University of Oulu

Kivimäki, M., Pentti, J., Ferrie, J., Batty, G., Nyberg, S., Jokela, M., Virtanen, M., Alfredsson, L., Dragano, N., Fransson, E., Goldberg, M., Knutsson, A., Koskenvuo, M., Koskinen, A., Kouvonen, A., Luukkonen, R., Oksanen, T., Rugulies, R., Siegrist, J., Singh-Manoux, A., Suominen, S., Theorell, T., Väänänen, A., Vahtera, J., Westerholm, P., Westerlund, H., Zins, M., Strandberg, T., Steptoe, A., Deanfield, J. (2018) Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study. Lancet Diabetes and Endocrinology, 6 (9), 705-713. doi:10.1016/S2213-8587(18)30140-2

Work stress and risk of death in men and women with and without cardiometabolic disease : a multicohort study

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Author: Kivimäki, Mika1,2,3; Pentti, Jaana1,2,4; Ferrie, Jane E.3,5;
Organizations: 1Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland.
2Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
3UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
4Univ Turku, Dept Publ Hlth, Turku, Finland.
5Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
6Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
7Uppsala Univ, Inst Publ Hlth & Caring Sci, Uppsala, Sweden.
8Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
9Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
10Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
11Jonkoping Univ, Sch Hlth & Welf, Jonkoping, Sweden.
12Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
13INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France.
14Versailles St Quentin Univ, UMS 011, Villejuif, France.
15Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
16Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
17Finnish Inst Occupat Hlth, Helsinki, Finland.
18Univ Helsinki, Fac Social Sci, Helsinki, Finland.
19SWPS Univ Social Sci & Humanities Wroclaw, Div Hlth Psychol, Wroclaw, Poland.
20Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland.
21Natl Res Ctr Working Environm, Copenhagen, Denmark.
22Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark.
23Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
24Ctr Res Epidemiol & Populat Hlth, INSERM, UMR 1018, Villejuif, France.
25Folkhalsan Res Ctr, Helsinki, Finland.
26Univ Skovde, Sch Hlth & Educ, Skovde, Sweden.
27Univ Kent, Sch Social Policy Sociol & Social Res, Canterbury, Kent, England.
28Turku Univ Hosp, Turku, Finland.
29Uppsala Univ, Dept Med Sci, Uppsala, Sweden.
30Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland.
31Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
32UCL, Natl Ctr Cardiovasc Prevent & Outcomes, London, England.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-05-06


Background: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

Methods: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort–reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

Results: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19–2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9–44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18–3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74–21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress–mortality association were not significant, apart from effort–reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06–1·41).

Interpretation: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

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Series: The Lancet. Diabetes & endocrinology
ISSN: 2213-8587
ISSN-E: 2213-8595
ISSN-L: 2213-8587
Volume: 6
Issue: 9
Pages: 705 - 713
DOI: 10.1016/S2213-8587(18)30140-2
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: The IPD-Work consortium was supported by NordForsk (the Nordic Research Programme on Health and Welfare), the UK Medical Research Council (K013351, R024227), and the Academy of Finland (311492).
Copyright information: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.