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Examining the relationship between the demand-control model and incident myocardial infarction and congestive heart failure in a representative sample of the employed women and men in Ontario, Canada, over a 15-year period

  • Quantitative Research
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Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Objectives

To examine the relationship between job strain and incident myocardial infarction and congestive heart failure in a representative population of men and women in Ontario, Canada, over a 15-year period.

Methods

A total of 14,508 respondents having provided responses to either the 2000/2001, 2002, or 2003 cycles of the Canadian Community Health Survey (CCHS) were aged 35 and older at the time and working. After removing respondents with pre-existing heart disease and missing data, our sample totaled 13,291 respondents. Responses were linked to administrative health care and hospitalization data to capture incident cases of myocardial infarction and congestive heart failure up to March 31, 2017. Job control and psychological demands were assessed using 5 items and 2 items respectively. A series of time-to-event regression models were run, adjusting sequentially for socio-demographic variables and health, other psychosocial work exposures, and health behaviours and body mass index.

Results

Over the study period, there were 199,583 person-years of follow-up (median follow-up: 15 years, 233 days). Higher incidence rates were observed for men (6.69 per 100 persons) than for women (2.77 per 100 persons). No clear relationship was observed for demand-control exposures and incidence of myocardial infarction and congestive heart failure in either men or women. After adjustment for socio-demographic factors, pre-existing health conditions, and other psychosocial exposures, the hazard ratio for high strain exposure (compared with low strain exposure) was 0.92 (0.46–1.84) for women and 0.75 (0.44–1.27) for men.

Conclusion

In this large prospective cohort in Canada, we observed no relationship between components of the demand-control model and incident myocardial infarction and congestive heart failure over a 15-year period.

Résumé

Objectifs

Examiner la relation entre les stresseurs psychosociaux au travail (job strain) et la survenue de l’infarctus du myocarde ainsi que de l’insuffisance cardiaque sur une période de 15 ans, dans une population représentative des hommes et des femmes de l’Ontario, Canada.

Méthodes

Au total, 14 508 participants ayant répondu aux cycles de 2000-2001, de 2002 ou de 2003 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) étaient des travailleurs âgés de 35 ans et plus. Après avoir exclus les répondants ayant une maladie coronarienne préexistante ou des données manquantes, notre échantillon totalisait 13 291 participants. Les réponses de ces participants ont été liées à leur données administratives sur les soins de santé et l’hospitalisation pour identifier les cas incidents d’infarctus du myocarde et d’insuffisance cardiaque jusqu’au 31 mars 2017. Les stresseurs psychosociaux au travail, soit la latitude décisionnelle et la demande psychologique, ont été évalués à l’aide de cinq et de deux items, respectivement. Une série de modèles de régression temporelle a été réalisée, en ajustant séquentiellement pour les variables sociodémographiques et la santé, d’autres expositions psychosociales au travail, les comportements de santé et l’indice de masse corporelle.

Résultats

Au cours de la période d’étude, 199 583 personnes-années ont été recensées (suivi médian : 15 ans et 233 jours). Des taux d’incidence plus élevés ont été observés chez les hommes (6,69 pour 100 personnes) par rapport aux femmes (2,77 pour 100 personnes). Aucune relation n’a été observée entre la latitude décisionnelle, la demande psychologique et l’incidence d’infarctus du myocarde et de l’insuffisance cardiaque chez les hommes ou les femmes. Après ajustement pour les variables sociodémographiques, les conditions de santé préexistantes et les autres expositions psychosociales, le rapport de risque pour une exposition au job strain (combinaison d’une latitude faible et d’une demande élevée) était de 0,92 (0,46 - 1,84) pour les femmes et de 0,75 (0,44 - 1,27) pour les hommes.

Conclusion

Dans cette vaste cohorte prospective canadienne, aucune relation n’a été observée entre les stresseurs psychosociaux au travail du modèle demande-latitude et la survenue de l’infarctus du myocarde et de l’insuffisance cardiaque sur une période de 15 ans.

