Effort-Reward Imbalance at Work and Incident Coronary Heart Disease-猫眼课题宝

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2018

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N. Dragano;J. Siegrist;S. Nyberg;T. Lunau;E. Fransson;L. Alfredsson;J. Bjorner;M. Borritz;H. Burr;R. Erbel;Göran Fahlén;M. Goldberg;M. Hamer;K. Heikkilä;K. Jöckel;A. Knutsson;I. Madsen;M. Nielsen;M. Nordin;T. Oksanen;J. Pejtersen;J. Pentti;R. Rugulies;P. Salo;J. Schupp;A. Singh‐Manoux;A. Steptoe;T. Theorell;J. Vahtera;H. Westerlund;M. Virtanen;M. Zins;M. Kivimäki

背景：工作压力作为冠心病危险因素的流行病学证据主要基于一种称为工作压力的单一测量方法，即高要求和低工作控制的结合。我们研究了一种补充性的压力测量方法，该方法评估了在工作中付出的努力和获得的奖励之间的不平衡，是否可以预测冠心病。方法：这项多队列研究（“IPD-Work”联盟）基于11项欧洲前瞻性队列研究的统一个人水平数据。通过有效的努力-回报不平衡和工作压力问卷，对90164名无冠心病的男性和女性进行了基线压力工作评估。我们将冠心病事件定义为首次非致死性心肌梗死或冠状动脉死亡。通过随机效应荟萃分析汇总特定研究的估计值。结果：在基线时，31.7%的研究成员报告了工作中的努力-回报不平衡，15.9%的人报告了工作压力。在a期间，我们无法提供对这里分析的单个研究数据的直接访问。代码可根据要求提供。IPD-Work联盟得到北欧保健和福利方案NordForsk的支持。M.K.得到了北福斯克联合王国医学研究理事会（K013351）和联合王国经济和社会研究理事会的教授奖学金的资助。A.S.是英国心脏基金会的教授。IPD-Work还得到了欧盟新职业安全和健康ERA研究方案的支持（由芬兰工作环境基金、瑞典健康、工作生活和福利研究委员会、德国社会意外保险和丹麦工作环境国家研究中心资助）；芬兰科学院；以及英国BUPA基金会。参与队列研究的资助机构在其网站上列出。这项研究独立于资助机构进行。没有一个资助机构在研究的设计和实施中发挥积极作用；收集、管理、分析和解释数据；审稿：手稿的准备、审查或批准；并决定投稿发表。作者报告没有利益冲突。补充直接URL平均随访9.8年，记录1078例冠状动脉事件。在对潜在混杂因素进行调整后，与没有不平衡相比，努力-奖励不平衡的风险比为1.16（95%置信区间为1.00-1.35）。付出回报失衡或工作紧张的风险比为1.16(1.01-1.34)，两者均存在的风险比为1.41（1.12-1.76）。结论：工作中努力-回报不平衡的个体患冠心病的风险增加，这似乎与工作压力经历无关。这些发现支持在未来的工作压力研究中，将关注点从工作压力扩展到工作压力。流行病学

Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease. Methods: This multicohort study (the “IPD-Work” consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort–reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis. Results: At baseline, 31.7% of study members reported effort– reward imbalance at work and 15.9% reported job strain. During a are unable to provide direct access to the data from the single studies analyzed here. Code is available on request. The IPD-Work consortium is supported by NordForsk, the Nordic Programme on Health and Welfare. M.K. is supported by the Medical Research Council, United Kingdom (K013351), NordForsk, and a professorial fellowship from the Economic and Social Research Council, United Kingdom. A.S. is a British Heart Foundation professor. IPD-Work was also supported by the EU New OSH ERA research programme (funded by the Finnish Work Environment Fund, Finland; the Swedish Research Council for Health, Working Life and Welfare, Sweden; the German Social Accident Insurance [DGUV], Germany; and the Danish National Research Centre for the Working Environment, Den- mark); the Academy of Finland; and the BUPA Foundation, United Kingdom. Funding bodies for participating cohort studies are listed on their Web sites. The study was conducted independently of funding agencies. None of the funding agencies played an active role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors report no conflicts of interest. Supplemental direct URL mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00–1.35) was observed for effort–reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01–1.34) for having either effort–reward imbalance or job strain and 1.41 (1.12–1.76) for having both these stressors compared to having neither effort–reward imbalance nor job strain. Conclusions: Individuals with effort–reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress. Epidemiology

Effort-Reward Imbalance at Work and Incident Coronary Heart Disease

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