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Am J Public Health. 1998 Jan;88(1):68-74.

Two alternative job stress models and the risk of coronary heart disease.

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International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, England.



This study examined the association between two alternative job stress models-the effort-reward imbalance model and the job strain model-and the risk of coronary heart disease among male and female British civil servants.


The logistic regression analyses were based on a prospective cohort study (Whitehall II study) comprising 6895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart disease over a mean 5.3 years of follow-up.


The imbalance between personal efforts (competitiveness, work-related overcommitment, and hostility) and rewards (poor promotion prospects and a blocked career') was associated with a 2.15-fold higher risk of new coronary heart disease. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new disease. The odds ratios for low job control were 2.38 and 1.56 for self-reported and externally assessed job control, respectively. Work characteristics were simultaneously adjusted and controlled for employment grade level, negative affectivity, and coronary risk factors.


This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imbalance model and the job strain model (job control only)-on coronary heart disease.

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