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Do changes in effort-reward imbalance at work contribute to an explanation of the social gradient in angina?
  1. T Chandola1,
  2. J Siegrist2,
  3. M Marmot1
  1. 1International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK
  2. 2Department of Medical Sociology, University of Duesseldorf, Germany
  1. 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;


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.

  • CHD, coronary heart disease
  • ERI, effort-reward imbalance
  • effort-reward imbalance
  • angina
  • social gradient
  • pathways

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  • Competing interests: none declared

  • Ethical clearance: Ethical approval for the Whitehall II study was obtained from the University College London Medical School Committee on the ethics of human research. The Whitehall II study participants gave written, informed consent, and the manuscript conforms to the principles outlined in the Declaration of Helsinki.