Workplace socioeconomic characteristics and coronary heart disease: a nationwide follow-up study

Per-Ola Forsberg; Henrik Ohlsson; Kristina Sundquist

doi:10.1136/bmjopen-2022-065285

Workplace socioeconomic characteristics and coronary heart disease: a nationwide follow-up study

BMJ Open. 2023 Jul 18;13(7):e065285. doi: 10.1136/bmjopen-2022-065285.

Authors

Per-Ola Forsberg¹, Henrik Ohlsson², Kristina Sundquist^{2

3

4}

Affiliations

¹ Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden per-ola.forsberg@med.lu.se.
² Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
³ Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Center for Community based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan.

Abstract

Objectives: Important gaps in previous research include a lack of studies on the association between socioeconomic characteristics of the workplace and coronary heart disease (CHD).We aimed to examine two contextual factors in association with individuals' risk of CHD: the mean educational level of all employees at each individual's workplace (education_work) and the neighbourhood socioeconomic characteristics of each individual's workplace (neighbourhood SES_work).

Design: Nationwide follow-up/cohort study.

Setting: Nationwide data from Sweden.

Participants: All individuals born in Sweden from 1943 to 1957 were included (n=1 547 818). We excluded individuals with a CHD diagnosis prior to 2008 (n=67 619), individuals without workplace information (n=576 663), individuals lacking residential address (n=4139) and individuals who had unknown parents (n=7076). A total of 892 321 individuals were thus included in the study (426 440 men and 465 881 women).

Primary and secondary outcome measures: The outcome variable was incident CHD during follow-up between 2008 and 2012. The association between education_work and neighbourhood SES_work and the outcome was explored using multilevel and cross-classified logistic regression models to determine ORs and 95% CIs, with individuals nested within workplaces and neighbourhoods. All models were conducted in both men and women and were adjusted for age, income, marital status, educational attainment and neighbourhood SES_residence.

Results: Low (vs high) education_work was significantly associated with increased CHD incidence for both men (OR 1.29, 95% CI 1.23 to 1.34) and women (OR 1.38, 95% CI 1.29 to 1.47) and remained significant after adjusting for potential confounders. These findings were not replicable for the variable neighbourhood SES_work.

Conclusions: Workplace socioeconomic characteristics, that is, the educational attainment of an individual's colleagues, may influence CHD risk, which represents new knowledge relevant to occupational health management at workplaces.

Keywords: cardiology; public health; social medicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Coronary Disease* / epidemiology
Coronary Disease* / etiology
Female
Follow-Up Studies
Humans
Male
Residence Characteristics
Socioeconomic Factors
Workplace