Occupational
Coronary Heart Disease Attributable to Psychosocial Stressors at Work Mathilde Lavigne-Robichaud* Mathilde Lavigne-Robichaud Trudel, X. Talbot, D. Milot, A. Gilbert-Ouimet, M. Brisson, C.
Background. Psychosocial stressors at work, including job strain and effort-reward imbalance (ERI), have been associated with an increased risk of coronary heart disease (CHD). However, the proportion of CHD events attributable to these work-related stressors has not been quantified in a prospective cohort study.
Methods. This 15-year prospective cohort study was conducted among employees from public and semi-public organizations in Quebec City, Canada, between 2004 and 2018. A total of 6,295 participants without cardiovascular disease at baseline were included, with essential eligibility criteria encompassing employment in the specified organizations and absence of pre-existing cardiovascular conditions. Psychosocial stressors were assessed using validated instruments measuring job strain and ERI. The primary outcome was the incidence of CHD events, identified through universally covered healthcare databases. Attributable fractions were estimated using the Kaplan-Meier method, with multiple imputation and inverse probability weighting applied to address selection and confounding biases.
Results. Over the 15-year follow-up, 669 CHD events occurred among the participants, who contributed a total of 112,297 person-years, yielding a CHD incidence rate of 5.96 per 1,000 person-years. The attributable fraction for job strain was 18.2% (95% confidence interval [CI]: 1.8% to 34.7%), and for ERI, it was 3.3% (95% CI: -1.6% to 8.2%). Combined exposure to both stressors resulted in an attributable fraction of 19.5% (95% CI: 0.7% to 38.4%).
Conclusions. In this cohort, combined exposure to job strain and ERI accounted for approximately one-fifth of CHD events. Implementing strategies to reduce these work-related stressors may effectively decrease the burden of CHD.