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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. 
___________________________________________________________________

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.
___________________________________________________________________

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. 
___________________________________________________________________

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)
___________________________________________________________________

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)

Job Strain and Cardiovascular Disease Risk Factors other than High Blood Pressure

Summary of 6 studies from:

Schnall PL, Landsbergis PA, Baker D.
Annual Review of Public Health, 15, 1994, 381-411.

+ 1 newly published study (1994), non-confirmatory
+ 1 older study (1991), confirmatory
(abstracts from 1995 Copenhagen conference not included)

Dependent Variable Design Studies Confirm
Smoking Cross-sectional 7 3
Serum cholesterol Cross-sectional 4 0
Sedentary behavior Cross-sectional 1 1
Body fat distribution Cross-sectional 1 1

LIST OF STUDIES

 
Dependent Variable Design Studies Confirm
Smoking Cross-sectional 7 3

Confirm

81. Mensch, B. S., Kandel, D. B. 1988. Do job conditions influence the use of drugs. J Health Soc Behav 29:169-84.

32. Green, K. L., Johnson, J. V. 1990. The effects of psychosocial work organization on patterns of cigarette smoking among male chemical plant employees. Am J Public Health 80:1368-71.

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

Non-confirm

37. Haratani, T., Kawakami, N., Araki, S. 1992. Job stress and cardiovascular risk factors in a Japanese working population. Presented at the 9th International Symposium on Epidemiology in Occupational Health, Cincinnati, OH.

86. Netterstrom, B., Kristensen, T. S., Damsgaard, M. T., Olsen, O., Sjol, A. 1991. Job strain and cardiovascular risk factors: A cross sectional study of employed Danish men and women. Brit J Ind Med 48:684-89.

90. Pieper, C., LaCroix, A. Z., Karasek, R. A. 1989. The relation of psychosocial dimensions of work with coronary heart disease risk factors: A meta-analysis of five United States data bases. Am J Epidemiol 129:483-94.

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)

 
Dependent Variable Design Studies Confirm
Serum cholesterol Cross-sectional 4 0

Non-confirm

37. Haratani, T., Kawakami, N., Araki, S. 1992. Job stress and cardiovascular risk factors in a Japanese working population. Presented at the 9th International Symposium on Epidemiology in Occupational Health, Cincinnati, OH.

86. Netterstrom, B., Kristensen, T. S., Damsgaard, M. T., Olsen, O., Sjol, A. 1991. Job strain and cardiovascular risk factors: A cross sectional study of employed Danish men and women. Brit J Ind Med 48:684-89.

90. Pieper, C., LaCroix, A. Z., Karasek, R. A. 1989. The relation of psychosocial dimensions of work with coronary heart disease risk factors: A meta-analysis of five United States data bases. Am J Epidemiol 129:483-94.

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)

 
Dependent Variable Design Studies Confirm
Sedentary behavior Cross-sectional 1 1

Confirm

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

 
Dependent Variable Design Studies Confirm
Body fat distribution Cross-sectional 1 1

Confirm

30. Georges, E., Wear, M. L., Mueller, W. H. 1992. Body fat distribution and job stress in Mexican-American men of the Hispanic Health and Nutrition Examination Survey. Am J Human Biol 4:657-67.

Note: In Alterman et al. (1994), while “job strain” was not associated with smoking, smoking was associated with lower demands (p=.058, crude) and lower decision latitude (p<.001, crude). they also used national job title averages (occupational linkage method) rather than self-reported scores.

Job Strain, Social Class and CVD

Cardiovascular disease

49. Johnson JV, Hall EM. 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 1988;78:1336-42.

CVD – cross-sectional – stronger effect for Swedish blue-collar men

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.

CVD – cohort – stronger effect for Swedish blue-collar men

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

CVD mortality – case-control – stronger effect for Swedish men
with less than high-school education

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

CHD – cohort – stronger effect for Framingham clerical women

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.

MI – case-control – slightly stronger effects among white- collar workers (Sweden)

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.

CVD morbidity – cross-sectional – similar (NS) effects for blue-collar vs white-collar Swedish women

CVD mortality – cohort – stronger effects for low work control
and low social support for white-collar vs blue-collar Swedish women

Ambulatory blood pressure

114. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth P. Changes in job strain in relation to changes in physiological states. Scand J Work Eviron Health 1988;14:189-96.

Work Ambulatory SBP – cohort – stronger effect for low status
jobs (e.g., waiters) out of 6 job titles in Sweden

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering TG. The association of ambulatory blood pressure with alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health 1994;20:349-63.

