TY - JOUR

T1 - Persistent and changing job strain and risk of coronary heart disease

T2 - A population-based cohort study of 1.6 million employees in Denmark

AU - Rugulies, Reiner

AU - Framke, Elisabeth

AU - Sorensen, Jeppe Karl

AU - Svane-Petersen, Annemette Coop

AU - Alexanderson, Kristina

AU - Bonde, Jens Peter

AU - Farrants, Kristin

AU - Flachs, Esben Meulengracht

AU - Hanson, Linda L. Magnusson

AU - Nyberg, Solja T.

AU - Kivimaki, Mika

AU - Madsen, Ida E. H.

PY - 2020

Y1 - 2020

N2 - Objectives This study aimed to examine the association between job strain and incident coronary heart disease (CHD) in Denmark, while accounting for changes of job strain.Methods We included all employees residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N=1660 150). We determined exposure to job strain from 1996-2009 using a job exposure matrix (JEM) with annual updates. Follow-up for incident CHD was from 2001-2010 via linkage to health records. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and incident CHD.Results During 16.1 million person-years, we identified 24 159 incident CHD cases (15.0 per 10 000 person-years). After adjustment for covariates, job strain in 2000 predicted onset of CHD during a mean follow-up of 9.71 years (HR 1.10, 95% CI 1.07-1.13). When analyzing changes in job strain from one year to the next and CHD in the subsequent year, persistent job strain (HR 1.07, 95% CI 1.03-1.10), onset of job strain (HR 1.20, 95% CI 1.12-1.29) and removal of strain (HR 1.20, 95% CI 1.12-1.28) were associated with higher CHD incidence compared to persistent no job strain. Associations were similar among men and women.Conclusions Job strain is associated with a higher risk of incident CHD in Denmark. As we used a JEM, we can rule out reporting bias. However, under- or overestimation of associations is possible due to non-differential misclassification of job strain and residual confounding by socioeconomic position.

AB - Objectives This study aimed to examine the association between job strain and incident coronary heart disease (CHD) in Denmark, while accounting for changes of job strain.Methods We included all employees residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N=1660 150). We determined exposure to job strain from 1996-2009 using a job exposure matrix (JEM) with annual updates. Follow-up for incident CHD was from 2001-2010 via linkage to health records. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and incident CHD.Results During 16.1 million person-years, we identified 24 159 incident CHD cases (15.0 per 10 000 person-years). After adjustment for covariates, job strain in 2000 predicted onset of CHD during a mean follow-up of 9.71 years (HR 1.10, 95% CI 1.07-1.13). When analyzing changes in job strain from one year to the next and CHD in the subsequent year, persistent job strain (HR 1.07, 95% CI 1.03-1.10), onset of job strain (HR 1.20, 95% CI 1.12-1.29) and removal of strain (HR 1.20, 95% CI 1.12-1.28) were associated with higher CHD incidence compared to persistent no job strain. Associations were similar among men and women.Conclusions Job strain is associated with a higher risk of incident CHD in Denmark. As we used a JEM, we can rule out reporting bias. However, under- or overestimation of associations is possible due to non-differential misclassification of job strain and residual confounding by socioeconomic position.

KW - cardiovascular disease

KW - CHD

KW - epidemiology

KW - JEM

KW - job control

KW - job exposure matrix

KW - psychological demand

KW - psychosocial work environment

KW - stress

KW - work stress

KW - ACUTE MYOCARDIAL-INFARCTION

KW - WORK-ENVIRONMENT

KW - CARDIOVASCULAR-DISEASE

KW - DANISH REGISTERS

KW - EXPOSURE MATRIX

KW - HEALTH

KW - CHALLENGES

KW - MORTALITY

KW - VALIDITY

KW - TRENDS

U2 - 10.5271/sjweh.3891

DO - 10.5271/sjweh.3891

M3 - Journal article

C2 - 32202306

VL - 46

SP - 498

EP - 507

JO - Scandinavian Journal of Work, Environment & Health

JF - Scandinavian Journal of Work, Environment & Health

SN - 0355-3140

IS - 5

ER -