Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women

Solja T Nyberg¹, Eleonor I Fransson², Katriina Heikkilä³, Kirsi Ahola³, Lars Alfredsson⁴, Jakob B Bjorner⁵, Marianne Borritz⁶, Hermann Burr⁷, Nico Dragano⁸, Marcel Goldberg⁹, Mark Hamer¹⁰, Markus Jokela¹¹, Anders Knutsson¹², Markku Koskenvuo¹³, Aki Koskinen³, Anne Kouvonen¹⁴, Constanze Leineweber¹⁵, Ida E H Madsen⁵, Linda L Magnusson Hanson¹⁵, Michael G Marmot¹⁰, Martin L Nielsen⁶, Maria Nordin¹⁶, Tuula Oksanen³, Jan H Pejtersen¹⁷, Jaana Pentti³, Reiner Rugulies¹⁸, Paula Salo¹⁹, Johannes Siegrist⁸, Andrew Steptoe¹⁰, Sakari Suominen²⁰, Töres Theorell¹⁵, Ari Väänänen³, Jussi Vahtera²¹, Marianna Virtanen³, Peter J M Westerholm²², Hugo Westerlund¹⁵, Marie Zins⁹, G David Batty²³, Eric J Brunner¹⁰, Jane E Ferrie²⁴, Archana Singh-Manoux²⁵, Mika Kivimäki²⁶; IPD-Work Consortium

Affiliations

¹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.
² School of Health Sciences, Jönköping University, Jönköping, SwedenInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenStress Research Institute, Stockholm University, Stockholm, Sweden.
³ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
⁴ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenCentre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
⁵ National Research Centre for the Working Environment, Copenhagen, Denmark.
⁶ Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
⁷ Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
⁸ Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
⁹ Versailles-Saint Quentin University, Versailles, FranceInserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
¹⁰ Department of Epidemiology and Public Health, University College London, London, U.K.
¹¹ Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
¹² Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
¹³ Department of Public Health, University of Helsinki, Helsinki, Finland.
¹⁴ School of Sociology, Social Policy & Social Work, Queen's University Belfast, Belfast, U.K.UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Belfast, U.K.
¹⁵ Stress Research Institute, Stockholm University, Stockholm, Sweden.
¹⁶ Department of Psychology, Umeå University, Umeå, Sweden.
¹⁷ The Danish National Centre for Social Research, Copenhagen, Denmark.
¹⁸ National Research Centre for the Working Environment, Copenhagen, DenmarkDepartment of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
¹⁹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Psychology, University of Turku, Turku, Finland.
²⁰ Folkhälsan Research Center, Helsinki, FinlandNordic School of Public Health, Göteborg, SwedenDepartment of Public Health, University of Turku, Turku, Finland.
²¹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Public Health, University of Turku, Turku, FinlandTurku University Hospital, Turku, Finland.
²² Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
²³ Department of Epidemiology and Public Health, University College London, London, U.K.Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, U.K.
²⁴ Department of Epidemiology and Public Health, University College London, London, U.K.School of Community and Social Medicine, University of Bristol, Bristol, U.K.
²⁵ Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, FranceDepartment of Epidemiology and Public Health, University College London, London, U.K.
²⁶ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Epidemiology and Public Health, University College London, London, U.K.Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.

PMID: 25061139
PMCID: PMC4113178
DOI: 10.2337/dc13-2936

Meta-Analysis

Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women

Solja T Nyberg et al. Diabetes Care. 2014 Aug.

. 2014 Aug;37(8):2268-75.

doi: 10.2337/dc13-2936.

Authors

Affiliations

¹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.
² School of Health Sciences, Jönköping University, Jönköping, SwedenInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenStress Research Institute, Stockholm University, Stockholm, Sweden.
³ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
⁴ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenCentre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
⁵ National Research Centre for the Working Environment, Copenhagen, Denmark.
⁶ Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
⁷ Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
⁸ Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
⁹ Versailles-Saint Quentin University, Versailles, FranceInserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
¹⁰ Department of Epidemiology and Public Health, University College London, London, U.K.
¹¹ Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
¹² Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
¹³ Department of Public Health, University of Helsinki, Helsinki, Finland.
¹⁴ School of Sociology, Social Policy & Social Work, Queen's University Belfast, Belfast, U.K.UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Belfast, U.K.
¹⁵ Stress Research Institute, Stockholm University, Stockholm, Sweden.
¹⁶ Department of Psychology, Umeå University, Umeå, Sweden.
¹⁷ The Danish National Centre for Social Research, Copenhagen, Denmark.
¹⁸ National Research Centre for the Working Environment, Copenhagen, DenmarkDepartment of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
¹⁹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Psychology, University of Turku, Turku, Finland.
²⁰ Folkhälsan Research Center, Helsinki, FinlandNordic School of Public Health, Göteborg, SwedenDepartment of Public Health, University of Turku, Turku, Finland.
²¹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Public Health, University of Turku, Turku, FinlandTurku University Hospital, Turku, Finland.
²² Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
²³ Department of Epidemiology and Public Health, University College London, London, U.K.Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, U.K.
²⁴ Department of Epidemiology and Public Health, University College London, London, U.K.School of Community and Social Medicine, University of Bristol, Bristol, U.K.
²⁵ Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, FranceDepartment of Epidemiology and Public Health, University College London, London, U.K.
²⁶ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Epidemiology and Public Health, University College London, London, U.K.Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.

PMID: 25061139
PMCID: PMC4113178
DOI: 10.2337/dc13-2936

Abstract

Objective: The status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as "job strain," is associated with incident type 2 diabetes independent of lifestyle factors.

Research design and methods: We extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses.

Results: There were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06-1.25) with no difference between men and women (1.19 [1.06-1.34] and 1.13 [1.00-1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00-1.23).

Conclusions: Findings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.

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Figures

**Figure 1**
Fixed-effect meta-analysis of age-, sex-, and SES-adjusted association between job strain and incident type 2 diabetes.

**Figure 2**
Associations of job strain and incident type 2 diabetes in healthy and unhealthy lifestyle subgroups.

See this image and copyright information in PMC

References

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Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women

Affiliations

Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical