The relationship between job strain and coronary heart disease: evidence from an English sample of the working male population

Background. Many, but not all, studies have reported that job strain is rel ated to cardiovascular morbidity and mortality. To date, this relationship has not been tested on an English full population sample. This study examin es whether the demand-control model of job strain contributes to our unders tanding of the determinants of coronary heart disease. Methods. The analysis uses data from 4350 working men aged 20-64 in the 199 3 Health Survey for England. Job demand and control characteristics were de termined by questionnaire. Several health outcomes were examined: self-rate d health; psychiatric health; angina and possible myocardial infarction, me asured by the Rose questionnaire; doctor-diagnosed heart disease; any heart disease. The relationship between job strain and the health outcomes was d etermined by logistic regression analyses after controlling for known confo unders. Results. Those in high strain jobs consistently reported poorer health on a ll measures than men with lower strain. Similarly, men reporting low job st rain were least likely to report poor health in 5/6 health outcomes. Those with intermediate levels of strain tended to have intermediate prevalence r ates for poor health. The pattern of association between job strain and the CHD was independent of coronary risk factors. Conclusions. The analyses broadly support Karasek's demand-control model of job strain. Health selection into low strain jobs may account for the lack of an association between job strain and doctor diagnosed heart disease wh ile independent associations between job strain and all CHD measures consid ered together indicate that job strain may have aetiological significance f or heart disease.