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Low job control and risk of coronary heart disease in whitehall ii (prospective cohort) study

BMJ 1997; 314 doi: (Published 22 February 1997) Cite this as: BMJ 1997;314:558
  1. Hans Bosma, senior research fellowa,
  2. Michael G Marmot, director, Whitehall II studya,
  3. Harry Hemingway, clinical lecturer in epidemiologya,
  4. Amanda C Nicholson, clinical lecturer in epidemiology and public healtha,
  5. Eric Brunner, senior research fellowa,
  6. Stephen A Stansfeld, codirector, Whitehall II studya
  1. a International Centre for Health and Society Department of Epidemiology and Public Health University College London Medical School London WC1E 6BT
  1. Correspondence to: Dr H Bosma Faculty of Medicine and Health Sciences Erasmus University Box 1738 3000DR Rotterdam Netherlands
  • Accepted 24 January 1997


Objective: To determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants.

Design: Prospective cohort study (Whitehall II study). At the baseline examination (1985-8) and twice during follow up a self report questionnaire provided information on psychosocial factors of the work environment and coronary heart disease. Independent assessments of the work environment were obtained from personnel managers at baseline. Mean length of follow up was 5.3 years.

Setting: London based office staff in 20 civil service departments.

Subjects: 10 308 civil servants aged 35-55 were examined-6895 men (67%) and 3413 women (33%).

Main outcome measures: New cases of angina (Rose questionnaire), severe pain across the chest, diagnosed ischaemic heart disease, and any coronary event.

Results: Men and women with low job control, either self reported or independently assessed, had a higher risk of newly reported coronary heart disease during follow up. Job control assessed on two occasions three years apart, although intercorrelated, had cumulative effects on newly reported disease. Subjects with low job control on both occasions had an odds ratio for any subsequent coronary event of 1.93 (95% confidence interval 1.34 to 2.77) compared with subjects with high job control at both occasions. This association could not be explained by employment grade, negative affectivity, or classic coronary risk factors. Job demands and social support at work were not related to the risk of coronary heart disease.

Conclusions: Low control in the work environment is associated with an increased risk of future coronary heart disease among men and women employed in government offices. The cumulative effect of low job control assessed on two occasions indicates that giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease.

Key messages

  • Low job control in the work environment contributes to the development of coronary heart disease among British male and female civil servants

  • The risk of heart disease is associated with both objective low job control and perceived low job control.

  • Increase in job control over time decreases the risk of coronary heart disease. This suggests that policies giving people a stronger say in decisions about their work or providing them with more variety in work tasks may contribute to better cardiovascular health


    • Accepted 24 January 1997
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