No association found between cardiovascular mortality, and job demands and decision latitude: Experience from the Västerbotten Intervention Programme in Sweden

Abstract

The current prospective study with the longest follow-up period in Northern Sweden aims to investigate the association between job demands and decision latitude and cardiovascular disease (CVD) mortality. Further, we aim to assess the effect of conventional risk factors (i.e., body mass index, alcohol consumption, physical activity, marital status, education and smoking) on the association between job demands and decision latitude and CVD mortality. The data originated from the Linnaeus database, available at the Center for Population Studies, Umeå University, Sweden. A cohort of men and women aged 40, 50 and 60 years were recruited from the Västerbotten Intervention Programme. Deaths due to stroke and myocardial infarction at the end of the follow up are considered the outcome. Baseline job characteristics were defined by the Swedish version of the Karasek demand/control model. Statistical methods include proportional Cox hazard modeling and Relative Excess Risk due to Interaction (RERI) to assess interactions. The findings from this study did not support the association between job demands and decision latitude and CVD mortality. Instead, conventional risk factors were found stronger predictors, most evidently education differentials were associated with CVD mortality. We know from previous research that the greater the attenuation of the gradient after adjustment for a given risk factor, the greater the potential to reduce educational inequality via interventions that target this factor. Based on the present findings of the experience in Västerbotten, further research is needed to identify other risk factors besides job strain and its components that would reduce the socioeconomic gradient in CVD mortality.