Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study with over 20 years of follow-up

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Abstract

Background

People spend a considerable amount of time at work over the course of their lives, which makes the workplace important to health and aging. However, little is known about the potential long-term effects of work-related stress on late-life health. This study aims to examine work-related stress in late midlife and educational attainment in relation to serious health problems in old age.

Methods

Data from nationally representative Swedish surveys were used in the analyses (n = 1,502). Follow-up time was 20–24 years. Logistic regressions were used to examine work-related stress (self-reported job demands, job control, and job strain) in relation to serious health problems measured as none, serious problems in one health domain, and serious problems in two or three health domains (complex health problems).

Results

While not all results were statistically significant, high job demands were associated with higher odds of serious health problems among women but lower odds of serious health problems among men. Job control was negatively associated with serious health problems. The strongest association in this study was between high job strain and complex health problems. After adjustment for educational attainment some of the associations became statistically nonsignificant. However, high job demands, remained related to lower odds of serious problems in one health domain among men, and low job control remained associated with higher odds of complex health problems among men. High job demands were associated with lower odds of complex health problems among men with low education, but not among men with high education, or among women regardless of level of education.

Conclusions

The results underscore the importance of work-related stress for long-term health. Modification to work environment to reduce work stress (e.g., providing opportunities for self-direction/monitoring levels of psychological job demands) may serve as a springboard for the development of preventive strategies to improve public health both before and after retirement.

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Most cited references 38

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Social conditions as fundamental causes of disease.

B Link, J. Phelan (1995)

Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens.

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Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden.

Anu Molarius, Kenneth Berglund, Charli Eriksson … (2007)

Socioeconomic conditions and lifestyle factors have been found to be related to self-rated health, which is an established predictor of morbidity and mortality. Few studies, however, have investigated the independent effect of material and psychosocial conditions as well as lifestyle factors on self-rated health. The association between socioeconomic conditions, lifestyle factors, and self-rated health was investigated using a postal survey questionnaire sent to a random population sample of men and women aged 18-79 years during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities in the central part of Sweden. Multivariate odds ratios for poor self-rated health were calculated for a range of variables. A total of 36 048 subjects with full data were included in the analysis. Similar analyses of the influence of working conditions were conducted among those employed aged 18-64 years (17 820 subjects). The overall prevalence of poor self-rated health was 7% among men and 9% among women. Poor self-rated health was most common among persons who had been belittled, who had experienced economic hardship, who lacked social support, or who had retired early. A low educational level was independently associated with poor self-rated health among men, but not among women. Physically inactive as well as underweight and obese subjects were more likely to have poor self-rated health than other subjects. Working conditions associated with poor self-rated health were dissatisfaction with work, low job control and worry about losing one's job. While a cross-sectional study does not allow definite conclusions as to which factors are determinants and which are consequences of poor self-rated, the present findings support the notion that both psychosocial and material conditions as well as lifestyle factors are independently related with poor self-rated health.

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Health inequalities and the psychosocial environment-two scientific challenges.

Sir Michael Marmot, Johannes Siegrist (2004)

As social inequalities in health continue to be a key public health problem, scientific advances in explaining these inequalities are needed. It is unlikely that there will be a single explanation of social inequalities in health. This introductory paper sets out one explanatory framework, exposure to adverse psychosocial environments during midlife, and particularly at work. We argue that exposure to an adverse psychosocial environment, in terms of job tasks, defined by high demands and low control and/or by effort-reward imbalance, elicits sustained stress reactions with negative long-term consequences for health. These exposures may be implicated in the association of socioeconomic status with health in two ways. First, these exposures are likely to be experienced more frequently among lower socioeconomic groups. Second, the size of the effects on health produced by adverse working conditions may be higher in lower status groups, due to their increased vulnerability. In this special issue, these arguments are illustrated by a collection of original contributions from collaborative research across Europe. The papers, in our view, advance the case for the robust associations between measures of adverse psychosocial environment and ill health, as they are based on comparative studies across several European countries and as they combine different types of study designs. This collaboration was enabled and supported by a European Science Foundation scientific programme on 'Social Variations in Health Expectancy in Europe'.

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Author and article information

Contributors

Charlotta Nilsen: charlotta.nilsen@ki.se

Ross Andel: randel@usf.edu

Stefan Fors: stefan.fors@ki.se

Bettina Meinow: bettina.meinow@ki.se

Alexander Darin Mattsson: alexander.darin.mattsson@ki.se

Ingemar Kåreholt: ingemar.kareholt@ki.se

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 27 August 2014

Publication date PMC-release: 27 August 2014

Publication date Collection: 2014

Volume: 14

Issue: 1

Electronic Location Identifier: 878

Affiliations

[ ]Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

[ ]School of Aging Studies, University of South Florida, Tampa, FL USA

[ ]International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

[ ]Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden

Article

Publisher ID: 7012

DOI: 10.1186/1471-2458-14-878

PMC ID: 4158079

PubMed ID: 25159829

SO-VID: 69b1f685-e91a-4ac2-9610-d2285431b53f

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 10 June 2014

Date accepted : 5 August 2014

Custom metadata

ScienceOpen disciplines: Public health

Keywords: work-related stress,psychosocial work environment,socioeconomic position,education,multimorbidity,complex health problems,old age,longitudinal,sweden

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ScienceOpen disciplines: Public health

Keywords: work-related stress, psychosocial work environment, socioeconomic position, education, multimorbidity, complex health problems, old age, longitudinal, sweden

Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study with over 20 years of follow-up

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Most cited references 38

Social conditions as fundamental causes of disease.

Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden.

Health inequalities and the psychosocial environment-two scientific challenges.

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