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Meta-Analysis
. 2018 Jan;61(1):75-83.
doi: 10.1007/s00125-017-4480-3. Epub 2017 Nov 13.

Workplace bullying and violence as risk factors for type 2 diabetes: a multicohort study and meta-analysis

Tianwei Xu  1   2 , Linda L Magnusson Hanson  3 , Theis Lange  4   5 , Liis Starkopf  4 , Hugo Westerlund  6 , Ida E H Madsen  7 , Reiner Rugulies  8   7   9 , Jaana Pentti  10   11 , Sari Stenholm  10   11 , Jussi Vahtera  10   11 , Åse M Hansen  8   7 , Mika Kivimäki  12   13   14 , Naja H Rod  8   6
Affiliations
Meta-Analysis

Workplace bullying and violence as risk factors for type 2 diabetes: a multicohort study and meta-analysis

Tianwei Xu et al. Diabetologia. 2018 Jan.

Abstract

Aims/hypothesis: The aim of this multicohort study was to examine whether employees exposed to social stressors at work, such as workplace bullying and violence, have an increased risk of type 2 diabetes.

Methods: The study included 45,905 men and women (40-65 years of age and free of diabetes at baseline) from four studies in Sweden, Denmark and Finland. Workplace bullying and violence were self-reported at baseline. Incident diabetes was ascertained through national health and medication records and death registers. Marginal structural Cox models adjusted for age, sex, country of birth, marital status and educational level were used for the analyses.

Results: Nine per cent of the population reported being bullied at work and 12% were exposed to workplace violence or threats of violence. Bullied participants had a 1.46 (95% CI 1.23, 1.74) times higher risk of developing diabetes compared with non-bullied participants. Exposure to violence or threats of violence was also associated with a higher risk of diabetes (HR 1.26 [95% CI 1.02, 1.56]). The risk estimates attenuated slightly when taking BMI into account, especially for bullying. The results were similar for men and women, and were consistent across cohorts.

Conclusions/interpretation: We found a higher risk of incident type 2 diabetes among employees exposed to bullying or violence in the workplace. Further research is needed to determine whether policies to reduce bullying and violence at work may reduce the incidence of type 2 diabetes in working populations. Research on the mechanisms is also highly warranted.

Keywords: Bullying; Diabetes; Meta-analysis; Occupational health; Stress; Violence; Workplace.

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Conflict of interest statement

Data availability

FPS and DWECS data are available on request from the authors. These data are not publicly available and there are no DOIs available in relation to these studies. The data for SLOSH and SWES are not publicly available because of legal restrictions. A strategy for data access has been developed that strives to make SLOSH data as accessible as possible while satisfying legal requirements, ethical principles and protection of the personal integrity of the participants. Requests for data for specific research projects or collaborations are welcome and can be addressed to data@slosh.se. The application form and more information about the study can be found at www.stressforskning.su.se/slosh.

Funding

The study was funded by NordForsk, the Nordic Research Program on Health and Welfare (no. 75021), Project on Psychosocial Work Environment and Healthy Ageing and Danish Working Environment Foundation (grant no. 09-2016-03).

Duality of interest

The authors declare no conflict of interest.

Contribution statement

TX and NHR contributed to the conception and design of the study, the analysis and interpretation of the data, and the drafting of the article. IEHM and JP contributed to the analysis of the data. LS contributed to the proofreading of the codes. LMH, TL, LS, HW, IEHM, JP, RR, SS, JV, ÅMH and MK contributed to the conception and design of the study and the critical revision of the article. All authors have read and approved submission of the manuscript. NHR is guarantor of the study.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
(a) Main analysis using a fixed-effect model on the association of workplace bullying with type 2 diabetes, after adjustment for age, sex, educational level, marital status and country of birth. (b) Sensitivity analysis using a fixed-effect model by sex, adjustments (based on SLOSH, FPS and DWECS), follow-up time (based on SLOSH, FPS and SWES07) and case ascertainment
Fig. 3
Fig. 3
(a) Main analysis using a fixed-effect model on the association of workplace violence with type 2 diabetes, after adjustment for age, sex, educational level, marital status and country of birth. (b) Sensitivity analysis using a fixed-effect model by sex, adjustments (based on SLOSH and DWECS), follow-up time (based on SLOSH and SWES07) and case ascertainment
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