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Review

Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis

Marianna Virtanen et al. BMJ. .

Abstract

Objective: To determine the association between self reported job insecurity and incident coronary heart disease.

Design: A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review.

Data sources: We obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches.

Review methods: Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models.

Results: The literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174,438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v ≥ 50 years), national unemployment rate, welfare regime, or job insecurity measure.

Conclusions: The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form atwww.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the EU New OSH ERA Research Program, Academy of Finland, and BUPA Foundation for the submitted work; MKi is supported by the Medical Research Council (grant K013351) and the Economic and Social Research Council, UK, and the US National Institutes of Health (grants R01HL036310 and R01AG034454); AS is a British Heart Foundation professor; GDB is a Wellcome Trust Fellow; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval: Ethical approval was obtained for all studies providing individual participant data for the meta-analysis. All participants gave informed consent to participate.

Figures

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Fig 1 Flow diagram of studies included in the meta-analysis
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Fig 2 Forest plot of individual studies investigating the association between job insecurity and incident CHD events among men and women, adjusted for age. Models adjusted for age (apart from the Blue Collar Study, in which only the fully adjusted model was available; and the Women’s Health Study, in which the model was adjusted for age, race, and drug randomisation). BCS=Blue Collar Study; Still Working; NHS=Nurses’ Health Study; CCH=Copenhagen City Heart Study; Whitehall II Study; WHS=Women’s Health Study; WOLF-S=Work, Lipids, Fibrinogen-Stockholm; BELSTRESS=Belgian Job Stress Project; IPAW=Intervention Project on Absence and Well-being; WOLF-N=Work, Lipids, Fibrinogen-Norrland; COPSOQ-I=Copenhagen Psychosocial Questionnaire version 1; HeSSup=Health and Social Support; PUMA=Burnout, Motivation and Job Satisfaction Study; DWECS=Danish Work Environment Cohort Study; FPS=Finnish Public Sector Study; HNR=Heinz-Nixdorf Recall Study; COPSOQ-II=Copenhagen Psychosocial Questionnaire version 2
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Fig 3 Forest plot of studies investigating the association between job insecurity and incident CHD, adjusted for multivariable analysis. Multivariable adjustment: age, sex, socioeconomic status, smoking, alcohol use, physical activity, body mass index, hypertension, hypercholesterolaemia, and diabetes (adjusted factors varied by study; table 1 shows a detailed list of adjusted covariates in different studies). BCS=Blue Collar Study; Still Working; NHS=Nurses’ Health Study; CCH=Copenhagen City Heart Study; Whitehall II Study; WOLF-S=Work, Lipids, Fibrinogen-Stockholm; BELSTRESS=Belgian Job Stress Project; IPAW=Intervention Project on Absence and Well-being; WOLF-N=Work, Lipids, Fibrinogen-Norrland; COPSOQ-I=Copenhagen Psychosocial Questionnaire version 1; HeSSup=Health and Social Support; PUMA=Burnout, Motivation and Job Satisfaction Study; DWECS=Danish Work Environment Cohort Study; FPS=Finnish Public Sector Study; HNR=Heinz-Nixdorf Recall Study; COPSOQ-II=Copenhagen Psychosocial Questionnaire version 2. The Women’s Health Study was excluded because no multivariable adjusted results were reported
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