Work Ambulatory Blood Pressure, Risk of hypertension – stronger effect for New York City men with 12 years or less of education


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Age


(“new” indicates articles published since the Ann. Rev. Pub. Health article by Schnall et al., 1994, was published; reference numbers are from the review article)

Cardiovascular disease

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.

CVD – cohort – stronger effect for older Swedish white-collar men

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

CHD symptoms – cross-sectional – stronger effect for older Swedish white-collar workers

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.

CHD – cohort – stronger effect for older women

Ambulatory blood pressure

101. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. The relationship between job strain, alcohol and ambulatory blood pressure. Hypertension 1992;19:488-94.

Work Ambulatory SBP –
stronger effect for older New York City men


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Social Support


(“new” indicates articles published since the Ann. Rev. Pub. Health article by Schnall et al., 1994, was published; reference numbers are from the review article)

Cardiovascular disease

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.

CVD – cross-sectional – stronger Job Strain effect if low social support

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.

Mortality – cohort – weaker high latitude effect if high social support

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.

Mortality – cohort – stronger Job Strain effect if low social support

Ambulatory blood pressure

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering TG. The association of ambulatory blood pressure with alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health 1994;20:349-63.

Work and Home Ambulatory DBP – stronger effect for New York City men with lower social support


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Gender


(“new” indicates articles published since the Ann. Rev. Pub. Health review article by Schnall et al., 1994 was published; reference numbers are from the review article)

Cardiovascular disease

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

CHD – cohort – stronger effect for women (Framingham, U.S.)

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

MI (hospitalizations) – cohort – similar effects for men and women (Sweden)

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

CHD – cohort – similar effects for men and women (Finland)

36. 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.

CHD – case-control – similar effects for men and women (Sweden)

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

CHD symptoms – cross-sectional – similar effects for men and women (Sweden)

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

CHD symptoms – cross-sectional – similar effects for men and women (Sweden)

Ambulatory blood pressure

75. Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension 1992;20:214-18.

cross-sectional – job strain associated with AmBP only for men (North Carolina)

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering T. Job strain, hypertension, and cardiovascular disease. In: Sauter SL, Murphy LR (eds.) Organizational Risk Factors for Job Stress. Washington, DC: American Psychological Association;1995:97-112.

cross-sectional – job strain associated with AmBP only for men (New York City)

116. Van Egeren LF. The relationship between job strain and blood pressure at work, at home, and during sleep. Psychosom Med 1992;54:337-43.

cross-sectional – job strain associated with AmBP for both women and men (North Carolina)

114. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth P. Changes in job strain in relation to changes in physiological states. Scand J Work Eviron Health 1988;14:189-96.

cohort – similar magnitude of association with systolic AmBP for both women and men, p-value >.05 since only 18 women vs 40 men in study (Sweden)

108. Theorell TPG, Ahlberg-Hulten G, Jodko M, Sigala F, Soderholm M, de la Torre B. Influence of job strain and emotion on blood pressure in female hospital personnel during work hours. Scand J Work Environ Health 1993;19:313-318.

cross-sectional – job strain associated with AmBP for women
[note: while this study did not include males, it is noted since it is one of the 3 studies that have found associations between job strain and AmBP among women]

Smoking

81. Mensch BS, Kandel DB. Do job conditions influence the use of drugs. J Health Soc Behav 1988;29:169-84.

cross-sectional – similar effects for men and women

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

cross-sectional – shift-work and piece-work associated with smoking only among men (Sweden)

Sedentary behavior

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

cross-sectional – lack of learning opportunities associated with sedentary behavior for both men and women – psychological work demands associated with sedentary beahvior only among women (Sweden)

Job Strain and Ambulatory Blood Pressure References

Job Strain and Ambulatory Blood Pressure


(“new” indicates articles published since the review article by Schnall et al., 1994 was published; reference numbers are from the review article)

