Job Strain as a Risk Factor for Type
2 Diabetes: A Pooled Analysis of
124,808 Men and Women
Diabetes Care 2014;37:2268–2275 | DOI: 10.2337/dc13-2936
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 col-
laborative 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 Eu-
ropean 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
1 Finnish Institute of Occupational Health, Hel-
sinki, Tampere, and Turku, Finland
2
School of Health Sciences, J ̈onk ̈oping University,
J ̈onk ̈oping, Sweden
3
Institute of Environmental Medicine, Karolinska
Institutet, Stockholm, Sweden
4
Stress Research Institute, Stockholm University,
Stockholm, Sweden
5
Centre for Occupational and Environmental Medi-
cine, Stockholm County Council, Stockholm, Sweden
6
National Research Centre for the Working Envi-
ronment, Copenhagen, Denmark
7
Department of Occupational and Environmen-
tal Medicine, Bispebjerg University Hospital, Co-
penhagen, Denmark
8 Federal Institute for Occupational Safety and
Health (BAuA), Berlin, Germany
9
Institute for Medical Sociology, Medical Faculty,
University of D ̈usseldorf, D ̈usseldorf, Germany
10
Versailles-Saint Quentin University, Versailles,
France
11
Inserm U1018, Centre for Research in Epidemi-
ology and Population Health, Villejuif, France
12 Department of Epidemiology and Public
Health, University College London, London, U.K.
13
Institute of Behavioral Sciences, University of
Helsinki, Helsinki, Finland
14 Department of Health Sciences, Mid Sweden
University, Sundsvall, Sweden
15
Department of Public Health, University of Hel-
sinki, Helsinki, Finland
16 School of Sociology, Social Policy & