Job insecurity and risk of diabetes: a meta-analysis of individual participant data
Jane E Ferrie1, Marianna Virtanen2, Markus Jokela2
1Department of Epidemiology and Public Health (Ferrie, Batty, Shipley, Tabák, Kivimäki), University College London, London, UK; School of Community and Social Medicine (Ferrie), University of Bristol, Bristol, UK; Finnish Institute of Occupational Health (Virtanen, Heikkilä, Koskinen, Oksanen, Pahkin, Pentti, Salo, Väänänen, Vahtera, Nyberg, Kivimäki), Helsinki, Tampere and Turku, Finland; Institute of Behavioural Sciences (Jokela, Kivimäki), University of Helsinki, Helsinki, Finland; National Research Centre for the Working Environment (Madsen, Bjorner, Rugulies), Copenhagen, Denmark; Institute of Environmental Medicine (Alfredsson, Fransson), Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine (Alfredsson, Theorell, Westerlund), Stockholm County Council, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (Batty), University of Edinburgh, Edinburgh, Scotland; Department of Occupational and Environmental Medicine (Borritz), Bispebjerg University Hospital, Copenhagen, Denmark; Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin) (Burr), Berlin, Germany; Institute for Medical Sociology, Medical Faculty (Dragano), University of Düsseldorf, Düsseldorf, Germany; National Institute for Health and Welfare (Elovainio), Helsinki, Finland; School of Health Sciences (Fransson), Jönköping University, Jönköping, Sweden; Stress Research Institute (Fransson), Stockholm University, Stockholm, Sweden; Department of Health Sciences (Knutsson), Mid Sweden University, Sundsvall, Sweden; Departments of Public Health (Koskenvuo) and Social Research (Kouvonen), University of Helsinki, Helsinki, Finland; Institute for Social and Economic Research (Kumari), University of Essex, Colchester, UK; Unit of Social Medicine (Nielsen), Frederiksberg University Hospital, Copenhagen, Denmark; Department of Psychology (Nordin), Umeå University, Umeå, Sweden; The Danish National Centre for Social Research (Pejtersen), Copenhagen, Denmark; Departments of Psychology (Salo) and Public Health (Suominen, Vahtera), University of Turku, Turku, Finland; Folkhälsan Research Center (Suominen), Helsinki, Finland; University of Skövde (Suominen), Skövde, Sweden; 1st Department of Medicine (Tabák), Semmelweis University Faculty of Medicine, Budapest, Hungary; Turku University Hospital (Vahtera), Turku, Finland; Department of Medical Sciences (Westerholm), Uppsala University, Uppsala, Sweden; Departments of Public Health and Psychology (Rugulies), University of Copenhagen, Copenhagen, Denmark jane.ferrie@bristol.ac.uk.
Background:
Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.
Methods:
We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.
Results:
The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).
Interpretation:
Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.
