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Do pre-employment influences explain the association between psychosocial factors at work and coronary heart disease? The Whitehall II study
  1. Taina Hintsa1,
  2. Martin J Shipley2,
  3. David Gimeno3,
  4. Marko Elovainio4,
  5. Tarani Chandola2,
  6. Markus Jokela1,2,
  7. Liisa Keltikangas-Järvinen1,
  8. Jussi Vahtera5,6,7,
  9. Michael G Marmot2,
  10. Mika Kivimäki2,7
  1. 1Department of Psychology, University of Helsinki, Finland
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  3. 3Division of Environmental and Occupational Health Sciences, The University of Texas Health Science Center, School of Public Health, San Antonio Regional Campus, San Antonio, Texas, USA
  4. 4National Institute for Health and Welfare, Helsinki, Finland
  5. 5Department of Public Health, University of Turku, Turku, Finland
  6. 6Turku University Hospital, Turku, Finland
  7. 7Finnish Institute of Occupational Health, Helsinki, Finland
  1. Correspondence to Taina Hintsa, University of Helsinki, PO Box 9, Helsinki, FIN-00014, Finland; taina.hintsa{at}helsinkifigi


Objectives To examine whether the association between psychosocial factors at work and incident coronary heart disease (CHD) is explained by pre-employment factors, such as family history of CHD, education, paternal education and social class, number of siblings and height.

Methods A prospective cohort study of 6435 British men aged 35–55 years at phase 1 (1985–1988) and free from prevalent CHD at phase 2 (1989–1990) was conducted. Psychosocial factors at work were assessed at phases 1 and 2 and mean scores across the two phases were used to determine long-term exposure. Selected pre-employment factors were assessed at phase 1. Follow-up for coronary death, first non-fatal myocardial infarction or definite angina between phase 2 and 1999 was based on clinical records (250 events, follow-up 8.7 years).

Results The selected pre-employment factors were associated with risk for CHD: HRs (95% CI) were 1.33 (1.03 to 1.73) for family history of CHD, 1.18 (1.05 to 1.32) for each quartile decrease in height and 1.16 (0.99 to 1.35) for each category increase in number of siblings. Psychosocial work factors also predicted CHD: 1.72 (1.08 to 2.74) for low job control and 1.72 (1.10 to 2.67) for low organisational justice. Adjustment for pre-employment factors changed these associations by 4.1% or less.

Conclusions In this occupational cohort of British men, the association between psychosocial factors at work and CHD was largely independent of family history of CHD, education, paternal educational attainment and social class, number of siblings and height.

  • Coronary heart disease
  • job control
  • organisational justice
  • pre-employment factors
  • epidemiology
  • psychology
  • public health
  • health promotion
  • workload

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  • Funding TH was supported by the Finnish Cultural Foundation, JV and MK by the Academy of Finland (projects 117604, 124332, 124327 and 129262), LKJ by the Academy of Finland (Work Consortium project 124399) and MJS by the British Heart Foundation. MGM is supported by an MRC research professorship. The Whitehall II study has been supported by grants from the British Medical Research Council (MRC), the British Heart Foundation, the British Health and Safety Executive, the British Department of Health, the National Heart, Lung, and Blood Institute (grant HL36310), the National Institute on Aging (grant AG13196), the Agency for Health Care Policy and Research (grant S06516) and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University College London Hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.