DECISION LATITUDE, PSYCHOLOGIC DEMAND, JOB STRAIN, AND CORONARY HEART-DISEASE IN THE WESTERN ELECTRIC STUDY

The hypothesis that low decision latitude and high psychologic demand are associated with an increased risk of the incidence of and mortalit y from coronary heart disease was investigated in a 25-year follow-up study of 1,683 men aged 38-56 years who participated in the Chicago We stern Electric Study (1957-1983). Scores for decision latitude and psy chologic demand, which had been linked to the 1960 US Census occupatio n codes, were assigned to men in the Western Electric cohort based on job title at the initial examination (1957-1958). After adjustment for major coronary risk factors, the relative risk for 25-year coronary d eath was 0.76 (95% confidence interval (Cl) 0.59-1.00) for a 20-point increase in the decision latitude score (approximate difference betwee n tertiles) and was 0.78 (95% CI 0.48-1.26) for a 10-point increase in the psychologic demand score (approximate difference between three gr oups). For job strain (defined by low decision latitude and high psych ologic demand), it was 1.40 (95% Cl 0.92-2.14). Controlling for occupa tional class reduced the magnitude of the relative risks between job c haracteristics and coronary mortality. Analysis stratified by occupati onal class indicated that the effect of decision latitude was more pro nounced for white-collar than for blue-collar workers. This study prov ided only limited evidence for associations between job characteristic s and coronary heart disease mortality.