ASSOCIATION BETWEEN PSYCHOSOCIAL FACTORS AT WORK AND NONFATAL MYOCARDIAL-INFARCTION IN A POPULATION-BASED CASE-CONTROL STUDY IN CZECH MEN

We examined the effect of decision latitude and work demand on risk of myocardial infarction in a former Soviet Bloc country and analyzed wh ether these factors contributed to the educational gradient in myocard ial infarction in this population. We conducted a case control study a mong full-time working men in the general population of five districts of the Czech Republic. Cases were 179 men 25-64 years of age with a f irst nonfatal myocardial infarction diagnosed in selected districts ov er a 1-year period, and controls were 784 men in the same age group ra ndomly selected from the population register. We used logistic regress ion to estimate the odds of developing myocardial infarction in relati on to self reported work demand and decision latitude at work and the contribution of these factors as well as standard risk factors to soci oeconomic differences in the risk of myocardial infarction. Cases repo rted lower decision latitude and lower work demand than controls. Age- adjusted odds ratios for the highest us lowest quartiles of decision l atitude and work demand were 0.43 (95% confidence interval = 0.25-0.75 ) and 0.54 (95% confidence interval 0.31-0.93), respectively. Further adjustment for coronary risk factors and education did not change thes e estimates. Decision latitude accounted for part of the association b etween education and myocardial infarction, and decision latitude and risk factors jointly explained virtually all of it:. The association b etween decision latitude at work and myocardial infarction found in ou r study is consistent with research in western populations and may par tly explain the socioeconomic gradient in myocardial infarction.