O-020 Effort-Reward Imbalance at Work and Cardiovascular Disease Mortality Among Older Workers in the United States: A Prospective Cohort Study

Introduction Several studies in Europe have suggested work stress in terms of Effort-Reward Imbalance (ERI) as a risk factor for cardiovascular disease (CVD). The purpose of this study was to provide evidence on ERI and CVD mortality in the United States (US). Methods We used data from the nationally population-based Health and Retirement Study. ERI was measured with a 9-item standardized scale at baseline between 2006-2008, and death information was verified by the US National Death Index through 2018. Cox proportional hazards regression models were applied to examine prospective associations of ERI with CVD mortality among 4553 older workers (aged 50 or above). Results In total 85 fatal cases of CVD were identified during 47129 person-years of follow-up time (CVD mortality rate = 1.80 per 1000 person-years). After adjustment for demographic factors, socioeconomic positions, health-related behaviors, and existing non-fatal CVD at baseline, E-R ratio was significantly associated with elevated risk of CVD mortality (aHR and 95% CI = 1.34 [1.06, 1.69]). Discussion For the first time in the US, we examined prospective associations between ERI and CVD, which is the leading cause of death in this country. Additional sensitivity analyses (excluding CVD death cases within the first 3 years of follow-up or existing non-fatal CVD cases at baseline) indicated robust and stable prospective associations of ERI at baseline with increased CVD mortality. Conclusion ERI at work may be a risk factor for CVD in older workers in the US. If further studies confirm our findings, interventions to promote psychosocial work environment are warranted.