Job Strain and Cardiovascular Disease

Summary of 18 studies from:
Schnall PL, Landsbergis PA, Baker D.
Annual Review of Public Health, 15, 1994, 381-411.

+ 6 newly published studies (1993-5), all non-confirmatory
+ 1 older study (1987), classified as confirmatory
(abstracts from 1995 Copenhagen conference not included)

Dependent Variable Design Studies Confirm
CVD morbidity/mortality
(2 w/ all-cause mortality)		 All 25 17
a. " " " Cohort 12 7 Cohort 12 7
b. " " " Case-control 4 4
c. " " " Cross Sectional 5 2
d. CHD symptoms All 4 4


LIST OF STUDIES

Dependent Variable Design Studies Confirm
a. CVD Cohort 12 7


Confirm - CVD

68. LaCroix, A. Z. 1984. High demand/low control work and the incidence of CHD in the Framingham Cohort. PhD Thesis. Univ. North Carolina, Chapel Hill.

5. Alfredsson, L., Spetz, C. L., Theorell, T. 1985. Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses. Int J Epidemiol 14:378-88.

33. Haan, M. N. 1988. Job strain and ischaemic heart disease: An epidemiological study of metal workers. Ann Clin Res 20:143-45.

50. Johnson, J. V., Hall, E. M., Theorell, T. 1989. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Eviron Health 15:271-79.

115. Theorell, T., Perski, A., Orth-Gomer, K., Hamsten, A., deFaire, U. 1991. The effect of returning to job strain on cardiac death risk after a first myocardial infarction before age 45. Int J Cardiol 30:61-67.

Confirm - all-cause mortality

8. Astrand, N. E., Hanson, B. S., Isacson, S. O. 1989. Job demands, job decision latitude, job support, and social network factors as predictors of mortality in a Swedish pulp and paper company. Br J Ind Med 46:334-40.

25. Falk, A., Hanson, B. S., Isacsson, S-O., Ostergren, P-O. 1992. Job strain and mortality in elderly men: Social network, support, and influence as buffers. Am J Public Health 82:1136-39.

Non-confirm - CVD

93. Reed, D. M., LaCroix, A. Z., Karasek, R. A., Miller, F. D., MacClean, C. A. 1989. Occupational strain and the incidence of coronary heart disease. Am J Epidemiol 129:495-502.

new. Suadicani P, Hein HO, Gyntelberg F. Are social inequalities as associated with the risk of ischaemic heart disease a result of psychosocial working conditions? Atherosclerosis 1993;101:165-75.

new. Alterman T, Shekelle RB, Vernon SW, Burau KD. Decision latitude, psychologic demand, job strain and coronary heart disease in the Western Electric Study. American Journal of Epidemiology 1994;139:620-7. (see note at end)

new. Hall EM, Johnson JV, Tsou T-S. Women, occupation, and risk of cardiovascular morbidity and mortality. Occupational Medicine: State of the Art Reviews 1993;8:709-19.

new. Hlatky MA, Lam LC, Lee KL, Clapp-Channing NE, Williams RB, Pryor DB, Califf RM, Mark DB. Job strain and the prevalence and outcome of coronary artery disease. Circulation 1995;92:327-333.
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Dependent Variable Design Studies Confirm
b. CVD Case-control 4 4

Confirm

54. Karasek, R. A., Baker, D., Marxer, F., Ahlbom, A., Theorell, T. 1981. Job decision latitude, job demands, and cardiovascular disease: A prospective study of Swedish men. Am J Public Health 71:694-705.

4. Alfredsson, L., Karasek, R. A., Theorell, T. 1982. Myocardial infarction risk and psychosocial work environment: An analysis of the male Swedish working force. Soc Sci Med 16:463-67.

110. Theorell, T., Hamsten, A., de Faire, U., Orth-Gomer, K., Perski, A. 1987. Psychosocial work conditions before myocardial infarction in young men. Int J Cardiol 15:33-46.

36. Hammar, N., Alfreddson, L., Theorell, T. Job characteristics and incidence of myocardial infarction: A study of men and women in Sweden, with particular reference to job strain. Int J Epidemiol 1994;23:277-284.
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Dependent Variable Design Studies Confirm
c. CVD Cross-sectional 5 2

Confirm

49. Johnson, J. V., Hall, E. M. 1988. Job strain, work place social support, and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Public Health 78:1336-42.

59. Karasek, R. A., Theorell, T., Schwartz, J. E., Schnall, P. L., Pieper, C. F., Michela, J. L. 1988. Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Survey (HANES). Am J Public Health 78:910-18.

Non-confirm

69. LaCroix, A. Z., Haynes, S. G. 1987. Chest pain in users of video display terminals (letter). JAMA 257:627-28.

new. Hall EM, Johnson JV, Tsou T-S. Women, occupation, and risk of cardiovascular morbidity and mortality. Occupational Medicine: State of the Art Reviews 1993;8:709-19.

new. Hlatky MA, Lam LC, Lee KL, Clapp-Channing NE, Williams RB, Pryor DB, Califf RM, Mark DB. Job strain and the prevalence and outcome of coronary artery disease. Circulation 1995;92:327-333.
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Dependent Variable Design Studies Confirm
d. CHD symptoms All 4 4


Confirm

55. Karasek, R. A., Gardell, B., Lindell, J. 1987. Work and non-work correlates of illness and behaviour in male and female Swedish white collar workers. J Occup Behav 8:187-207.

53. Karasek, R. A. 1990. Lower health risk with increased job control among white collar workers. J Organiza Behav 11:171-85.

54. Karasek, R. A., Baker, D., Marxer, F., Ahlbom, A., Theorell, T. 1981. Job decision latitude, job demands, and cardiovascular disease: A prospective study of Swedish men. Am J Public Health 71:694-705.

new. Braun S, Hollander R. A study of job stress among women and men in the Federal Republic of Germany. Health Education Research 1987;2:45-51. (see note at end)
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Note: The Alterman et al. 1994 study, while classified as non-confirmatory, provides results that are nearly significant: OR=1.40 (95% CI 0.92-2.14) for Job Strain controlling for CVD risk factors. Only after controlling for occupational status (blue-collar vs white-collar) does the OR drop to 1.03. Blue-collar status was strongly associated with job strain. However, while decision latitude was significantly associated with reduced risk, psychologic demand was also associated with reduced risk.

Note: The Braun and Hollander study claims to be non-confirmatory for an association between job strain (demands divided by latitude) and a CHD symptom indicator. However, the (crude) correlations between job strain and outcome (r=.13 for women, r=.10 for men, r=.11 for the total sample) are significant at p<.05 for the sample with 476 men and 319 women. The authors also state that "multivariate analysis supported the earlier findings" for the CHD symptom indicator.

Note: 2 of the 3 new (non-confirmatory) studies -- Hall et al., 1993 and Alterman et al., 1994 -- both used national job title averages (occupational linkage method) rather than self-reported scores.

Note: In 3 separate cases, 2 study designs are included in the same published article:
Karasek et al., 1981 (case-control and CHD symtpoms)
Hall et al., 1993 (cross-sectional and cohort)
Hlatky et al., 1995 (cross-sectional and cohort)

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