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Effort–reward imbalance at work and 5-year changes in blood pressure: the mediating effect of changes in body mass index among 1400 white-collar workers

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Abstract

Purpose

A number of prospective studies have documented the effect of adverse psychosocial work factors (work stress) on high blood pressure (BP). Weight gain could be an important pathway by which work stress exerts its effect on BP. No previous prospective study has examined this mediating effect. The aim of the present study was to examine the mediating effect of body mass index (BMI) in the association between psychosocial work factors from Siegrist’s effort–reward imbalance model (ERI) and ambulatory BP (ABP).

Methods

A prospective study was conducted among 1436 white-collar workers. Data were collected three times during a 5-year period. ERI was measured using validated scales, at each time. BMI was measured by a trained assistant. ABP was measured every 15 min during a working day.

Results

ERI exposure onset over 3 years was indirectly associated with ABP changes (0.49 mmHg; 95 % CI 0.05, 1.22), through BMI changes, in women with baseline BMI ≥25 kg/m2. An effect of similar magnitude and of borderline significance was observed for ERI chronic exposure. No mediating effect was observed among men, and using ERI exposure over 5 years.

Conclusion

The mediating effect of BMI was of small magnitude and observed in certain subgroups and time frame only. Subgroup-specific mediating pathways might be involved to explain the effect of work stress on cardiovascular diseases risk.

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Fig. 1
Fig. 2

Adapted from Baron and Kenny (1986)

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Abbreviations

BP:

Blood pressure

ABP:

Ambulatory blood pressure

BMI:

Body mass index

ERI:

Effort–reward imbalance

CVD:

Cardiovascular diseases

References

  • Aboa-Eboule C et al (2007) Job strain and risk of acute recurrent coronary heart disease events. JAMA 298(14):1652–1660. doi:10.1001/jama.298.14.1652

    Article  CAS  Google Scholar 

  • Babu GR et al (2014) Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med 71(3):220–227. doi:10.1136/oemed-2013-101396

    Article  Google Scholar 

  • Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Personal Soc Psychology 51:1173–1182

    Article  CAS  Google Scholar 

  • Berrington de Gonzalez A et al (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363(23):2211–2219. doi:10.1056/NEJMoa1000367

    Article  CAS  Google Scholar 

  • Block JP, He Y, Zaslavsky AM, Ding L, Ayanian JZ (2009) Psychosocial stress and change in weight among US adults. Am J Epidemiol 170(2):181–192. doi:10.1093/aje/kwp104

    Article  Google Scholar 

  • Brunner EJ, Chandola T, Marmot MG (2007) Prospective effect of job strain on general and central obesity in the Whitehall II Study. Am J Epidemiol 165(7):828–837

    Article  Google Scholar 

  • Chandola T et al (2008) Work stress and coronary heart disease: What are the mechanisms? Eru Heart J 29:640–648

    Article  Google Scholar 

  • Claes N (2007) The PreCardio-Study protocol—a randomized clinical trial of a multidisciplinary electronic cardiovascular prevention programme. BMC Cardiovasc disorder 4(7):27

    Article  Google Scholar 

  • Daveluy C, Pica L, Audet N, Courtemanche R, Lapointe F (2000) Quebec health and social survey, 2nd edn. Institut de la statistique du Québec, Québec

    Google Scholar 

  • Dolan E et al (2005) Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 46(1):156–161

    Article  CAS  Google Scholar 

  • Efron B (1987) Better bootstrap confidence-intervals. J Am Stat Assoc 82(397):171–185. doi:10.2307/2289144

    Article  Google Scholar 

  • El-Atat F, Aneja A, McFarlane S, Sowers J (2003) Obesity and hypertension. Endocrinol Metab Clin N Am 32(4):823–854

    Article  CAS  Google Scholar 

  • Fujishiro K, Lawson CC, Hibert EL, Chavarro JE, Rich-Edwards JW (2015) Job strain and changes in the body mass index among working women: a prospective study. Int J Obes (Lond) 39(9):1395–1400. doi:10.1038/ijo.2015.91

