Impact of occupational stress on stroke across occupational classes and genders
Introduction
Previous studies have indicated that workers in lower occupational classes are more vulnerable to occupational stress than workers in higher occupational classes (Hallqvist et al., 1998, Kivimäki et al., 2002, Lynch et al., 1997, Theorell et al., 1998, Wege et al., 2008). Only a few studies have prospectively investigated the association between occupational class and occupational stress using stroke as the outcome (Kivimäki et al., 2009, Kuper et al., 2007, Toivanen, 2008, Toivanen and Hemström, 2008, Virtanen and Notkola, 2002). Of those, one study showed that female lower occupational class non-manual workers with low job control had a significantly higher risk of stroke mortality (Toivanen & Hemström, 2008). Other prospective studies did not test whether lower occupational class workers were more susceptible when exposed to occupational stress (Kivimäki et al., 2009, Kuper et al., 2007). Thus, there is no prospective study that has addressed different vulnerabilities to stress across occupational classes using incident stroke as an outcome. In addition, there may be gender differences in the health impact of socioeconomic factors as well as occupational stress (Kopp, Skrabski, Szekely, Stauder, & Williams, 2007). Nevertheless, few studies have addressed the potential interaction between gender and occupational or employment status and gender differences in work hazard exposures and the health impact. Furthermore, the prospective associations between occupational class/occupational stress and health outcomes have not been examined extensively outside Western societies. Data from the Jichi Medical School Cohort Study of a Japanese working population, a large-scale prospective cohort study, allowed an approach to this important issue. The aims of the present study were to analyze the association between incident stroke, occupational class and stress and examine whether the association is found in both men and women in a prospective study of Japanese male and female workers.
Section snippets
Study populations
Data were acquired from routine mass screening examinations for cardiovascular diseases in the aged, which were carried out in Japan in accordance with relevant legal regulations. The regulations required municipal governments to manage the program efficiently and to make it available to all residents who wished to participate. The local government office invited all potential participants in each community to attend screenings by sending letters or using public information channels. The
Results
Table 1 shows the relationships between occupational classes and the examined variables at baseline. Male white-collar workers were younger, had higher educational attainment and were less physically active than male blue-collar workers. The two occupational categories were significantly associated. Specifically, three-quarters of white-collar workers and a third of blue-collar workers filled supervisory or managerial positions. Regarding psychosocial job characteristics, active and, to a
Discussion
In a cohort of Japanese workers, we found a significantly higher risk of incident stroke in men with high job strain among blue-collar workers and those in non-managerial jobs, but not among white-collar workers or those in managerial positions. The opposite trends were observed in women, i.e., significant elevated risks among white-collar and managerial workers, but not among blue-collar workers or those in non-managerial positions. To the best of our knowledge, this is the first study to
Conclusion
The findings of this study suggest that the health impact of occupational stress characterized by high job demands and low control is greater among male workers in lower occupational classes. Amid significant changes in the working environment, it is imperative to accumulate observational data over a period of time to confirm the relationships between occupational class, occupational stress and stroke in Japanese women.
Conflict of interest
None.
Acknowledgment
This study was partly supported by a grant-in-aid from the Foundation for the Development of the Community, Tochigi, Japan, and by Grant-in-Aid for Scientific Research.
References (40)
- et al.
Combined effects of uncertainty and organizational justice on employee health: testing the uncertainty management model of fairness judgments among Finnish public sector employees
Social Science & Medicine
(2005) - et al.
Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm heart epidemiology program (SHEEP)
Social Science & Medicine
(1998) - et al.
The impact of multiple role occupancy on health-related behaviours in Japan: differences by gender and age
Public Health
(2006) - et al.
National strategy for suicide prevention in Japan
Lancet
(2003) - et al.
Is job strain a major source of cardiovascular disease risk?
Scandinavian Journal of Work & Environmental Health
(2004) Socio-economic differences in health. Are control beliefs fundamental mediators?
