Krisztina D. László

Job insecurity and health: A study of 16 European countries

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45–70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.

Financial strain predicts recurrent events among women with coronary artery disease

BACKGROUND Although a number of epidemiological studies have found an association between socioeconomic status (SES) indices such as income and education and coronary morbidity and mortality, few have looked at health consequences arising from actually experiencing financial shortcomings. The objective of the present study was to examine whether financial strain predicts recurrent coronary artery disease (CAD) events among women with established CAD. METHODS Two hundred two women (mean age 62+/-9 years) hospitalized for an acute coronary event were followed over a period of 3.5 years. Demographic, socioeconomic, lifestyle-related, psychosocial and biological characteristics were obtained by means of questionnaires and clinical examination. Data on recurrent cardiac events were collected from the Swedish discharge and death registers. RESULTS Women experiencing financial strain over the past year had an increased risk for recurrent events, i.e. the combination of all-cause mortality, new acute myocardial infarction and unstable angina pectoris during the follow-up with an unadjusted hazard ratio (HR) of 3.2 (95% CI 1.6-6.6), and a HR of 2.76 (95% CI 1.02-7.50) after controlling for education, household income, age, cohabiting status, inclusion diagnosis and rehabilitation therapy. Adjustment for potential mediators, i.e. psychosocial factors, lipids, diabetes mellitus, smoking, body-mass index, blood pressure, physical activity, alcohol consumption, participation in other cardiac rehabilitation programs did not alter the results significantly. CONCLUSIONS Financial strain was a predictor for recurrent events among women with CAD, independently of commonly used SES indicators such as education and household income. Future studies will have to explore the mechanism behind this association.

Effects of a stress management program on vital exhaustion and depression in women with coronary heart disease: a randomized controlled intervention study

Objectives.  Psychosocial factors, including depression and vital exhaustion (VE) are associated with adverse outcome in coronary heart disease (CHD). Women with CHD are poor responders to psychosocial treatment and knowledge regarding which treatment modality works in them is limited. This randomized controlled clinical study evaluated the effect of a 1‐year stress management program, aimed at reducing symptoms of depression and VE in CHD women.

Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program

Abstract.  László KD, Ahnve S, Hallqvist J, Ahlbom A, Janszky I. (Karolinska Institute, Stockholm, Sweden; Semmelweis University, Budapest, Hungary; Uppsala University, Uppsala, Sweden; and Karolinska Institute, Stockholm, Sweden). Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. J Intern Med 2010; 267:599–611.

Work-related stress factors and menstrual pain: a nation-wide representative survey

While imposing research has been conducted with respect to the biological determinants of painful menstruation, little is known about the psychosocial factors, including work-related stress that might influence menstrual pain. We conducted a study in which we aimed to determine besides the prevalence of dysmenorrhoea whether menstrual pain was associated with job control, co-worker social support, job security and dissatisfaction with the job. Data of 2772 working women aged 18–55 years, participants in the Hungarostudy 2002 nation-wide representative survey was analyzed. Binary logistic regression was used to determine the association between work stress factors and menstrual pain. Altogether 15.5% of women reported to experience menstrual pain that limits their daily activity. Low job control, low co-worker social support and low job security were found to be associated with a higher risk for menstrual pain even after controlling for the effect of age, educational attainment, parity status, smoking, body-mass index and treatment for gynecological problems. Job dissatisfaction was also related to dysmenorrhoea, albeit not significantly. The relationship between work-related psychosocial factors and painful menstruation deserves further investigation in order to determine the possible pathways of this association.

Psychosocial Stress Related to the Loss of a Close Relative the Year Before or During Pregnancy and Risk of Preeclampsia

The role of stress in the pathogenesis of preeclampsia has only been investigated in a few studies, and the findings are not conclusive. We analyzed whether maternal bereavement shortly before or during pregnancy is associated with an increased risk of preeclampsia. We conducted a cohort study of singleton births in Denmark during 1978–2008 and in Sweden during 1973–2006 (n=4 122 490) by linking national population-based registers. Mothers were considered exposed to bereavement if they lost a parent, a sibling, a partner, or a child the year before or during pregnancy (n=124 553). The risk of preeclampsia was slightly increased for women who lost a close relative during the 6 months before conception (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06–1.23) or during the first trimester of pregnancy (OR, 1.15; 95% CI, 1.03–1.29). Exposure during these periods tended to be more closely related to early preeclampsia (delivery before 34 weeks of gestation; OR, 1.37; 95% CI, 1.12–1.67) than to late preeclampsia (OR, 1.13; 95% CI, 1.06–1.20). The strongest association was observed between loss of a child and early preeclampsia when the exposure window was from 6 months before pregnancy until start of second trimester (OR, 4.03; 95% CI, 2.46–6.61). Our results related to timing of exposure suggest that severe stress may influence early placentation. However, the public health implications of our findings are limited in populations with a low prevalence of severe stress exposures.

