MYOCARDIAL INFARCTION AND PSYCHOSOCIAL WORK ENVIRONMENT

The risk of coronary heart disease varies by socioeconomic position, being greatest in the most socially and economically disadvantaged members of the community. Understanding the factors that explain this variation is a critical prelude to prevention. In this issue, Andersen et al (p. 886) investigate whether differential patterns of exposure and susceptibility to the psychosocial work environment are causal intermediates in the pathway from social position to myocardial infarction.

Data from three Danish prospective studies involving 16 214 20–75 year olds were used. Incident myocardial infarctions over follow up were related to psychosocial work exposures using a job exposure matrix. During follow up over 700 subjects suffered an infarct with a clear gradient in hazard ratio by socioeconomic position. Risk of myocardial infarction showed strong and graded associations with decision authority and skill discretion when considered as separate factors, but only with skill discretion when both factors and several other cardiovascular risks were analysed together. Risk estimates were somewhat lower in the adjusted analyses. No evidence was found of synergy. The …