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The contribution of major risk factors and job strain to occupational class differences in coronary heart disease incidence: the MONICA Brianza and PAMELA population-based cohorts
  1. Marco M Ferrario1,
  2. Giovanni Veronesi1,
  3. Lloyd E Chambless2,
  4. Roberto Sega3,
  5. Carla Fornari3,
  6. Matteo Bonzini1,
  7. Giancarlo Cesana3
  1. 1Dipartimento di Medicina Sperimentale, Università degli Studi dell'Insubria, Varese, Italy
  2. 2Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Dipartimento di Medicina Clinica e Preventiva, Università degli Studi di Milano – Bicocca, Monza, Italy
  1. Correspondence to Marco M Ferrario, Medicina del Lavoro e Preventiva, Ospedale di Circolo di Varese, Fondazione Macchi, Viale Borri 57, I-21100, Varese, Italy; marco.ferrario{at}


Objectives We investigated the contribution of major coronary heart disease (CHD) risk factors and job strain to occupational class differences in CHD incidence in a pooled-cohort prospective study in northern Italy.

Methods 2964 men aged 25–74 from four northern Italian population-based cohorts were investigated at baseline and followed for first fatal or non-fatal CHD event (171 events). Standardised procedures were used for baseline risk factor measurements, follow-up and validation of CHD events. Four occupational classes were derived from the Erikson–Goldthorpe–Portocarero social class scheme: higher and lower professionals and administrators, non-manual workers, skilled and unskilled manual workers, and the self-employed. HRs were estimated with Cox models.

Results Among CHD-free subjects, with non-manual workers as the reference group, age-adjusted excess risks were found for professionals and administrators (+84%, p=0.02), the self-employed (+72%, p=0.04) and manual workers (+63%, p=0.04). The relationship was consistent across different CHD diagnostic categories. Adjusting for major risk factors only slightly reduced the reported excess risks. In a sub-sample of currently employed subjects, adjusting for major risk factors, sport physical activity and job strain reduced the excess risk for manual workers (relative change = −71.4%) but did not substantially modify the excess risks of professionals and administrators and the self-employed.

Conclusions In our study, we found higher CHD incidence rates for manual workers, professionals and administrators, and the self-employed, compared to non-manual workers. When the entire spectrum of job categories is considered, the job strain model helped explain the CHD excess risk for manual workers but not for other occupational classes.

  • Cohort study
  • coronary heart disease
  • occupational class
  • risk factors
  • job stress, epidemiology
  • cardiovascular
  • stress
  • longitudinal studies

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  • Funding The MONICA Brianza Study was mainly supported by the health administration of the Lombardy Region. The follow-up was partially supported by grants from the Italian Ministry of Health and was carried out in collaboration with the Centro di Epidemiologia, Sorveglianza e Promozione della Salute of the Istituto Superiore di Sanità, Rome.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethic Committee of the University Hospital of Monza.

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