Income and recurrent events after a coronary event in women

Strong evidence supports the existence of a social gradient in poor prognosis in patients with coronary heart disease (CHD). However, knowledge regarding what factors may explain this relationship is limited. We aimed to analyze in women CHD patients the association between personal income and recurrent events and to determine whether lifestyle, biological and psychosocial factors contribute to the explanation of this relationship. Altogether 188 women hospitalized for a cardiac event were assessed for personal income, demographic factors, lipids, inflammatory markers, cortisol, creatinine, lifestyle and psychosocial factors, i.e. alcohol consumption, smoking habits, body-mass index, depressive symptoms, anxiety, vital exhaustion, availability of social interaction, hostility and anger-related characteristics and were followed for cardiovascular death and recurrent acute myocardial infarction (AMI). During the 6-year follow-up 18 patients deceased and 31 experienced cardiovascular death or non-fatal AMI. After adjustment for confounders, patients with medium and high income had lower risk for recurrent events relative to those with low income (HR (95% CI): 0.38 (0.15–0.97) and 0.39 (0.17–0.93), respectively). Controlling for smoking reduced by 12.8% the risk for recurrent events associated with high versus low income, while adjusting for depression decreased the risk for middle versus low income by 13.5%. Anger symptoms explained 16.7% of the risk for recurrent events associated with middle versus low income and 10.2% of the risk for high versus low income. We suggest that in women with CHD low income is associated with recurrent events and that smoking, depressive symptomatology and anger symptoms may contribute to the explanation of this relationship.

Anger expression and prognosis after a coronary event in women.

BACKGROUND Suggestive evidence supports that anger is associated with increased cardiovascular morbidity and mortality. However, the knowledge regarding the impact of anger on prognosis after a coronary event, especially among women is limited. We investigated whether anger expression increases the risk of recurrent events in women with coronary heart disease (CHD). METHODS Women (n=203) hospitalized for an acute cardiac event were assessed for the four scales of the Framingham Anger Questionnaire, demographic, biomedical and lifestyle factors and were followed for 6.4+/-1 years for total mortality and the combination of cardiovascular death and non-fatal acute myocardial infarction (AMI). RESULTS After adjustment for confounders such as age, inclusion diagnosis and smoking in the proportional hazard models the tendency to suppress angry feelings was associated with the combination of cardiac death and recurrent AMI (hazard ratio (HR): 1.19, 95% confidence interval (CI): 0.99-1.42) and with all-cause mortality (HR:1.29, 95% CI: 1.03-1.60). Each unit increase in the outward expression of anger increased by 42% the risk for cardiac death or a new AMI (95% CI: 1.01-2.00). Among the potential biological mediators only inflammatory markers attenuated somewhat the relationship. Anger symptoms and discussion of anger were not related to prognosis. CONCLUSIONS The outward expression and the suppression of anger seem to be associated with prognosis in women with CHD. Future studies need to confirm these findings and to test whether behavioural intervention programs aiming to reduce detrimental anger behaviour in women can influence CHD prognosis.

Alcohol consumption is associated with a lower incidence of acute myocardial infarction: results from a large prospective population‐based study in Norway

Compelling evidence suggests that light‐to‐moderate alcohol consumption is associated with a reduced risk of acute myocardial infarction (AMI), but several issues from previous studies remain to be addressed. The aim of this study was to investigate some of these key issues related to the association between alcohol consumption and AMI risk, including the strength and shape of the association in a low‐drinking setting, the roles of quantity, frequency and beverage type, the importance of confounding by medical and psychiatric conditions, and the lack of prospective data on previous drinking.

Job insecurity and prognosis after myocardial infarction: The SHEEP Study

BACKGROUND The prognostic role of job insecurity in coronary heart disease is unknown. We aimed to analyze whether job insecurity predicts mortality and recurrent events after a first acute myocardial infarction (AMI). METHODS We studied non-fatal AMI cases involved in the Stockholm Heart Epidemiology Program who were in paid employment and younger than 65 years (n=676). Shortly after their AMI, patients completed a questionnaire about job insecurity, demographic, work-related, clinical and lifestyle factors and participated in a clinical examination three months after discharge from the hospital. They were followed for 8.5 years for mortality and cardiovascular events. RESULTS After adjusting for previous morbidity, demographic and work-related factors, job insecurity was associated with an increased risk of the combined endpoint of cardiac death and non-fatal AMI, of total mortality and of heart failure; the hazard ratios (HR) and the 95% confidence intervals (CI) were 1.50 (1.02-2.22), 1.69 (1.04-2.75) and 1.62 (1.07-2.44), respectively. Similar associations, but with less statistical power were observed between job insecurity and cardiac death (HR (95% CI): 1.57 (0.80-3.09)) and stroke (HR (95% CI): 1.46 (0.71-3.02)), respectively. Adjustment for potential mediators, i.e. sleep problems, health behaviour, hypertension, blood lipids, glucose, inflammatory and coagulation factors did not alter considerably the relationship between job insecurity and the combination of cardiac mortality and non-fatal AMI. CONCLUSIONS Our results suggest that job insecurity is an adverse prognostic factor in patients with a first AMI. Future studies are needed to confirm this finding and to determine the mechanisms underlying the observed relationship.