Job insecurity and risk of diabetes: a meta-analysis of individual participant data

Abstract

Background: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.

Methods: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.

Results: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I² = 24%, p = 0.2; multivariable-adjusted model: I² = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).

Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

Figure 1:

Study-specific analyses of association between job insecurity and incident diabetes (A) after adjustment for age and sex and (B) after adjustment for age, sex, socioeconomic status, obesity, physical activity, alcohol use and smoking. Values greater than 1.0 indicate an increased risk of incident diabetes. CI = confidence interval, OR = odds ratio. See Table 1 for full study names.

Figure 2:

Subgroup analyses of association between job insecurity and incident diabetes after adjustment for age, sex, socioeconomic status, obesity, physical activity, alcohol use and smoking (15 cohorts, n = 108 525; 2850 incident cases of diabetes). Values greater than 1.0 indicate an increased risk of incident diabetes. CE = clinical examination (oral glucose tolerance test), CI = confidence interval, EMR = electronic medical record, OR = odds ratio.