Perceived Job Insecurity as a Risk Factor for Incident Coronary Heart Disease: Systematic Review and Meta-analysis
Marianna Virtanen, professor1, Solja T Nyberg, statistician1, G David Batty, reader in epidemiology23, Markus Jokela, senior research fellow4, Katriina Heikkilä, specialist researcher1, Eleonor I Fransson, senior lecturer567, Lars Alfredsson, professor of epidemiology68, Jakob B Bjorner, professor9, Marianne Borritz, researcher10, Hermann Burr, scientist11, Annalisa Casini, postdoctoral researcher12, Els Clays, assistant professor13, Dirk De Bacquer, professor13, Nico Dragano, professor14, Marko Elovainio, professor15, Raimund Erbel, professor of medicine16, Jane E Ferrie, senior research fellow217, Mark Hamer, principal research associate2, Karl-Heinz Jöckel, professor18, France Kittel, professor of health psychology and research methodology12, Anders Knutsson, professor of public health19, Markku Koskenvuo, professor of epidemiology20, Aki Koskinen, statistician1, Thorsten Lunau, researcher14, Ida E H Madsen, researcher9, Martin L Nielsen, senior registrar10, Maria Nordin, lecturer in sociology21, Tuula Oksanen, assistant chief medical officer1, Krista Pahkin, team leader2, Jan H Pejtersen, senior researcher22, Jaana Pentti, statistician1, Reiner Rugulies, professor of psychosocial work environment research923, Paula Salo, professor124, Martin J Shipley, statistician2, Johannes Siegrist, professor14, Andrew Steptoe, British Heart Foundation professor of psychology2, Sakari B Suominen, professor252627, Töres Theorell, professor emeritus7, Salla Toppinen-Tanner, team leader1, Ari Väänänen, adjunct professor1, Jussi Vahtera, professor of public health12628, Peter J M Westerholm, professor emeritus29, Hugo Westerlund, professor of epidemiology7, Natalie Slopen, postdoctoral fellow3031, Ichiro Kawachi, professor of social epidemiology30, Archana Singh-Manoux, research director232, Mika Kivimäki, professor of social epidemiology124 For the IPD-Work Consortium
Abstract
Objective To determine the association between self reported job insecurity and incident coronary heart disease.
Design A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review.
Data sources We obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches.
Review methods Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models.
Results The literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174 438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v ≥50 years), national unemployment rate, welfare regime, or job insecurity measure.
Conclusions The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.