38. Harenstam AB, Theorell TPG. Work conditions and urinary excretion of catecholamines — A study of prison staff in Sweden. Scand J Work Environ Health 1988;14:257-64.
75. Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women Hypertension 1992;20:214-18.
99. Schnall PL, Landsbergis PA, Schwartz JE, Warren K, Pickering TG. The relationship between job strain, ambulatory blood pressure and hypertension. Paper presented at the Ninth International Symposium on Epidemiology in Occupational Health, Cincinnati, OH, September, 1992.
101. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. The relationship between job strain, alcohol and ambulatory blood pressure. Hypertension 1992;19:488-94.
new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering TG. The association of ambulatory blood pressure with alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health 1994;20:349-63.
new. Schnall PL, Landsbergis PA, Schwartz JE, Warren K, Pickering TG. The relationship between job strain and change in ambulatory blood pressure: Results of 3 years of follow-up. Submitted to New England Journal of Medicine 1995.
108. Theorell TPG, Ahlberg-Hulten G, Jodko M, Sigala F, Soderholm M, de la Torre B. Influence of job strain and emotion on blood pressure in female hospital personnel during work hours. Scand J Work Environ Health 1993;19:313-318.
109. Theorell T, deFaire U, Johnson J, Hall EM, Perski A, Stewart W. Job strain and ambulatory blood pressure profiles. Scand J Work Environ Health 1991;17:380-385.
114. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth P. Changes in job strain in relation to changes in physiological states. Scand J Work Eviron Health 1988;14:189-96.
116. Van Egeren LF. The relationship between job strain and blood pressure at work, at home, and during sleep. Psychosom Med 1992;54:337-43.
 

Job Strain and Casual Blood Pressure


(all non-significant associations, except 37)

3. Albright, C. L., Winkleby, M. A., Ragland, D. R., Fisher, J., Syme, S. L. 1992. Job strain and prevalence of hypertension in a biracial population or urban bus drivers. Am J Public Health 82:984-89.
19. Chapman, A., Mandryk, J. A., Frommer, M. S., Edye, B. V., Ferguson, D. A. 1990. Chronic perceived work stress and blood pressure among Australian government employees. Scand J Work Eviron Health 16:258-69.
37. Haratani, T., Kawakami, N., Araki, S. 1992. Job stress and cardiovascular risk factors in a Japanese working population. Presented at the 9th International Symposium on Epidemiology in Occupational Health, Cincinnati, OH.
75. Light, K. C., Turner, J. R., Hinderliter, A. L. 1992. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension 20:214-18.
79. Matthews, K. A., Cottington, E. M., Talbott, E., Kuller, L. H., Siegel, J. M. 1987. Stressful work conditions and diastolic blood pressure among blue collar factory workers. Am J Epidemiol 126:280-91.
86. Netterstrom, B., Kristensen, T. S., Damsgaard, M. T., Olsen, O., Sjol, A. 1991. Job strain and cardiovascular risk factors: A cross sectional study of employed Danish men and women. Brit J Ind Med 48:684-89.
90. Pieper, C., LaCroix, A. Z., Karasek, R. A. 1989. The relation of psychosocial dimensions of work with coronary heart disease risk factors: A meta-analysis of five United States data bases. Am J Epidemiol 129:483-94.
116. Van Egeren, L. F. 1992. The relationship between job strain and blood pressure at work, at home, and during sleep. Psychosom Med 54:337-43.
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.
 

Effects of Job Strain on Blood Pressure: A Prospective Study of Male and Female White-Collar Workers

Chantal Guimont, MD, PhD, Chantal Brisson, PhD, Gilles R. Dagenais, MD, FRCP, Alain Milot, MD, MSc, FRCP, Michel Vézina, MD, MPH, FRCP, Benoît Mâsse, PhD, Jocelyne Moisan, PhD, Nathalie Laflamme, PhD, and Caty Blanchette, MS

American Journal of Public Health | August 2006, Vol 96, No. 8

Objectives. We evaluated whether cumulative exposure to job strain increases blood pressure.

Methods. A prospective study of 8395 white-collar workers was initiated during 1991 to 1993. At follow-up, 7.5 years later, 84% of the participants were reassessed to estimate cumulative exposure to job strain.

Results. Compared with men who had never been exposed, men with cumulative exposure and those who became exposed during follow-up showed significant systolic blood pressure increments of 1.8 mm Hg (95% confidence interval [CI] = 0.1, 3.5) and 1.5 mm Hg (95% CI= 0.2, 2.8), respectively, and relative risks of blood pressure increases in the highest quintile group of 1.33 (95% CI= 1.01, 1.76) and 1.40 (95% CI= 1.14, 1.73). Effect magnitudes were smaller among women. Effects tended to be more pronounced among men and women with low levels of social support at work.

Conclusions. Among these white-collar workers, exposure to cumulative job strain had a modest but significant effect on systolic blood pressure among men. The risk was of comparable magnitude to that observed for age and sedentary behavior. Men and women with low levels of social support at work appeared to be at higher risk for increases in blood pressure. (Am J Public Health. 2006;96: 1436–1443. doi:10.2105/AJPH.2004.057679

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