Lack of predictability at work and risk of acute myocardial infarction: an 18-year prospective study of industrial employees

Am J Public Health. 2008 Dec;98(12):2264-71. doi: 10.2105/AJPH.2007.122382. Epub 2008 Oct 15.


Objectives: We examined whether the distinctive components of job control-decision authority, skill discretion, and predictability-were related to subsequent acute myocardial infarction (MI) events in a large population of initially heart disease-free industrial employees.

Methods: We prospectively examined the relation between the components of job control and acute MI among private-sector industrial employees. During an 18-year follow-up, 56 fatal and 316 nonfatal events of acute MI were documented among 7663 employees with no recorded history of cardiovascular disease at baseline (i.e., 1986).

Results: After adjustment for demographics, psychological distress, prevalent medical conditions, lifestyle risk factors, and socioeconomic characteristics, low decision autonomy (P < .53) and skill discretion (P < .10) were not significantly related to subsequent acute MI. By contrast, low predictability at work was associated with elevated risk of acute MI (P = .02). This association was driven by the strong effect of predictability on acute MI among employees aged 45 to 54 years.

Conclusions: Prospective evidence suggests that low predictability at work is an important component of job control, increasing long-term risk of acute MI among middle-aged employees.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health
  • Burnout, Professional / complications
  • Burnout, Professional / epidemiology*
  • Decision Making, Organizational
  • Employment / organization & administration
  • Employment / psychology*
  • Factor Analysis, Statistical
  • Female
  • Finland / epidemiology
  • Humans
  • Internal-External Control
  • Life Style
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / etiology
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / etiology
  • Private Sector
  • Probability
  • Professional Autonomy*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Socioeconomic Factors
  • Surveys and Questionnaires