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Workplace
Original research
Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study
  1. Johannes Siegrist1,
  2. Marcel Goldberg2,
  3. Marie Zins2,
  4. Morten Wahrendorf3
  1. 1 Centre for Health and Society, Institute of Medical Sociology, Professor Emeritus, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  2. 2 Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris Saclay University, UVSQ, UMS 011, Paris, France
  3. 3 Centre for Health and Society, Institute of Medical Sociology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  1. Correspondence to Dr Morten Wahrendorf, Medical Faculty, Centre for Health and Society, Institute of Medical Sociology, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany; wahrendorf{at}uni-duesseldorf.de

Abstract

Background Studies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP.

Methods We used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30–70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort–reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale.

Results SEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort–reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found.

Conclusions Disadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.

  • sociology
  • occupational health
  • occupational stress

Data availability statement

Data may be obtained from a third party and are not publicly available. Access to raw data requires the submission of a research project that is examined by the CONSTANCES International Scientific Committee and authorised by the Institutional Steering Committee.

https://doi.org/10.1136/oemed-2022-108794

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Access to raw data requires the submission of a research project that is examined by the CONSTANCES International Scientific Committee and authorised by the Institutional Steering Committee.

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    Footnotes

    • Contributors All authors (JS, MG, MZ and MW) have contributed as follows: MG and MZ designed the study, including quality assurance and control, and helped supervise the field activities and provided the data. MW and JS developed the study’s analytical strategy and the conceptual frame of the study. MW had the main responsibility for data management and analyses, and JS drafted the first version of the manuscript. All authors critically reviewed the first draft of the manuscript and approved its submission. MW is responsible for the overall content as guarantor.

    • Funding This work was supported by funding from the German research foundation (Deutsche Forschungsgemeinschaft; DFG), project number 426165351. The CONSTANCES Cohort Study was supported and funded by the Caisse nationale d’assurance maladie des travailleurs salariés (CNAM). The CONSTANCES Cohort Study is an 'Infrastructure nationale en Biologie et Santé' and benefits from a grant from ANR (ANR-11-INBS-0002). CONSTANCES is also partly funded by MSD, AstraZeneca and Lundbeck.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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