Men with cardiometabolic disease and elevated work stress have a clinically significant risk for mortality independent of conventional risk factors, according to research published in Lancet Diabetes and Endocrinology.

Data from 7 cohort studies in the Individual-Participant-Data Meta-analysis in Working Populations consortium were used to examine the link between work stress and mortality.

Researchers identified 102,633 individuals (1,423,753 person-years), 9441 of whom had prevalent cardiometabolic disease at baseline. Patients’ age, sex, harmonized measures of smoking, alcohol consumption, leisure-time physical activity, body mass index, and socioeconomic status were also assessed at baseline. Two main analyses were used to indicate work stress: job strain (job demand-control) and effort-reward imbalance. The study population was 43.4% men, mean age 43.9 years; 25.8% of the study group had low socioeconomic status.

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Men who had cardiometabolic disease and job strain experienced “substantially higher” rates of age-standardized mortality than those without job strain (149.8 vs 97.7 per 10,000 person-years; mortality difference 52.1 per 10,000 person-years; hazard ratio: 1.68; 95% CI, 1.19-2.35). For women, age-adjusted death rates were 64 vs 53.2 for job strain vs no job strain, and mortality was not significantly associated with job strain or effort-reward imbalance.

Researchers also compared death rates associated with job strain with death rates associated with established risk factors. Results of this analysis showed that mortality was similar between men with and without job strain and current vs never or former smokers (52.1 vs 78.1 per 10,000 person-years) but higher than mortality rates for hypertension, elevated total cholesterol, obesity, physical inactivity, and high alcohol consumption (5.9 to 44 per 10,000 person-years).

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Study limitations include the use of a single measurement of work stressors and risk factors as well as the possibility that prevalent cardiometabolic disease was underestimated in certain studies.

“To our knowledge, this is the first large-scale study to examine the work stress-mortality association stratified by cardiometabolic risk profile,” the researchers noted. “Our data showed that job strain substantially increased mortality risk even in subgroups of men with prevalent cardiometabolic disease but a favorable cardiometabolic risk profile, suggesting that standard care targeting conventional and lifestyle risk factors does not necessarily mitigate the excess mortality risk associated with job strain.”

The concluded: “Subsequent research should employ intervention designs to establish whether systematic screening and management of work stressors, such as job strain, would contribute to improved health outcomes in men with prevalent coronary heart disease, stroke, or diabetes.”


Kivimäki M, Pentti J, Ferrie JE, et al; for the IPD-Work consortium. Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study [published online June 5, 2018]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(18):30140-2