- et al.
Accumulation of health risk behaviours is associated with lower socioeconomic status and women’s urban residence: a multilevel analysis in Japan
BMC Public Health
(2005) Double exposure: the combined impact of the home and work environments on psychosomatic strain in Swedish women and men
International Journal of Health Services
(1992)- et al.
Does autonomic function limk social position to coronary risk? The Whitehall II study
Circulation
(2005) - et al.
Impacts of educational level and employment status on mortality for Japanese women and men: the Jichi Medical School Cohort study
European Journal of Epidemiology
(2006)
The Jichi Medical School (JMS) cohort study: design, baseline data and standardized mortality ratios
Journal of Epidemiology
Some health benefits of physical activity: the Framingham study
Archives of Internal Medicine
Healthy work: Stress, productivity, and the reconstruction of working life
Epidemiology of job stress and health in Japan: review of current evidence and future direction
Industrial Health
Occupational class and exposure to job stressors among employed men and women in Japan
Journal of Epidemiology
Five-year stability of job characteristics scale scores among a Japanese working population
Journal of Epidemiology
The relevance of psychosocial factors in acute ischemic heart disease: a case-control study of a Japanese population
Japanese Circulation Journal
Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees
British Medical Journal
Socioeconomic position, psychosocial work environment and cerebrovascular disease among women: the Finnish public sector study
International Journal of Epidemiology
Chronic stress and social changes: socioeconomic determination of chronic stress
Annals of the New York Academy of Sciences
Cited by (55)
Happiness and life expectancy by main occupational position among older workers: Who will live longer and happy?
2021, SSM - Population HealthCitation Excerpt :These studies have found that the highly educated groups consistently recorded a higher percentage of their lives feeling satisfied and happy. Nonetheless, past research has shown that those in lower occupational position are more vulnerable to stress and burnout (Tsutsumi et al., 2011), which goes in line with our findings because we found that, overall, those in routine jobs were expected to live fewer years in a happy state. This result may be also linked to the Healthy Worker Effect where workers usually exhibit lower overall death rates than the general population because those with chronic illnesses or disabilities are not into employment (Shah, 2009).
A review of psychosocial factors and stroke: A new public health problem
2019, Revue NeurologiqueCitation Excerpt :Five studies [13,33,45,46,59] observed a non-significant positive association in women, while 2 [37,47] observed a non-significant association in men. To the opposite, 2 studies reported a significant association between PSF and stroke for women [37,43] and 5 for men [32,43,45,46,59]. One study [11] observed a significant positive association for ischemic stroke, but not for hemorrhagic stroke.
Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015
2018, SSM - Population HealthOccupational status and job stress in relation to cardiovascular stress reactivity in Japanese workers
2016, Preventive Medicine ReportsCitation Excerpt :Furthermore, in Japan, there are greater sex differences in associations between socioeconomic status, stress levels, and health outcomes than in Western countries (Kawachi and Knodo, 2007). Women with a high occupational status who are exposed to high job stress have a higher risk of stroke incidents than those who are exposed to low job stress, but this association does not hold for men (Tsutsumi et al., 2011). Japanese men with lower occupational status perceive themselves to have poorer health and physical functioning than men with higher occupational status, which is also the case in men in Western countries.
Perceived stress, common carotid intima media thickness and occupational status: The Paris Prospective Study III
2016, International Journal of CardiologyCitation Excerpt :More specifically, three recent large-scale prospective studies found stress-related variables to be associated with coronary heart disease or cardiovascular mortality only in participants of low socio-economic status [1–3]. Similarly, the association of perceived stress or job strain with high BP or stroke may be stronger among working participants of low occupational status and unemployed participants only [4–7]. Altogether these findings advocate for stratifying analyses regarding socio-economic status when investigating the relationships between cardiovascular health and psychological stress.
A Bad Day at Work May Be Worse Than You Think: High Job Strain and Stroke
2016, World Neurosurgery