Job stress and the occupational gradient in coronary heart disease risk inwomen - The Stockholm Female Coronary Risk Study

Recent studies of men have shown that job stress is important in understand ing the occupational gradient in coronary heart disease (CHD), but these re lationships have rarely been studied in women. With increasing numbers of w omen in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in curre ntly employed women. We used data from the Stockholm Female Coronary Risk S tudy, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8. 83) increased age-adjusted risk for CHD, Simultaneous adjustment for tradit ional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01 -6.14). Neither job control nor the Karasek demand-control model of job stress subs tantially explained the increased CHD risk of women in the lowest occupatio nal classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk. (C) 2000 Elsevier Science Ltd. All rights reserved.