ORIGINAL ARTICLE

Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies

I Andersen¹, H Burr², T S Kristensen², M Gamborg¹, M Osler³, E Prescott⁴, F Diderichsen³

¹ Copenhagen Centre for Prospective Population Studies, Danish Epidemiology Science Centre, at the Institute of Preventive Medicine, H:S Kommunehospitalet, Copenhagen University Hospital, DK-1399 Copenhagen K, Denmark
² National Institute of Occupational Health, Lersø Parkalle 105, DK-2100 Copenhagen Ø, Denmark
³ Copenhagen Centre for Prospective Population Studies, at the Institute of Public Health, Copenhagen University, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
⁴ Department of Cardiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø

Correspondence to:
Correspondence to:
Mrs I Andersen
Institute of Preventive Medicine, Danish Epidemiology Science Centre, H:S Kommunehospitalet, DK-1399 Copenhagen, Denmark; ia{at}ipm.hosp.dk

Aim: To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment.

Methods: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 214 employees, 44% women, aged 20–75 years, with initial examination between 1974 and 1992 were followed until 1996 for incident (hospital admission or death) MI. Register based information on job categories was used. Psychosocial job exposures were measured indirectly by means of a job exposure matrix based on the Danish Work Environment Cohort Study 1990.

Results: During follow up, 731 subjects were diagnosed with an MI: 610 men and 121 women (35% fatal). The hazards by socioeconomic position showed a graded effect with a hazard ratio (HR) of 1.57 (95% CI 1.23 to 2.03) for unskilled workers compared to executive managers. Despite a strong and graded association in risk of MI related to decision authority and skill discretion, only skill discretion mediated the effect of socioeconomic position. The HR for unskilled workers was reduced to 1.47 (0.93 to 2.31) after adjustment for decision authority and other cardiovascular risk factors, and to 1.07 (0.72 to 1.60) after adjustment for skill discretion and cardiovascular risk factors. No sign of synergy was found.

Conclusions: Decision authority and skill discretion were strongly related to socioeconomic position; and the effect on risk of MI was partially mediated by skill discretion. Improvements in psychosocial work environment, especially possibilities for skill discretion, might contribute to reducing the incidence of MI and social inequality in MI.

Abbreviations: BMI, body mass index; CCHS, The Copenhagen City Heart Studies; CHD, coronary heart disease; CMS, The Copenhagen Male Study; DWECS, Danish Work Environment Cohort Study; ECM, Employment Classification Module; GPS, The Glostrup Population Studies; HR, hazard ratio; IHD, ischaemic heart disease; ISIC, International Standard Classification of all Economic Activity; JEM, job exposure matrix; MI, myocardial infarction; MONICA, MONItoring Trends and Determinants in CArdiovascular Diseases; SBP, systolic blood pressure; SHEEP, Stockholm Heart Epidemiology Program

Keywords: decision latitude; JEM; myocardial infarction; skill discretion; socioeconomic position

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