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Lancet Diabetes Endocrinol. 2018 Sep;6(9):705-713. doi: 10.1016/S2213-8587(18)30140-2. Epub 2018 Jun 5.

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

Author information

1
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: m.kivimaki@ucl.ac.uk.
2
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland.
3
Department of Epidemiology and Public Health, University College London, London, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK.
4
Department of Epidemiology and Public Health, University College London, London, UK.
5
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
6
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
7
Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
8
Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
9
Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
10
Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
11
Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France; Versailles St-Quentin University, UMS 011, Villejuif, France.
12
Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
13
Department of Public Health, University of Helsinki, Helsinki, Finland.
14
Finnish Institute of Occupational Health, Helsinki, Finland.
15
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Division of Health Psychology, SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland; Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, UK.
16
National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
17
Department of Epidemiology and Public Health, University College London, London, UK; Inserm UMR 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
18
Department of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; School of Health and Education, University of Skövde, Skövde, Sweden; School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
19
Stress Research Institute, Stockholm University, Stockholm, Sweden.
20
Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
21
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
22
Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland.
23
National Centre for Cardiovascular Prevention and Outcomes, University College London, London, UK.

Abstract

BACKGROUND:

Although 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.

METHODS:

In 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.

RESULTS:

We 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).

INTERPRETATION:

In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

FUNDING:

NordForsk, UK Medical Research Council, and Academy of Finland.

PMID:
29884468
PMCID:
PMC6105619
DOI:
10.1016/S2213-8587(18)30140-2
[Indexed for MEDLINE]
Free PMC Article

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