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Job strain and loss of healthy life years between ages 50 and 75 by sex and occupational position: analyses of 64 934 individuals from four prospective cohort studies
  1. Linda L Magnusson Hanson1,
  2. Hugo Westerlund1,2,
  3. Holendro S Chungkham1,3,
  4. Jussi Vahtera4,
  5. Naja H Rod5,
  6. Kristina Alexanderson2,
  7. Marcel Goldberg6,7,
  8. Mika Kivimäki8,9,
  9. Sari Stenholm4,10,
  10. Loretta G Platts1,
  11. Marie Zins6,7,
  12. Jenny Head8
  1. 1 Stress Research Institute, Stockholm University, Stockholm, Sweden
  2. 2 Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3 Indian Statistical Institute, North-East Centre, Tezpur University, Tezpur, India
  4. 4 Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  5. 5 Department of Public Health, Copenhagen University, Copenhagen, Denmark
  6. 6 Population-based Epidemiologic Cohorts Unit-UMS 011, Inserm, Villejuif, France
  7. 7 Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Inserm, Villejuif, France
  8. 8 Department of Epidemiology and Public Health, University College London, London, UK
  9. 9 Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  10. 10 School of Health Sciences, University of Tampere, Tampere, Finland
  1. Correspondence to Dr Linda L Magnusson Hanson, Stress Research Institute, Stockholm University, Stockholm 106 91, Sweden; linda.hanson{at}


Objectives Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study.

Methods Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up.

Results Multistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent.

Conclusions These findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain.

  • epidemiology
  • stress
  • longitudinal studies
  • organisation of work
  • workload

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  • Contributors All authors contributed to the conception and design of the study, interpretation of data, critical revision of the manuscript for important intellectual content, gave approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LLMH, HW, JV, MG, MK, MZ and JH contributed to acquisition and analysis of data for the work. HSC and JH performed the main statistical analyses. LLMH and HW drafted the paper. JH had full access to individual participant data in the study and takes responsibility for the integrity of the unpublished data and the accuracy of the data analysis. JH is guarantor.

  • Funding The study was financially supported by the Swedish Research Council for Health, Working Life and Welfare (2007-1762 and 2009-1758); UK Economic and Social Research Council (ES/K01336X/1) under the ERA-AGE2 initiative and NordForsk the Nordic Programme on Health and Welfare (grant 75021). In addition, the study has been funded by the Academy of Finland (286294 and 294154 for SS). MK was also supported by the Medical Research Council (K013351). The funders had no role in the design or in the collection, analysis, interpretation of data, in writing of the report or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was given for each cohort in each country from relevant ethical committees/boards. The Finnish Public Sector Study was approved by the ethics committee of the Finnish Institute of Occupational Health (60/13/03/00/2011). The GAZEL study was approved by the national commission overseeing data collection, storage and use in France (Commission nationale de l’informatique et des libertés (#88/25 (11/08/88))). The Swedish Longitudinal Occupational Survey of Health was approved by the Regional Research Ethics Board in Stockholm (2006/158-31, 2008/240-32, 2008/1808-32, 2010/0145-32, 2012/373-31/5, 2013/2173-32, 2015/2187-32). The Whitehall II study was approved by the University College London Medical School committee on the ethics of human research. Informed consent was obtained for all participants.

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

  • Data sharing statement The GAZEL, Swedish Longitudinal Occupational Survey of Health and Whitehall II study all have established policies for data sharing. Requests for data or results can be addressed to the respective data managers. For further information see, (GAZEL), (Swedish Longitudinal Occupational Survey of Health), and (Whitehall II). For information about the Finnish Public Sector Study, contact Mika Kivimaki (

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