Each of these psychosocial stressors is associated with heart disease risk, and the combination was especially dangerous for men, according to a study published in the journal Circulation: Cardiovascular Quality and Outcomes .
Research Highlights:
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Psychosocial Stressors at Work and Risk of Coronary Heart Disease in Men and Women: 18-Year Prospective Cohort Study of Pooled Exposures
Background
Psychosocial stressors at work, such as job strain and effort-reward imbalance (ERI), may increase the risk of coronary heart disease (CHD). Effort-reward imbalance (ERI) indicates an imbalance between effort and the rewards received. Evidence on the adverse effect of combined exposure to these occupational stressors on the risk of coronary heart disease is scarce. This study examines the separate and combined effect of job strain and ERI exposure on the incidence of coronary heart disease in a prospective cohort of white-collar workers in Quebec, Canada.
Methods
Six thousand four hundred and sixty-five white-collar workers without cardiovascular disease (mean age, 45.3 ± 6.7) were followed for 18 years (2000 to 2018). Job strain and ERI were measured with validated questionnaires. Coronary heart disease events were retrieved from medical-administrative databases using validated algorithms. Cox marginal models were used to calculate hazard ratios (HRs) stratified by sex. Multiple imputations and inverse probability weightings were applied to minimize potential threats to internal validity.
Results
Among 3118 men, 571 had a first coronary heart disease event. Exposure to job strain or effort-reward imbalance (ERI) was associated with an adjusted increased risk of coronary heart disease of 49% (HR, 1.49 [95% CI, 1.07–2.09]).
Combined exposure to job strain and IRE was associated with an adjusted increased risk of coronary heart disease of 103% (HR, 2.03 [95% CI, 1.38–2.97]).
Exclusion of early cases of coronary heart disease and censoring at retirement did not alter these associations.
Among 3347 women, 265 had a first coronary heart disease event. The results were inconclusive (passive work HR, 1.24 [95% CI, 0.80–1.91]; active work HR, 1.16 [95% CI, 0.70–1.94]; job strain, 1.08 [95% CI, 0.66–1.77]; ERI HR, 1.02 [95% CI, 0.72–1.45]).
Conclusions In this prospective cohort study, men exposed to job strain or ERI, separately and in combination, had an increased risk of coronary heart disease. Early interventions on these work-related psychosocial stressors in men may be effective prevention strategies to reduce the burden of coronary heart disease. Among women, more research is required. |
Comments
Men who say they have stressful jobs and also feel they go to great lengths for low reward had twice the risk of heart disease compared to men free of those stressors, according to new research published today in Circulation: Cardiovascular Quality and Outcomes , a peer-reviewed journal of the American Heart Association .
"Given the significant amount of time people spend at work, understanding the relationship between work stressors and cardiovascular health is crucial for public health and workforce well-being," said the study’s lead author. Mathilde Lavigne-Robichaud, RD, MS, PhD candidate in Population. Health and Optimal Health Practices Research Unit, CHU Quebec-Université Laval Research Center in Quebec, Canada. "Our study highlights the pressing need to proactively address stressful work conditions, to create healthier work environments that benefit employees and employers."
Heart disease is the number one cause of death in the U.S. according to American Heart Association statistics. In 2020, nearly 383,000 Americans died from heart disease.
Research has shown that two psychosocial stressors ( job stress and effort-reward imbalance at work ) can increase the risk of heart disease. However, few studies have examined the combined effect.
“Job strain refers to work environments where employees face a combination of high job demands and little control over their work. High demands can include a heavy workload, tight deadlines and numerous responsibilities, while low control means the employee has little say in decision-making and how they perform their tasks,” Lavigne-Robichaud explained.
“ Effort-reward imbalance occurs when employees invest great effort in their work, but perceive the rewards they receive in return (such as salary, recognition, or job security) as insufficient or unequal to the effort. For example, if you are always going above and beyond, but feel like you are not getting the credit or rewards you deserve, that is called effort-reward imbalance .”
The study found:
Men who said they had experienced job stress or an effort-reward imbalance had a 49 percent increased risk of heart disease compared to men who did not report those stressors.
Men who reported both job strain and effort-reward imbalance had twice the risk of heart disease compared to men who did not say they were experiencing the combined stressors.
The impact of psychosocial stress at work on women’s heart health was inconclusive.
In men, the combined impact of job strain and effort-reward imbalance was similar to the magnitude of the impact of obesity on coronary heart disease risk.
"Our results suggest that interventions aimed at reducing work environment stressors could be particularly effective for men and could also have positive implications for women, as these stressors are associated with other prevalent health problems such as depression "said Lavigne-Robichaud. "The study’s inability to establish a direct link between psychosocial stressors at work and coronary heart disease in women indicates the need for further investigation of the complex interaction of various stressors and women’s heart health."
Interventions could include different approaches, such as providing supportive resources, promoting work-life balance, improving communication and empowering employees to have more control over their work, he said.
"The American workforce is among the most stressed in the world, and these workplace stressors can be as harmful to health as obesity and secondhand smoke," Eduardo J. Sánchez, MD, MPH, FAHA, FAAFP, American Heart Association medical director of prevention. “This study adds to the growing body of evidence that the workplace should be prioritized as a vehicle to promote cardiovascular health for all. “The American Heart Association remains committed and committed to providing employers with the resources and information they need to actively support the health of their employees and communities through science-backed policy and cultural changes.”
Background and details of the study:
The researchers studied nearly 6,500 white-collar workers, average age about 45, without heart disease, and followed them for 18 years, from 2000 to 2018.
They studied health and workplace survey information from 3,118 men and 3,347 women in a wide range of jobs in Quebec. The surveys included employees working in senior management, professional, technical and clerical positions. Education levels ranged from no high school diploma to a college degree.
The researchers measured job strain and effort-reward imbalance with results from pretested questionnaires and retrieved information on heart disease using established health databases.
One limitation of the study is that the researchers studied men and women in white-collar jobs primarily in Quebec, Canada, and the results may not fully represent the diversity of the American working population. However, the study’s findings may be relevant to white-collar workers in the United States and other high-income countries with similar work structures, according to Lavigne-Robichaud.
