Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis.
OBJECTIVE
To determine the association between self reported job insecurity and incident coronary heart disease.


METHODS
A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review.


METHODS
We obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches.


METHODS
Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models.


RESULTS
The literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174,438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v ≥ 50 years), national unemployment rate, welfare regime, or job insecurity measure.


CONCLUSIONS
The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.
Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland. marianna.virtanen@ttl.fi
Marianna
M
Virtanen
Solja T
ST
Nyberg
G David
GD
Batty
Markus
M
Jokela
Katriina
K
Heikkilä
Eleonor I
EI
Fransson
Lars
L
Alfredsson
Jakob B
JB
Bjorner
Marianne
M
Borritz
Hermann
H
Burr
Annalisa
A
Casini
Els
E
Clays
Dirk
D
De Bacquer
Nico
N
Dragano
Marko
M
Elovainio
Raimund
R
Erbel
Jane E
JE
Ferrie
Mark
M
Hamer
Karl-Heinz
KH
Jöckel
France
F
Kittel
Anders
A
Knutsson
Markku
M
Koskenvuo
Aki
A
Koskinen
Thorsten
T
Lunau
Ida E H
IE
Madsen
Martin L
ML
Nielsen
Maria
M
Nordin
Tuula
T
Oksanen
Krista
K
Pahkin
Jan H
JH
Pejtersen
Jaana
J
Pentti
Reiner
R
Rugulies
Paula
P
Salo
Martin J
MJ
Shipley
Johannes
J
Siegrist
Andrew
A
Steptoe
Sakari B
SB
Suominen
Töres
T
Theorell
Salla
S
Toppinen-Tanner
Ari
A
Väänänen
Jussi
J
Vahtera
Peter J M
PJ
Westerholm
Hugo
H
Westerlund
Natalie
N
Slopen
Ichiro
I
Kawachi
Archana
A
Singh-Manoux
Mika
M
Kivimäki
D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D020415:Personnel Downsizing / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report; D013315:Stress, Psychological / Q000453:epidemiology*; D014478:Unemployment / Q000523:psychology*