Occup Environ Med 70:663-669 doi:10.1136/oemed-2012-101331
  • Review

Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies

Open Access
  1. Johannes Siegrist1
  1. 1Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Life-Science Center, Düsseldorf, Germany
  2. 2Faculty of Medicine, Institute of Medical Sociology, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
  1. Correspondence to Hanno Hoven, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Life-Science Center, Merowingerplatz 1a, Düsseldorf D-40225, Germany; Hanno.hoven{at}
  • Received 26 December 2012
  • Revised 26 March 2013
  • Accepted 10 May 2013
  • Published Online First 5 June 2013


Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.

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