Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees

doi:10.1136/bmj.325.7369.857

BMJ 2002;325:857 ( 19 October )

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Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees

Mika Kivimäki, acting professor, ^a Päivi Leino-Arjas, senior researcher, ^a Ritva Luukkonen, statistician, ^a Hilkka Riihimäki, professor, ^a Jussi Vahtera, senior researcher, ^a Juhani Kirjonen, emeritus professor. ^b

^a Department of Psychology, University of Helsinki, PO Box 13, FIN-00014, Finland, ^b Department of Physical Education, University of Jyväskylä, Jyväskylä, Finland

Correspondence to M Kivimäki mika.kivimaki{at}occuphealth.fi

Objective: To examine the association between work stress,according to the job strain model and the effort-reward imbalancemodel, and the risk of death from cardiovasculardisease.
Design: Prospective cohort study. Baseline examinationin 1973 determined cases of cardiovascular disease, behaviouraland biological risks, and stressful characteristics of work. Biologicalrisks were measured at 5 year and 10 year followup.
Setting: Staff of a company in the metal industry inFinland.
Participants: 812 employees (545 men, 267 women) who werefree from cardiovascular diseases atbaseline.
Main outcome measure: Cardiovascular mortality 1973-2001 from thenational mortalityregister.
Results: Mean length of follow up was 25.6 years. Afteradjustment for age and sex, employees with high job strain, acombination of high demands at work and low job control, had a2.2-fold (95% confidence interval 1.2 to 4.2) cardiovascular mortalityrisk compared with their colleagues with low job strain. The correspondingrisk ratio for employees with effort-reward imbalance (low salary,lack of social approval, and few career opportunities relativeto efforts required at work) was 2.4 (1.3 to 4.4). These ratiosremained significant after additional adjustment for occupationalgroup and biological and behavioural risks at baseline. High jobstrain was associated with increased serum total cholesterol atthe 5 year follow up. Effort-reward imbalance predicted increasedbody mass index at the 10 year followup.
Conclusions: High job strain and effort-reward imbalanceseem to increase the risk of cardiovascular mortality. The evidencefrom industrial employees suggests that attention should be paidto the prevention of workstress.

What is already known on this topic
Job strain (high demands and low job control) and effort-reward imbalance (high demands, low security, few career opportunities) elicit stress at work

Their status as risk factors for cardiovascular mortality has, however, remained uncertain

What this study adds
Job strain and effort-reward imbalance were each associated with a doubling of the risk of cardiovascular death among employees who were free from overt cardiovascular diseases at baseline

Job strain and effort-reward imbalance also predicted adverse changes in biological factors such as cholesterol concentration and body mass index

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