Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men.

Abstract

The association between specific job characteristics and subsequent cardiovascular disease was tested using a large random sample of the male working Swedish population. The prospective development of coronary heart disease (CHD) symptoms and signs was analyzed using a multivariate logistic regression technique. Additionally a case-controlled study was used to analyze all cardiovascular-cerebrovascular (CHD-CVD) deaths during a 6 yr follow-up. The indicator of CHD symptoms and signs was validated in a 6 yr prospective study of CHD deaths (standardized mortality ratio 5.0; P .ltoreq. 0.001). A hectic and psychologically demanding job increases the risk of developing CHD symptoms and signs (standardized odds ratio [SOR] 1.29, P < 0.025) and premature CHD-CVD death (relative risk [RR] 4.0, P < 0.01). Low decision latitude, expressed as low intellectual discretion and low personal schedule freedom, is also associated with increased risk of cardiovascular disease. Low intellectual discretion predicts the development of CHD symptoms and signs (SOR 1.44, P < 0.01), while low personal schedule freedom among the majority of workers with the minimum statutory education increases the risk of CHD-CVD death (RR 6.6, P < 0.0002). The associations exist after controlling for age, education, smoking and overweight.