Abstract
Objective The aim of this study was to explore the relation between the risk of first-ever stroke at working age and psychological work environmental factors. Methods A consecutive multicenter matched 1:2 case-control study of acute stroke cases (N=198, age 30-65 years) who had been working full-time at the time of their stroke and 396 sex- and age-matched controls. Stroke cases and controls answered questionnaires on their psychosocial situation during the previous 12 months. The psychosocial work environment was assessed using three different measures: the job-control-demand model, the effort-reward imbalance (ERI) score, and exposures to conflict at work. Results Among 198 stroke cases and 396 controls, job strain [odds ratio (OR) 1.30, 95% confidence interval (95% CI) 1.05-1.62], ERI (OR 1.28, 95% CI 1.01-1.62), and conflict at work (OR 1.75, 95% CI 1.07-2.88) were independent risk factors of stroke in multivariable regression models. Conclusions Adverse psychosocial working conditions during the past 12 months were more frequently observed among stroke cases. Since these factors are presumably modifiable, interventional studies targeting job strain and emotional work environment are warranted.
Highlights
Stroke is a multi-factorial disease caused by an interplay between genetic and environmental risk factors
We investigated the combined effect of job strain and Effort-Reward Imbalance (ERI) in univariate and multivariable regression models
We investigated the combined effect of job strain and ERI (Table 4)
Summary
Stroke is a multi-factorial disease caused by an interplay between genetic and environmental risk factors. Well-documented risk factors include age, hypertension, diabetes, cigarette smoking, physical inactivity, carotid atherosclerosis and atrial fibrillation. During the last few decades, a growing body of evidence suggests that psychosocial factors contribute. Education and socioeconomic status are consistently reported to be associated with stroke [1], and an association with psychosocial stress has been suggested [2]. There is an accumulating literature suggesting association between cardiovascular disease and the psychosocial work environment [3,4,5]. The main body of evidence comes from studies on coronary heart disease, while stroke has been less studied
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