    Article  CAS  Google Scholar 

  • Gilbert-Ouimet M, Brisson C, Vezina M, Milot A, Blanchette C (2011) Repeated effort-reward imbalance exposure, increased blood pressure, and hypertension incidence among white-collar workers. Am J Epidemiol 173:S122

    Google Scholar 

  • Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vezina M (2013) Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scand J Work Environ Health. doi:10.5271/sjweh.3390

    Google Scholar 

  • Hayes AF (2009) Beyond baron and kenny: statistical mediation analysis in the new millennium. Commun Monogr. doi:10.1080/03637750903310360

  • He FJ, Li J, Macgregor GA (2013) Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomised trials. BMJ 346:f1325. doi:10.1136/bmj.f1325

    Article  Google Scholar 

  • Inc SI (2000) The SAS system for Sun OS. Cary

  • Kivimaki M et al (2006a) Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Int J Obes (Lond) 30(6):982–987. doi:10.1038/sj.ijo.0803229

    Article  CAS  Google Scholar 

  • Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J (2006b) Work stress in the etiology of coronary heart disease-a meta-analysis. Scand J Work Environ Health 32(6):431–442

    Article  Google Scholar 

  • Kivimaki M et al (2012) Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet 380(9852):1491–1497. doi:10.1016/S0140-6736(12)60994-5

    Article  Google Scholar 

  • Kouvonen A, Kivimaki M, Cox SJ, Cox T, Vahtera J (2005) Relationship between work stress and body mass index among 45,810 female and male employees. Psychosom Med 67(4):577–583

    Article  Google Scholar 

  • Landsberg L et al (2013) Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of the Obesity Society and the American Society of Hypertension. J Clin Hypertens (Greenwich) 15(1):14–33. doi:10.1111/jch.12049

    Article  CAS  Google Scholar 

  • Landsbergis PA, Dobson M, Koutsouras G, Schnall P (2013) Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health 103(3):e61–e71. doi:10.2105/AJPH.2012.301153

    Article  Google Scholar 

  • Lawes CM, Vander Hoorn S, Rodgers A (2008) Global burden of blood-pressure-related disease, 2001. Lancet 371(9623):1513–1518. doi:10.1016/S0140-6736(08)60655-8

    Article  Google Scholar 

  • MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V (2002) A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 7(1):83–104

    Article  Google Scholar 

  • Maina G, Bovenzi M, Palmas A, Prodi A, Filon FL (2011) Job strain, effort-reward imbalance and ambulatory blood pressure: results of a cross-sectional study in call handler operators. Int Arch Occup Environ Health 84(4):383–391. doi:10.1007/s00420-010-0576-5

    Article  Google Scholar 

  • Manolis AJ, Poulimenos LE, Kallistratos MS et al (2014) Sympathetic overactivity in hypertension and cardiovascular disease. Curr Vasc Pharmacol 12(1):4–15

    Article  CAS  Google Scholar 

  • Mozaffarian D, Benjamin EJ, Go AS, et al (2015) Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circ 131(4):e29–e322

    Article  Google Scholar 

  • Niedhammer I, Siegrist J, Landre MF, Goldberg M, Leclerc A (2000) Étude des qualités psychométriques de la version française du modèle du Déséquilibre Efforts/Récompenses. Rev Epidém et Santé Publ 48:419–437

    CAS  Google Scholar 

  • Nyberg ST et al (2013) Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women. PLoS ONE 8(6):e67323. doi:10.1371/journal.pone.0067323

    Article  CAS  Google Scholar 

  • O’Brien E (2003) The working group on blood pressure monitoring of the European Society of Hypertension. Blood Press Monit 8(1):17–18. doi:10.1097/01.mbp.0000057011.67622.05

    Article  Google Scholar 

  • O’Brien E, Mee F, Atkins N, O’Malley K (1991) Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens 9(6):573–574

    Article  Google Scholar 

  • O’Brien E et al (2000) Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society. BMJ 320(7242):1128–1134