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Acknowledgements

We thank Alex Kopp at ICES who conducted the analyses and had full access to the data, using syntax prepared by PS.

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR). RG was supported as a Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto and St. Michael’s Hospital. MGO held a CIHR research grant for her postdoctoral fellowship. PS was supported by a Research Chair in Gender, Work and Health from CIHR. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by the MOHLTC and the Canadian Institute for Health Information (CIHI).

Author information

Authors and Affiliations

  1. Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada

    Peter Smith & Cameron A. Mustard

  2. Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia

    Peter Smith

  3. Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada

    Peter Smith & Cameron A. Mustard

  4. Department of Health Sciences, Université du Québec à Rimouski, Campus de Lévis, 1595, boul. Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada

    Mahee Gilbert-Ouimet

  5. Axe santé des populations et pratiques optimales en santé, Centre de recherche FRQS du CHU de Quebec City, 1050, chemin Sainte-Foy, local K0-03, Québec, QC, G1S 4L8, Canada

    Mahee Gilbert-Ouimet & Chantal Brisson

  6. Département de médecine sociale et préventive, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada

    Chantal Brisson

  7. Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Richard H. Glazier

  8. Department of Family and Community Medicine, Dalla Lana School of Public Health, Health Sciences Building, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada

    Richard H. Glazier

  9. The Institute of Health Policy, Management and Evaluation at University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada

    Richard H. Glazier

  10. Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Richard H. Glazier

Authors
  1. Peter Smith
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  2. Mahee Gilbert-Ouimet
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  3. Chantal Brisson
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  4. Richard H. Glazier
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  5. Cameron A. Mustard
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Contributions

PS led the design of the study and hypothesis generation with contributions from all study authors. PS wrote the first draft of the manuscript, and all authors contributed to the interpretation of the data and critical review of the paper and approved the final version.

Corresponding author

Correspondence to Peter Smith.

Ethics declarations

The study obtained ethics approval from the University of Toronto Health Research Ethics Board.

Conflict of interest

The authors declare that they have no conflict of interest.

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The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

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Appendix

Appendix

Table 3 Distribution of categorical study variables and incidence of heart disease. Employed Ontario respondents to the 2000/2001, 2002, and 2003 cycles of the CCHS working 15 or more hours per week and free of cardiovascular disease at time of survey (N = 13,291)
Full size table
Table 4 Average values for continuous study variables among populations with and without incident heart disease over the study period. Employed Ontario respondents to the 2000/2001, 2002, and 2003 cycles of the CCHS working 15 or more hours per week and free of cardiovascular disease at time of survey (N = 13,291)
Full size table
Table 5 Incidence and corresponding 95% confidence intervals of cardiovascular disease by job control, psychological demand quartiles and demand-control groups including a fifth group of respondents centered around the median of the job control and psychological demand distributions (mid-population). Employed Ontario respondents to the 2000/2001, 2002, and 2003 cycles of the CCHS working 15 or more hours per week and free of cardiovascular disease at time of survey (N = 13,291)
Full size table
Table 6 Hazard ratios and corresponding 95% confidence intervals for quartiles of job control and psychological demands and incident heart disease over an approximately 15-year follow-up. Employed Ontario respondents to the 2000/2001, 2002, and 2003 cycles of the CCHS working 15 or more hours per week and free of cardiovascular disease at time of survey (N = 13,291)
Full size table

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Smith, P., Gilbert-Ouimet, M., Brisson, C. et al. Examining the relationship between the demand-control model and incident myocardial infarction and congestive heart failure in a representative sample of the employed women and men in Ontario, Canada, over a 15-year period. Can J Public Health 112, 280–288 (2021). https://doi.org/10.17269/s41997-020-00378-3

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  • DOI: https://doi.org/10.17269/s41997-020-00378-3

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