Scandinavian Journal of Work, Environment & Health (Sep 2020)

Persistent and changing job strain and risk of coronary heart disease. A population-based cohort study of 1.6 million employees in Denmark

  • Reiner Rugulies,
  • Elisabeth Framke,
  • Jeppe Karl Sørensen,
  • Annemette Coop Svane-Petersen,
  • Kristina Alexanderson,
  • Jens Peter Bonde,
  • Kristin Farrants,
  • Esben Meulengracht Flachs,
  • Linda L Magnusson Hanson,
  • Solja T Nyberg,
  • Mika Kivimäki,
  • Ida EH Madsen

DOI
https://doi.org/10.5271/sjweh.3891
Journal volume & issue
Vol. 46, no. 5
pp. 498 – 507

Abstract

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OBJECTIVES: This study aimed to examine the association between job strain and incident coronary heart disease (CHD) in Denmark, while accounting for changes of job strain. METHODS: We included all employees residing in Denmark in 2000, aged 30–59 years with no prevalent CHD (N=1 660 150). We determined exposure to job strain from 1996–2009 using a job exposure matrix (JEM) with annual updates. Follow-up for incident CHD was from 2001–2010 via linkage to health records. We used Cox regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and incident CHD. RESULTS: During 16.1 million person-years, we identified 24 159 incident CHD cases (15.0 per 10 000 person-years). After adjustment for covariates, job strain in 2000 predicted onset of CHD during a mean follow-up of 9.71 years (HR 1.10, 95% CI 1.07–1.13). When analyzing changes in job strain from one year to the next and CHD in the subsequent year, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence compared to persistent no job strain. Associations were similar among men and women. CONCLUSIONS: Job strain is associated with a higher risk of incident CHD in Denmark. As we used a JEM, we can rule out reporting bias. However, under- or overestimation of associations is possible due to non-differential misclassification of job strain and residual confounding by socioeconomic position.

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