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Update on work-related psychosocial factors and the development of ischemic heart disease: a systematic review
Jan Hyld Pejtersen1, Hermann Burr, Harald Hannerz
1From the *The Danish National Centre for Social Research, Copenhagen, Denmark; †Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany; ‡National Research Centre for the Working Environment, Copenhagen, Denmark; and §Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
Insights
Most studies on occupational psychosocial factors and ischemic heart disease (IHD) lack sufficient statistical power. Only the control aspect of job strain consistently emerged as a risk factor for myocardial infarction in adequately powered analyses.
Area of Science:
- Occupational Health
- Cardiovascular Epidemiology
- Psychosocial Risk Factors
Background:
- Occupational psychosocial factors are increasingly recognized as potential contributors to cardiovascular disease.
- Previous reviews have explored the link between workplace stress and ischemic heart disease (IHD), but often with limitations in study design and statistical power.
Purpose of the Study:
- To update the evidence on the relationship between occupational psychosocial factors and the incidence of ischemic heart disease (IHD).
- To critically evaluate the statistical power of studies examining these associations.
Main Methods:
- Systematic review of prospective or case-control studies with externally determined IHD outcomes and specific psychosocial exposures.
- Inclusion criteria focused on study design, outcome definition, exposure assessment (excluding shift work, trauma, violence, accidents, social capital), and acceptable statistical power (to detect a 20% increased risk).
- Evaluation of 44 papers, with 11 new papers meeting initial criteria and all 44 assessed for statistical power.
Main Results:
- Only 2 out of 44 papers (10 out of 169 statistical analyses) possessed adequate statistical power.
- Findings from these two underpowered studies suggested that the control dimension of job strain was associated with excess risk for myocardial infarction.
- The majority of studies were underpowered, hindering definitive conclusions about psychosocial factors as IHD risk factors.
Conclusions:
- A significant number of studies investigating occupational psychosocial factors and IHD are underpowered.
- The limited adequately powered research suggests a potential role for the control dimension of job strain in myocardial infarction risk.
- Future research must prioritize sufficient statistical power to reliably assess the impact of workplace psychosocial factors on IHD incidence.
Abstract:
The present review deals with the relationship between occupational psychosocial factors and the incidence of ischemic heart disease (IHD) with special regard to the statistical power of the findings. This review with 4 inclusion criteria is an update of a 2009 review of which the first 3 criteria were included in the original review: (1) STUDY: a prospective or case-control study if exposure was not self-reported (prognostic studies excluded); (2) OUTCOME: definite IHD determined externally; (3) EXPOSURE: psychosocial factors at work (excluding shift work, trauma, violence or accidents, and social capital); and (4) Statistical power: acceptable to detect a 20% increased risk in IHD. Eleven new papers met the inclusion criteria 1-3; a total of 44 papers were evaluated regarding inclusion criteria 4. Of 169 statistical analyses, only 10 analyses in 2 papers had acceptable statistical power. The results of the 2 papers pointed in the same direction, namely that only the control dimension of job strain explained the excess risk for myocardial infarction for job strain. The large number of underpowered studies and the focus on psychosocial models, such as the job strain models, make it difficult to determine to what extent psychosocial factors at work are risk factors of IHD. There is a need for considering statistical power when planning studies.
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