title: A longitudinal study comparing the effort-reward imbalance and demand-control models using objective measures of physician utilization.
abstract: BACKGROUND
  The objectives of this study were to compare the predictive validity of the demand-control and effort-reward imbalance models using objective measures of physician utilization.
  
  
  METHODS
  Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand-control and effort-reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression.
  
  
  RESULTS
  Neither job strain nor effort-reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%.
  
  
  CONCLUSIONS
  In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.
authors.affiliation: Department of Health Care and Epidemiology, University of British Columbia, Canada. ostry@interchange.ubc.ca
authors.forename: Alec S
authors.initials: AS
authors.lastname: Ostry
authors.forename: Ruth
authors.initials: R
authors.lastname: Hershler
authors.forename: Lisa
authors.initials: L
authors.lastname: Chen
authors.forename: Clyde
authors.initials: C
authors.lastname: Hertzman
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015233:Models, Statistical; D010820:Physicians / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012649:Self Concept; D012959:Socioeconomic Factors; D013312:Stress, Physiological / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016526:Workload