ORIGINAL ARTICLE

Do changes in effort-reward imbalance at work contribute to an explanation of the social gradient in angina?

T Chandola¹, J Siegrist² and M Marmot¹

¹ International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK
² Department of Medical Sociology, University of Duesseldorf, Germany

Correspondence to:
Correspondence to:
Dr T Chandola
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; t.chandola{at}ucl.ac.uk

Aims: To determine whether an increase in effort-reward imbalance over time increases the risk of angina, and whether such increases are associated with lower occupational position.

Methods: Effort-reward imbalance (ERI) at work was measured in the Whitehall II occupational cohort of London based civil servants at baseline (1985–88) and in 1997. Coronary heart disease was measured in a self-reported health questionnaire by combining the Rose Angina Questionnaire with doctor diagnosed angina in 2001.

Results: Among men, increase in ERI over time was associated with an increased risk of incident angina. Moreover, as increases in ERI were more common among lower grade civil servants, change in imbalance, to some extent, contributed to explaining the social gradient in angina. Among women, increases in imbalance were not associated with risk of angina, and therefore did not contribute to the explanation of the social gradient.

Conclusions: Reductions in effort-reward imbalance at work may reduce the risk of coronary heart disease among men.

Abbreviations: CHD, coronary heart disease; ERI, effort-reward imbalance

Keywords: effort-reward imbalance; angina; social gradient; pathways

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Smith, P, Beaton, D (2008). Measuring change in psychosocial working conditions: methodological issues to consider when data are collected at baseline and one follow-up time point. Occup. Environ. Med. 65: 288-296 [Abstract] [Full Text]  
• Smith, P., Frank, J., Bondy, S., Mustard, C. (2008). Do Changes in Job Control Predict Differences in Health Status? Results From a Longitudinal National Survey of Canadians. Psychosom. Med. 70: 85-91 [Abstract] [Full Text]  
• Kivimaki, M., Vahtera, J., Elovainio, M., Virtanen, M., Siegrist, J. (2007). Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models?. Occup. Environ. Med. 64: 659-665 [Abstract] [Full Text]  
• Brunner, E. J., Chandola, T., Marmot, M. G. (2007). Prospective Effect of Job Strain on General and Central Obesity in the Whitehall II Study. Am J Epidemiol 165: 828-837 [Abstract] [Full Text]  
• Chandola, T., Brunner, E., Marmot, M. (2006). Chronic stress at work and the metabolic syndrome: prospective study. BMJ 332: 521-525 [Abstract] [Full Text]  
• Loomis, D. (2005). Work in brief. Occup. Environ. Med. 62: 211-211 [Full Text]