title: Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women.
abstract: OBJECTIVE
  The status of psychosocial stress at work as a risk factor for type 2 diabetes is unclear because existing evidence is based on small studies and is subject to confounding by lifestyle factors, such as obesity and physical inactivity. This collaborative study examined whether stress at work, defined as "job strain," is associated with incident type 2 diabetes independent of lifestyle factors.
  
  
  METHODS
  We extracted individual-level data for 124,808 diabetes-free adults from 13 European cohort studies participating in the IPD-Work Consortium. We measured job strain with baseline questionnaires. Incident type 2 diabetes at follow-up was ascertained using national health registers, clinical screening, and self-reports. We analyzed data for each study using Cox regression and pooled the study-specific estimates in fixed-effect meta-analyses.
  
  
  RESULTS
  There were 3,703 cases of incident diabetes during a mean follow-up of 10.3 years. After adjustment for age, sex, and socioeconomic status (SES), the hazard ratio (HR) for job strain compared with no job strain was 1.15 (95% CI 1.06-1.25) with no difference between men and women (1.19 [1.06-1.34] and 1.13 [1.00-1.28], respectively). In stratified analyses, job strain was associated with an increased risk of diabetes among those with healthy and unhealthy lifestyle habits. In a multivariable model adjusted for age, sex, SES, and lifestyle habits, the HR was 1.11 (1.00-1.23).
  
  
  CONCLUSIONS
  Findings from a large pan-European dataset suggest that job strain is a risk factor for type 2 diabetes in men and women independent of lifestyle factors.
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.
authors: Solja T
authors: ST
authors: Nyberg
authors: School of Health Sciences, Jönköping University, Jönköping, SwedenInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenStress Research Institute, Stockholm University, Stockholm, Sweden.
authors: Eleonor I
authors: EI
authors: Fransson
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Katriina
authors: K
authors: Heikkilä
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Kirsi
authors: K
authors: Ahola
authors: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenCentre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors: Lars
authors: L
authors: Alfredsson
authors: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors: Jakob B
authors: JB
authors: Bjorner
authors: Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
authors: Marianne
authors: M
authors: Borritz
authors: Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
authors: Hermann
authors: H
authors: Burr
authors: Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors: Nico
authors: N
authors: Dragano
authors: Versailles-Saint Quentin University, Versailles, FranceInserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
authors: Marcel
authors: M
authors: Goldberg
authors: Department of Epidemiology and Public Health, University College London, London, U.K.
authors: Mark
authors: M
authors: Hamer
authors: Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
authors: Markus
authors: M
authors: Jokela
authors: Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
authors: Anders
authors: A
authors: Knutsson
authors: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: Markku
authors: M
authors: Koskenvuo
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Aki
authors: A
authors: Koskinen
authors: School of Sociology, Social Policy & Social Work, Queen's University Belfast, Belfast, U.K.UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Belfast, U.K.
authors: Anne
authors: A
authors: Kouvonen
authors: Stress Research Institute, Stockholm University, Stockholm, Sweden.
authors: Constanze
authors: C
authors: Leineweber
authors: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors: Ida E H
authors: IE
authors: Madsen
authors: Stress Research Institute, Stockholm University, Stockholm, Sweden.
authors: Linda L
authors: LL
authors: Magnusson Hanson
authors: Department of Epidemiology and Public Health, University College London, London, U.K.
authors: Michael G
authors: MG
authors: Marmot
authors: Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
authors: Martin L
authors: ML
authors: Nielsen
authors: Department of Psychology, Umeå University, Umeå, Sweden.
authors: Maria
authors: M
authors: Nordin
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Tuula
authors: T
authors: Oksanen
authors: The Danish National Centre for Social Research, Copenhagen, Denmark.
authors: Jan H
authors: JH
authors: Pejtersen
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Jaana
authors: J
authors: Pentti
authors: National Research Centre for the Working Environment, Copenhagen, DenmarkDepartment of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
authors: Reiner
authors: R
authors: Rugulies
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Psychology, University of Turku, Turku, Finland.
authors: Paula
authors: P
authors: Salo
authors: Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors: Johannes
authors: J
authors: Siegrist
authors: Department of Epidemiology and Public Health, University College London, London, U.K.
authors: Andrew
authors: A
authors: Steptoe
authors: Folkhälsan Research Center, Helsinki, FinlandNordic School of Public Health, Göteborg, SwedenDepartment of Public Health, University of Turku, Turku, Finland.
authors: Sakari
authors: S
authors: Suominen
authors: Stress Research Institute, Stockholm University, Stockholm, Sweden.
authors: Töres
authors: T
authors: Theorell
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Ari
authors: A
authors: Väänänen
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Public Health, University of Turku, Turku, FinlandTurku University Hospital, Turku, Finland.
authors: Jussi
authors: J
authors: Vahtera
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
authors: Marianna
authors: M
authors: Virtanen
authors: Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
authors: Peter J M
authors: PJ
authors: Westerholm
authors: Stress Research Institute, Stockholm University, Stockholm, Sweden.
authors: Hugo
authors: H
authors: Westerlund
authors: Versailles-Saint Quentin University, Versailles, FranceInserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
authors: Marie
authors: M
authors: Zins
authors: Department of Epidemiology and Public Health, University College London, London, U.K.Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, U.K.
authors: G David
authors: GD
authors: Batty
authors: Department of Epidemiology and Public Health, University College London, London, U.K.
authors: Eric J
authors: EJ
authors: Brunner
authors: Department of Epidemiology and Public Health, University College London, London, U.K.School of Community and Social Medicine, University of Bristol, Bristol, U.K.
authors: Jane E
authors: JE
authors: Ferrie
authors: Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, FranceDepartment of Epidemiology and Public Health, University College London, London, U.K.
authors: Archana
authors: A
authors: Singh-Manoux
authors: Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, FinlandDepartment of Epidemiology and Public Health, University College London, London, U.K.Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland solja.nyberg@ttl.fi m.kivimaki@ucl.ac.uk.
authors: Mika
authors: M
authors: Kivimäki
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014937:Work / Q000523:psychology / Q000706:statistics & numerical data