Literature Review
Having a high-stress job may be linked to an increased risk of stroke, according to a meta-analysis published online ahead of print October 14 in Neurology. “Having a lot of job stress has been linked to heart disease, but studies on job stress and stroke have shown inconsistent results,” said Dingli Xu, MD, of the Department of Cardiology at Nanfang Hospital, Southern Medical University in Guangzhou, China. “It’s possible that high-stress jobs lead to more unhealthy behaviors, such as poor eating habits, smoking, and a lack of exercise.”
Dr. Xu and colleagues conducted a meta-analysis to evaluate the association between job strain and the risk of stroke. The analysis looked at all of the available research on job strain and stroke risk. The six prospective cohort studies analyzed comprised 138,782 participants who were followed for three to 17 years.
Jobs were classified into four groups based on psychological job demand and job control. Psychological job demand, the researchers explained, referred to time pressure, mental load, and coordination responsibilities. Job control was defined as an individual’s potential control over work-related decision-making. The four groups of jobs were low-strain jobs (ie, those with low demand and high control), passive jobs (ie, those with low demand and low control), active jobs (ie, those with high demand and high control), and high-strain jobs (ie, those with high demand and low control).
Examples of passive jobs include janitors, miners, and other manual laborers. Low-stress jobs included natural scientists and architects. High-stress jobs are found in the service industry and include waitresses and nursing aides. Active jobs include doctors, teachers, and engineers. In the six studies, the percentage of those with high-stress jobs ranged from 11% to 27% of participants.
The analysis found that people with high-stress jobs had a 22% higher risk of stroke than those with low-stress jobs. Women with high-stress jobs had a 33% higher risk of stroke than women with low-stress jobs. People with high-stress jobs were 58% more likely to have an ischemic stroke than those with low-stress jobs. People in passive and active jobs did not have any increased risk of stroke.
The researchers calculated that 4.4% of the stroke risk resulted from the high-stress jobs. For women, that number increased to 6.5%.
“Based on this study, it is reasonable to consider testing interventions aimed at increasing job control, such as decentralization of decision-making, and flexibility in job structure, such as telecommuting. If effective, such workplace changes could have a major public health impact,” said Jennifer J. Majersik, MD, Associate Professor of Neurology at the University of Utah in Salt Lake City, in an accompanying editorial.
One limitation of the research, Dr. Xu noted, was that job stress was measured at only one point in time. In addition, other factors such as high blood pressure or high cholesterol were not adequately adjusted for in the original studies.