Nyberg, Solja T2; Fransson, Eleonor I2; Heikkilä, Katriina2; Ahola, Kirsi2; Alfredsson, Lars2; Bjørner, Jakob4; Borritz, Marianne4; Burr, Hermann2; Dragano, Nico2; Goldberg, Marcel2; Hamer, Mark2; Jokela, Markus2; Knutsson, Anders2; Koskenvuo, Markku2; Koskinen, Aki2; Kouvonen, Anne2; Leineweber, Constanze2; Madsen, Ida E H2; Magnusson Hanson, Linda L2; Marmot, Michael G2; Nielsen, Martin L5; Nordin, Maria2; Oksanen, Tuula2; Pejtersen, Jan H2; Pentti, Jaana2; Rugulies, Reiner2; Salo, Paula2; Siegrist, Johannes2; Steptoe, Andrew2; Suominen, Sakari2; Theorell, Töres2; Väänänen, Ari2; Vahtera, Jussi2; Virtanen, Marianna2; Westerholm, Peter J M2; Westerlund, Hugo2; Zins, Marie2; Batty, G David2; Brunner, Eric J2; Ferrie, Jane E2; Singh-Manoux, Archana2; Kivimäki, Mika2
1 Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 unknown3 Natural History Museum of Denmark, Natural History Museum of Denmark, Faculty of Science, Københavns Universitet4 Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet5 Natural History Museum of Denmark, Natural History Museum of Denmark, Faculty of Science, Københavns Universitet
A Pooled Analysis of 124,808 Men and Women
OBJECTIVE: The status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as "job strain," is associated with incident type 2 diabetes independent of lifestyle factors. RESEARCH DESIGN AND METHODS: We extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses. RESULTS: There were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06-1.25) with no difference between men and women (1.19 [1.06-1.34] and 1.13 [1.00-1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00-1.23). CONCLUSIONS: Findings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.
Diabetes Care, 2014, Vol 37, Issue 8, p. 2268-2275