Joensuu, A. Koskinen, S.T.-T., M.V., A.V., M. Kivimäki); Institute of Behavioural Sciences (M. Jokela, M. Kivimäki) and Department of Public Health (M. Koskenvuo), University of Helsinki, Helsinki, Finland; Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden (A. Knutsson); Department of Psychology, Umeå University, Umeå, Sweden (M.N.); Finnish Institute of Occupational Health, Turku, Finland (T.O., J.P., P.S., J.V.); Danish National



Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.


We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.


In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.


Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.


psychological; stress; stroke; work

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