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November 10, 2015; 85 (19) Article

Association between job strain and risk of incident stroke

A meta-analysis

Yuli Huang, Shuxian Xu, Jinghai Hua, Dingji Zhu, Changhua Liu, Yunzhao Hu, Tiebang Liu, Dingli Xu
First published October 14, 2015, DOI: https://doi.org/10.1212/WNL.0000000000002098
Yuli Huang
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Shuxian Xu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Jinghai Hua
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Dingji Zhu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Changhua Liu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Yunzhao Hu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Tiebang Liu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Dingli Xu
From the Department of Cardiology (Y. Huang, J.H., D.Z., C.L., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Shenzhen Psychiatric College (S.X.), Anhui Medical University; Department of Psychiatry (S.X., T.L.), Shenzhen Key Laboratory of Psychological Health Center, Shenzhen; and Clinical Medicine Research Center (Y. Huang, Y. Hu), the First People's Hospital of Shunde, Foshan, PR China.
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Citation
Association between job strain and risk of incident stroke
A meta-analysis
Yuli Huang, Shuxian Xu, Jinghai Hua, Dingji Zhu, Changhua Liu, Yunzhao Hu, Tiebang Liu, Dingli Xu
Neurology Nov 2015, 85 (19) 1648-1654; DOI: 10.1212/WNL.0000000000002098

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Abstract

Objective: Prospective cohort studies regarding job strain and the risk of stroke are controversial. This meta-analysis aimed to evaluate the association between job strain and the risk of stroke.

Methods: The PubMed, Embase, and PsycINFO databases were searched for prospective cohort studies with data on job strain and the risk of stroke. Studies were included if they reported adjusted relative risks (RRs) with 95% confidence intervals (CIs) of stroke from job strain. Subgroup analyses were conducted according to sex and stroke type.

Results: Six prospective cohort studies comprising 138,782 participants were included. High strain jobs were associated with increased risk of stroke (RR 1.22, 95% CI 1.01–1.47) compared with low strain jobs. The result was more pronounced for ischemic stroke (RR 1.58, 95% CI 1.12–2.23). The risk of stroke was significant in women (RR 1.33, 95% CI 1.04–1.69) and nonsignificant in men (RR 1.26, 95% CI 0.69–2.27), but the difference in RRs in sex subgroups was not significant. Neither active (RR 1.07, 95% CI 0.90–1.28) nor passive (RR 1.01, 95% CI 0.86–1.18) job characteristics were associated with an increased risk of stroke compared with low strain jobs.

Conclusions: Exposure to high strain jobs was associated with an increased risk of stroke, especially in women. Further studies are needed to confirm whether interventions to reduce work stress decrease the risk of stroke.

GLOSSARY

CHD=
coronary heart disease;
CI=
confidence interval;
CVD=
cardiovascular disease;
DCM=
demand–control model;
HR=
hazard ratio;
PAR=
population attributable risk;
RR=
relative risk

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Supplemental data at Neurology.org

  • Editorial, page 1640

  • Received December 17, 2014.
  • Accepted in final form April 28, 2015.
  • © 2015 American Academy of Neurology
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Letters: Rapid online correspondence

  • Re:Job strain and risk of stroke: Is current research conclusive?
    • Dingli Xu, Director, Nanfang Hospital, Southern Medical Universitydinglixu@fimmu.com
    • Yuli Huang,Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou
    Submitted December 30, 2015
  • Stress and cardiovascular disease: could working better mean less stroke?
    • Simona Lattanzi, MD, Department of Experimental and Clinical Medicine, Marche Polytechnic Universityalfierelattanzisimona@gmail.com
    • Mauro Silvestrini, Ancona, Italy
    Submitted November 04, 2015
  • Job strain and risk of stroke: Is current research conclusive?
    • Renzo Bianchi, Post-Doctoral Fellow, University of Neuchatelrenzo.bianchi@unine.ch
    Submitted October 23, 2015
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