    Article  Google Scholar 

  • Peter R, Siegrist J (1997) Chronic work stress, sickness absence, and hypertension in middle managers: General or specific sociological explanations? Soc Sci Med 45(7):1111–1120

    Article  CAS  Google Scholar 

  • Peter R, Alfredsson L, Hammar N, Siegrist J, Theorell T, Westerholm P (1998) High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study. J Epidemiol Community Health 52(9):540–547

    Article  CAS  Google Scholar 

  • Peter R, Alfredsson L, Knutsson A, Siegrist J, Westerholm P (1999) Does a stressful psychosocial work environment mediate the effects of shift work on cardiovascular risk factors? Scand J Work Environ Health 25(4):376–381

    Article  CAS  Google Scholar 

  • Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891

    Article  Google Scholar 

  • Rosengren A et al (2004) Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 364(9438):953–962

    Article  Google Scholar 

  • Rothman KJ, Greenland S, Last TL (2008) Modern epidemiology, 3rd edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  • Santé Québec (1993) Enquête québécoise sur la santé cardiovasculaire [Quebec survey on cardiovascular health] 1990, Rapport final

  • Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41

    Article  CAS  Google Scholar 

  • Siegrist J (2003) The model of effort-reward imbalance: measurement. In: http://www.uni-duesseldorf.de/MedicalSociology/index-eri.htm. Accessed 21 June 2006

  • Siegrist J, Rodel A (2006) Work stress and health risk behavior. Scand J Work Environ Health 32(6):473–481

    Article  Google Scholar 

  • Theorell T (2014) Commentary triggered by the Individual Participant Data Meta-Analysis Consortium study of job strain and myocardial infarction risk. Scand J Work Environ Health 40(1):89–95

    Article  Google Scholar 

  • Trudel X, Brisson C, Milot A, Masse B, Vezina M (2015) Adverse psychosocial work factors, blood pressure and hypertension incidence: repeated exposure in a 5-year prospective cohort study. J Epidemiol Community Health. doi:10.1136/jech-2014-204914

    Google Scholar 

  • Vrijkotte TGM, Van Doornen LJP, De Geus EJC (2000) Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension 35(4):880–886

    Article  CAS  Google Scholar 

  • Whitlock G et al (2009) Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 373(9669):1083–1096. doi:10.1016/S0140-6736(09)60318-4

    Article  Google Scholar 

  • Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB (2002) Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 162(16):1867–1872

    Article  Google Scholar 

  • Xu L, Siegrist J, Cao W, Li L, Tomlinson B, Chan J (2004) Measuring job stress and family stress in Chinese working women: a validation study focusing on blood pressure and psychosomatic symptoms. Women Health 39(2):31–46. doi:10.1300/J013v39n02_03

    Article  Google Scholar 

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Acknowledgments

This research was supported by a grant from the Canadian Institutes of Health Research (CIHR). XT was supported by a CIHR training award and Dr. Brisson was a CIHR Investigator when this work was conducted.

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Authors and Affiliations

  1. Axe santé des populations et pratiques optimales en santé, Centre de recherche FRQS du CHU de Quebec, 1050, Chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada

    Xavier Trudel & Chantal Brisson

  2. Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada

    Chantal Brisson & Michel Vézina

  3. Département de médecine, Université Laval, Quebec City, QC, Canada

    Alain Milot

  4. Département de médecine sociale et préventive, Université de Montréal, Montreal, QC, Canada

    Benoit Masse

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  1. Xavier Trudel
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  2. Chantal Brisson
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  4. Benoit Masse
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  5. Michel Vézina
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Correspondence to Xavier Trudel.

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This study was approved by the ethical review board of the CHU de Québec.

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Informed consent was obtained from all participants include in this study.

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Trudel, X., Brisson, C., Milot, A. et al. Effort–reward imbalance at work and 5-year changes in blood pressure: the mediating effect of changes in body mass index among 1400 white-collar workers. Int Arch Occup Environ Health 89, 1229–1238 (2016). https://doi.org/10.1007/s00420-016-1159-x

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  • DOI: https://doi.org/10.1007/s00420-016-1159-x

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