Job Strain as a Risk Factor for Type 2 Diabetes: A Pooled Analysis of 124,808 Men and Women
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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. RESEARCH DESIGN AND 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.
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Job strain is associated with an increased risk of T2DM.
“Meta-analytic evidence indicates that job strain, which is defined as high job demands coupled with low control at work, is associated with an increased risk of T2DM 78”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [78]
In 13 European studies (n=124,808; n=3703 incident cases; 10.3 year follow-up), work stress defined by job strain is associated with increased risk of T2DM (HR 1.15, 95% CI 1.06-1.25).
“| 13 European studies ( n = 124,808; n = 3703 incident cases of diabetes mellitus; 10.3 year follow-up) | Work stress defined by job strain | *HR 1.15 (95% CI 1.06-1.25). | Nyberg (2014) 72 |”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as Nyberg (2014) 72
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- Authors
- Nyberg, S. T., Fransson, E. I., Heikkilä, K., Ahola, K., Alfredsson, L., Bjorner, J. B., Borritz, M., Burr, H., Dragano, N., Goldberg, M., Hamer, M., Jokela, M., Knutsson, A., Koskenvuo, M., Koskinen, A., Kouvonen, A., Leineweber, C., Madsen, I. E. H., Magnusson Hanson, L. L., Marmot, M. G., Nielsen, M. L., Nordin, M., Oksanen, T., Pejtersen, J. H., Pentti, J., Rugulies, R., Salo, P., Siegrist, J., Steptoe, A., Suominen, S., Theorell, T., Väänänen, A., Vahtera, J., Virtanen, M., Westerholm, P. J. M., Westerlund, H., Zins, M., Batty, G. D., Brunner, E. J., Ferrie, J. E., Singh-Manoux, A., & Kivimäki, M.
- Affiliations
- Finnish Institute of Occupational Health (FI)
- Stockholm University (SE)
- Region Stockholm (SE)
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Bispebjerg Hospital (DK)
- Federal Institute for Occupational Safety and Health (DE)
- Heinrich Heine University Düsseldorf (DE)
- Inserm (FR)
- University College London (GB)
- University of Helsinki (FI)
- Mid Sweden University (SE)
- Queen's University Belfast (GB)
- National Research Centre for the Working Environment (DK)
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Umeå University (SE)
- Danish National Centre for Social Research (DK)
- University of Copenhagen (DK)
- University of Turku (FI)
- Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
- Uppsala University (SE)
- University of Bristol (GB)
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland
- Corresponding author
- Nyberg, Solja T.
- ORCID
- Nyberg, Solja T.
- Fransson, Eleonor I.
- Heikkilä, Katriina
- Ahola, Kirsi
- Alfredsson, Lars
- Borritz, Marianne
- Burr, Hermann
- Goldberg, Marcel
- Hamer, Mark
- Jokela, Markus
- Koskinen, Aki
- Kouvonen, Anne
- Leineweber, Constanze
- Madsen, Ida E.H.
- Marmot, Michael G.
- Nielsen, Martin L.
- Oksanen, Tuula
- Pejtersen, Jan H.
- Rugulies, Reiner
- Salo, Paula
- Steptoe, Andrew
- Suominen, Sakari
- Theorell, Töres
- Väänänen, Ari
- Vahtera, Jussi
- Virtanen, Marianna
- Westerholm, Peter J.M.
- Westerlund, Hugo
- Zins, Marie
- Batty, G. David
- Brunner, Eric J.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-07-12
- Volume
- 37
- Issue
- 8
- Pages
- 2268-2275
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4113178
- OpenAlex
- W2170266504
- Semantic Scholar
- 2580fd34e0b56f482ac6120b5a529e6243bc1dcf
- Cited by
- 249
- References
- 39
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 11 · 2023: 19 · 2022: 34 · 2021: 21 · 2020: 28 · 2019: 22 · 2018: 20 · 2017: 26 · 2016: 22 · 2015: 17 · 2014: 6
- FWCI
- 4.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- HAL (submittedVersion, other-oa)
- Diva portal (Dalarna University Library) (submittedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- National Research Centre
- British Heart Foundation (R01AG034454, K013351, RG/10/005/28296, RG/13/2/30098, RG/07/008/23674, R01HL036310)
- Bupa Foundation
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Työsuojelurahasto
- Deutsche Gesetzliche Unfallversicherung
- National Institutes of Health
- Medical Research Council (MR/K013351/1, MR/K023241/1, K013351, MR/K026992/1, R01AG034454)
- Economic and Social Research Council (R01AG034454, ES/J023299/1, ES/F02679X/1, R01HL036310)
- National Institute on Aging (R01AG034454)
- National Heart, Lung, and Blood Institute (R01HL036310)
- Topics
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- job strain, type 2 diabetes, occupational stress, lifestyle factors, obesity, physical inactivity, socioeconomic status, sex differences, incident diabetes risk
- MeSH terms
- Adult, Burnout, Professional, Diabetes Mellitus, Type 2, Europe, Female, Humans, Life Style, Male, Middle Aged, Obesity, Surveys and Questionnaires, Risk Factors, Stress, Psychological, Work, Cohort Studies, Incidence
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