Contributors: Department of Epidemiology and Public Health; University College of London London (UCL); Finnish Institute of Occupational Health; Stress Research Institute; Stockholm University; School of Health Science; Jönköping University Sweden; Institute of Environmental Medicine; Karolinska Institutet Stockholm; Centre for Occupational and Environmental Medicine; Stockholm County Council; National Research Centre for the Working Environment; National Research Centre for the Working Environment (NRCWE); Department of Occupational and Environmental Medicine; Bispebjerg University Hospital (BUH); Federal Institute for Occupational Safety and Health (BAuA); School of Public Health; Université libre de Bruxelles (ULB); Department of Public Health; State University of Ghent; Universiteit Gent = Ghent University (UGENT); Department of Medical Sociology; Heinrich Heine Universität Düsseldorf = Heinrich Heine University Düsseldorf; The Netherlands Organisation for Applied Scientific Research (TNO); Centre de recherche en épidémiologie et santé des populations (CESP); Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM); Institute of Behavioural Sciences Helsinki (IBS); Faculty of Medecine Helsinki; Helsingin yliopisto = Helsingfors universitet = University of Helsinki-Helsingin yliopisto = Helsingfors universitet = University of Helsinki; Department of Health Sciences; Mid Sweden University; School of Sociology, Social Policy, & Social Work; Queen's University Belfast (QUB); Department of Psychology; Umeå University, Sweden; Department of Public Health Copenhagen; Faculty of Health and Medical Sciences; University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH); Nordic School of Public Health; University of Turku; Folkhälsan Research Center; Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Aff airs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.
نبذة مختصرة : International audience ; Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. 30,214 (15%) of 197,473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%. Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Finnish Work Environment Fund, the Academy ...
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