TY - JOUR T1 - Persistent and changing job strain and risk of coronary heart disease. A population-based cohort study of 1.6 million employees in Denmark JO - Scandinavian Journal of Work, Environment & Health PY - 2020/9VL - 46 IS - 5 SP - 498 EP - 507 AU - Rugulies, Reiner AU - Framke, Elisabeth AU - Sørensen, Jeppe K AU - Svane-Petersen, Annemette Coop AU - Alexanderson, Kristina AU - Bonde, Jens Peter AU - Farrants, Kristin AU - Flachs, Esben M AU - Magnusson Hanson, Linda L AU - Nyberg, Solja T AU - Kivimäki, Mika AU - Madsen, Ida Elisabeth Huitfeldt M3 - doi: 10.5271/sjweh.3891 UR - https://www.sjweh.fi/show_abstract.php?abstract_id=3891 KW - cardiovascular disease KW - CHD KW - cohort study KW - coronary heart disease KW - Denmark KW - employee KW - epidemiology KW - JEM KW - job control KW - job exposure matrix KW - job strain KW - psychological demand KW - psychosocial work environment KW - strain KW - stress KW - work stress N2 - '

'

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.

SN - 0355-3140 ER -