Is the demand-control model still a usefull tool to assess work-related psychosocial risk for ischemic heart disease? Results from 14 year follow up in the Copenhagen City Heart study

OBJECTIVES: To test the usefulness of the Demand-Control Model as predictor for ischemic heart disease (IHD). MATERIALS AND METHODS: One thousand one hundred forty six actively employed men and women from the general population of Copenhagen participated at baseline in 1993-1994. They filled in questionnaires on the Demand-Control Model, job title, work place, civil status, family income, leisure time activity, smoking, medication, social support, social relations, conflicts, job responsibility, satisfaction, and insecurity and went through a medical examination, including measurements of coronary risk factors. All deaths and hospital admissions due to IHD, including first myocardial infarction (MI) in the cohort were traced in the Danish registries of deaths and hospital admissions to June 2007. RESULTS: 104 cases of first time hospitalisation or death due to IHD including 49 cases of MI occurred during 14 years follow up. Odds ratio (OR) compared to the relaxed group was 1.1 (0.1-3.1) among women and 1.6 (0.4-4.9) among men after confounder adjustment. Neither demands nor control were significantly associated with IHD. Among men 50 years of age or more, the risk for IHD was, however, elevated in the job strain group and the active group (OR = 3.5 and 3.2 respectively). Job insecurity was, however, strongly associated with IHD in men (OR = 2.7 (1.1-5.6)) after all adjustments. The risk was increased for MI too (OR = 2.7 (1.2-6.1)). Among women, the only significant association with IHD was for job dissatisfaction (OR = 3.0 (1.2-7.6)). CONCLUSION: In this population and in a period and society characterized by relative wealth and increasing employment rates, the Demand-control Model did not predict IHD. However, the feeling of job insecurity predicted both IHD and MI among men and job dissatisfaction predicted IHD among women.