Elsevier

Annals of Epidemiology

Volume 14, Issue 1, January 2004, Pages 24-30
Annals of Epidemiology

Prospective study of job insecurity and coronary heart disease in US women

https://doi.org/10.1016/S1047-2797(03)00074-7Get rights and content

Abstract

Purpose

To examine prospectively the relationship between job insecurity and incidence of coronary heart disease (CHD) among women.

Methods

We conducted the study in 36,910 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 US states. These women were 46 to 71 years old, and did not have diagnosed CHD, stroke, or cancer at baseline (1992). We collected information on job insecurity in 1992 and coronary heart disease incidence between baseline (June 1, 1992) and return of the 1996 questionnaire.

Results

During 4 years of follow-up, we documented 154 incident cases of CHD (113 non-fatal cases of myocardial infarction (MI) and 41 CHD deaths). After adjustment for a wide array of potential confounders, the relative risk (RR) of total CHD over 2-year follow-up was 1.35 (95% CI, 0.78–2.34) and 1.04 (95% CI, 0.69–1.57) over 4-year follow-up. Job insecurity appeared to significantly increase the risk of non-fatal MI in the short term (2-year follow-up: RR = 1.89, 95% CI, 1.03–3.50), though not over a longer follow-up period (RR = 1.28, 95% CI, 0.82–2.00), nor fatal CHD in the short term (RR = 0.49, 95% CI, 0.22–2.08).

Conclusion

These data suggest that job insecurity may increase the short-term risk of non-fatal MI in women.

Introduction

There is overwhelming evidence to suggest that job loss and unemployment is harmful to health. Unemployment has been linked to increased mortality 1., 2., 3., 4., 5., 6., increased morbidity (7), increased rates of general practice consultation 8., 9., decreased immune function (10), and depression (11). By contrast, fewer studies have focused on the deleterious health effects of job insecurity. Job insecurity is defined as an employee's perception of potential threat to continuity in one's current employment (12). In comparison to the actual loss of material resources (income) caused by unemployment, the condition of job insecurity is believed to lead to psychological stress due to uncertainty about the future. With the exception of a few studies 13., 14., many studies have reported adverse effects of job insecurity on selfreported illness symptoms 15., 16., elevated blood pressure (17), sleep disturbance, anxiety, and depression (18), increased health service use 19., 20., 21., as well as higher secretion of cortisol (22).

Job insecurity may constitute a major source of stress for individuals working in industries that are downsizing or undergoing intense market competition and consolidation, such as occurred in the U.S. health care industry during the 1990s. During that time, the spread of managed care, growing price competition, and decreasing Medicare and Medicaid payments intensified the economic pressure on providers, especially hospitals. In response, hospitals sought to contain costs by such means as reducing the number of beds, decreasing patient length of stays (23), reducing the level of nurse staffing, substituting non-professional and unlicensed personnel for professional registered nurses (RNs), and increasing the workload of nurses as a result of all of the above 24., 25.. These changes likely increased the level of job insecurity in the nursing workforce.

In the present study, we examined prospectively, the association between job insecurity and the incidence of coronary heart disease (CHD) in a cohort of middle-aged and older women who are mostly registered nurses. This study focused on job insecurity measured in 1992, at the beginning of the spread of job insecurity among US registered nurses, in relation to its potential effect on CHD incidence from 1992 to 1996.

Section snippets

Study population

Study subjects were drawn from the Nurses' Health Study, which is an ongoing cohort of U.S. female registered nurses (26). The Nurses' Health Study was established in 1976, when 121,700 female registered nurses 30 to 55 years of age completed a mailed questionnaire requesting information about risk factors for cardiovascular disease and cancer as well as other major health conditions. Since then, follow-up questionnaires have been mailed every 2 years to the cohort to update information on

Results

Table 1 shows the age-standardized distribution of risk factors for CHD and other characteristics according to job insecurity. The mean ages were similar comparing women with secure job and insecure jobs. Women reporting an insecure job were somewhat more likely to report a personal history of hypertension and diabetes mellitus compared with those having a secure job. They were also somewhat less likely to be currently married, more likely to be engaged in part-time work, and more likely to

Discussion

Our data suggest that job insecurity may increase the risk of non-fatal MI in the short term (2-year follow-up), though not over a longer period. Caution must be exercised in interpreting our findings, which are based on a relatively small number of events, with only non-fatal MI showing a statistically significant association with job insecurity in the short term. The number of cases of fatal CHD was too sparse to reach a definite conclusion. Our finding of a short-term effect of job

Acknowledgements

This research was funded by a grant from the National Institute of Aging Research (R01-AG-12806) and by the Dana Foundation. The Nurses' Health Study was funded by a grant from the National Institute of Health (NIH) (R01-CA-87969). Dr. Kawachi was supported by a NIH Career Development Award (HL-03453). The authors wish to thank the members of the Nurses' Health Study for their continuing participation and support.

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