Do psychosocial stressors at work increase the incidence of coronary heart disease in white-collar workers, and does this differ by sex and gender-related characteristics?
Psychosocial stressors at work significantly increase the risk of incident coronary heart disease, particularly in men with concurrent job strain and effort-reward imbalance, highlighting the need for sex- and gender-specific occupational health interventions.
Background: Psychosocial stressors at work (PSW) are modifiable occupational stressors associated with an increased coronary heart disease (CHD) incidence. While systematic reviews suggest differences between women and men, there has been limited examinations of potential effect modifiers. This study aimed to explore the effect modifications of characteristics related to sex (biological) and gender (sociocultural) in the associations between PSW and CHD incidence over an 18-year follow-up. Methods: This study relied on a prospective cohort of 5192 white-collar workers (50 % women) from 19 public and semi-public enterprises in Quebec, Canada. PSW, defined according to the job strain and effort-reward imbalance (ERI) models, were assessed using self-administered, validated questionnaires. Incident CHD cases were identified from medico-administrative databases using validated algorithms. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the associations between PSW and CHD incidence, stratified by sex, and characteristics related to sex (age) and gender (education level, occupational position, and children load). Results: Associations between PSW and CHD incidence differed by sex. In men, being exposed to both job strain and ERI was associated with a 2-fold increased CHD risk (HR: 2.01, 95 % CI: 1.52-2.65), rising to a 2.80-fold risk among those aged 60 and older (HR: 2.80, 95 % CI: 1.90-4.13). Amplified associations were also observed in men with lower education (HR: 3.23, 95 % CI: 1.73-6.03) and a low children load (HR: 2.48, 95 % CI: 1.74-3.54). In women, the association between ERI and CHD was stronger, although it remained marginally non-significant, among those under 60 years-old (HR: 1.57, 95 % CI: 0.96-2.57), with a lower education level (HR: 1.84, 95 % CI: 0.95-3.56) and with an intermediate to high children load (HR: 1.72, 95 % CI: 0.96-3.10). Conclusions: This study reinforces the importance of considering sex- and gender-related characteristics - such as age, education, and caregiving responsibilities - when examining the associations between PSW and CHD incidence. However, the findings observed among women require replication in larger prospective cohorts.
Harsini et al. (Sat,) studied this question.