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Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data

(2012) LANCET. 380(9852). p.1491-1497
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Abstract
Background : Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods : We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings : 30 214 (15%) of 197 473 participants reported job strain. In 1.49 million person-years at risk (mean follow-up 7.5 years [SD 1.7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1.23 (95% CI 1.10-1.37). This effect estimate was higher in published (1.43, 1.15-1.77) than unpublished (1.16, 1.02-1.32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1.31, 1.15-1.48) and 5 years (1.30, 1.13-1.50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3.4%. Interpretation : Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.
Keywords
PROSPECTIVE COHORT, ACUTE MYOCARDIAL-INFARCTION, WORK STRESS, FOLLOW-UP, CARDIOVASCULAR-DISEASE, PSYCHOSOCIAL RISK, SOCIAL SUPPORT, WHITEHALL-II, 52 COUNTRIES, BASE-LINE

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MLA
Kivimäki, Mika, Solja T Nyberg, G David Batty, et al. “Job Strain as a Risk Factor for Coronary Heart Disease: a Collaborative Meta-analysis of Individual Participant Data.” LANCET 380.9852 (2012): 1491–1497. Print.
APA
Kivimäki, M., Nyberg, S. T., Batty, G. D., Fransson, E. I., Heikkilä, K., Alfredsson, L., Bjorner, J. B., et al. (2012). Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. LANCET, 380(9852), 1491–1497.
Chicago author-date
Kivimäki, Mika, Solja T Nyberg, G David Batty, Eleonor I Fransson, Katriina Heikkilä, Lars Alfredsson, Jakob B Bjorner, et al. 2012. “Job Strain as a Risk Factor for Coronary Heart Disease: a Collaborative Meta-analysis of Individual Participant Data.” Lancet 380 (9852): 1491–1497.
Chicago author-date (all authors)
Kivimäki, Mika, Solja T Nyberg, G David Batty, Eleonor I Fransson, Katriina Heikkilä, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Jane E Ferrie, Goedele A Geuskens, Marcel Goldberg, Mark Hamer, Wendela E Hooftman, Irene L Houtman, Matti Joensuu, Markus Jokela, France Kittel, Anders Knutsson, Markku Koskenvuo, Aki Koskinen, Anne Kouvonen, Meena Kumari, Ida EH Madsen, Michael G Marmot, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jaana Pentti, Reiner Rugulies, Paula Salo, Johannes Siegrist, Archana Singh-Manoux, Sakari B Suominen, Ari Väänänen, Jussi Vahtera, Marianna Virtanen, Peter JM Westerholm, Hugo Westerlund, Marie Zins, Andrew Steptoe, and Töres Theorell. 2012. “Job Strain as a Risk Factor for Coronary Heart Disease: a Collaborative Meta-analysis of Individual Participant Data.” Lancet 380 (9852): 1491–1497.
Vancouver
1.
Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. LANCET. 2012;380(9852):1491–7.
IEEE
[1]
M. Kivimäki et al., “Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data,” LANCET, vol. 380, no. 9852, pp. 1491–1497, 2012.
@article{3121720,
  abstract     = {Background : Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. 
Methods : We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. 
Findings : 30 214 (15%) of 197 473 participants reported job strain. In 1.49 million person-years at risk (mean follow-up 7.5 years [SD 1.7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1.23 (95% CI 1.10-1.37). This effect estimate was higher in published (1.43, 1.15-1.77) than unpublished (1.16, 1.02-1.32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1.31, 1.15-1.48) and 5 years (1.30, 1.13-1.50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3.4%. 
Interpretation : Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.},
  author       = {Kivimäki, Mika and Nyberg, Solja T and Batty, G David and Fransson, Eleonor I and Heikkilä, Katriina and Alfredsson, Lars and Bjorner, Jakob B and Borritz, Marianne and Burr, Hermann and Casini, Annalisa and Clays, Els and De Bacquer, Dirk and Dragano, Nico and Ferrie, Jane E and Geuskens, Goedele A and Goldberg, Marcel and Hamer, Mark and Hooftman, Wendela E and Houtman, Irene L and Joensuu, Matti and Jokela, Markus and Kittel, France and Knutsson, Anders and Koskenvuo, Markku and Koskinen, Aki and Kouvonen, Anne and Kumari, Meena and Madsen, Ida EH and Marmot, Michael G and Nielsen, Martin L and Nordin, Maria and Oksanen, Tuula and Pentti, Jaana and Rugulies, Reiner and Salo, Paula and Siegrist, Johannes and Singh-Manoux, Archana and Suominen, Sakari B and Väänänen, Ari and Vahtera, Jussi and Virtanen, Marianna and Westerholm, Peter JM and Westerlund, Hugo and Zins, Marie and Steptoe, Andrew and Theorell, Töres},
  issn         = {0140-6736},
  journal      = {LANCET},
  keywords     = {PROSPECTIVE COHORT,ACUTE MYOCARDIAL-INFARCTION,WORK STRESS,FOLLOW-UP,CARDIOVASCULAR-DISEASE,PSYCHOSOCIAL RISK,SOCIAL SUPPORT,WHITEHALL-II,52 COUNTRIES,BASE-LINE},
  language     = {eng},
  number       = {9852},
  pages        = {1491--1497},
  title        = {Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data},
  url          = {http://dx.doi.org/10.1016/S0140-6736(12)60994-5},
  volume       = {380},
  year         = {2012},
}

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