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. 2016 Jun;26(3):470-7.
doi: 10.1093/eurpub/ckw025. Epub 2016 Mar 31.

A systematic review of studies in the contributions of the work environment to ischaemic heart disease development

Töres Theorell  1 , Katarina Jood  2 , Lisbeth Slunga Järvholm  3 , Eva Vingård  4 , Joep Perk  5 , Per Olov Östergren  6 , Charlotte Hall  7
Affiliations

A systematic review of studies in the contributions of the work environment to ischaemic heart disease development

Töres Theorell et al. Eur J Public Health. 2016 Jun.

Abstract

Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system.

Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed.

Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence.

Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

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Figures

Figure 1
Figure 1
Flow chart of the literature search, screening, review- and quality assessment
Figure 2
Figure 2
(a) Association between job strain and development of ischaemic heart disease. The graph is based on data from the least adjusted model in studies expressing the strength of the association either as HR, OR or RR. The figure also provides an informal homogeneity test. Case control studies (above blue line) are compared with prospective cohort studies (below blue line). (b) Association between occupational noise and development of ischaemic heart disease. The graph is based on data from the least adjusted model in studies expressing the strength of the association either as hazard ratios (HR), OR or RR
Figure 3
Figure 3
Funnel plot illustrating possible publication bias based upon data on job strain in relation to IHD
See this image and copyright information in PMC

References

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