title: Organizational instability and cardiovascular risk factors in white-collar employees: an analysis of correlates of structural instability of workplace organization on risk factors for coronary heart disease in a sample of 3,904 white collar employees in the Stockholm region.
abstract: BACKGROUND
  The economic crisis in Sweden in the 1990s led to major reorganization at many workplaces, which appears to have had negative consequences for occupational and public health.
  
  
  METHODS
  Psychosocial questionnaires and medical screening data for 3,904 white-collar employees in 15 major companies plus a large number of small-scale entrepreneurs in Stockholm were used. Subjects were part of a study of working conditions and cardiovascular risk factors (WOLF). Workplaces were categorized using interview data from managers and union representatives. Categories were compared regarding job strain, blood pressure, serum cholesterol, triglycerides, and fibrinogen among employees.
  
  
  RESULTS
  The companies formed five categories: 'Stable', 'Changing/Growing', 'Threatened Private', 'Questioned Public', plus 'Small Firms'. Compared with the 'Stable' group, employees in 'Changing/Growing' companies had higher job strain (0.28 SD, p<0.001). In the 'Threatened Private' group, job strain (0.30 SD, p<0.001), cholesterol (0.18 mmol/l, p<0.05) and triglycerides (0.09 mmol/l, p<0.05) were elevated. The 'Questioned Public' group had higher cholesterol (0.22 mmol/l, p<0.01), triglycerides (0.10 mmol/l, p<0.01) and fibrinogen (0.13 mmol/l, p<0.05). In 'Small Firms', job strain (0.30 SD, p<0.001), cholesterol (0.28 mmol/l, p<0.001), triglycerides (0.14 mmol/l, p<0.001) and fibrinogen (0.19 mmol/l, p<0.001) were elevated. With the exception of lower systolic blood pressure (2.1 mmHg; p<0.05) in the 'Changing/Growing' category, there were no significant differences in blood pressure between the groups.
  
  
  CONCLUSIONS
  In addition to traditional measures of organizational instability, such as downsizing, expansion in a favourable economic climate, appears to be adversely correlated with job strain and psychophysiology. The study also raises concerns about employees in small firms.
authors.affiliation: National Institute for Psychosocial Medicine, Stockholm, Sweden. hugo.westerlund@ipm.ki.se
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
authors.forename: Töres
authors.initials: T
authors.lastname: Theorell
authors.forename: Lars
authors.initials: L
authors.lastname: Alfredsson
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D004651:Employment; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D017132:Workplace
chemical_list: D014280:Triglycerides; D005340:Fibrinogen; D002784:Cholesterol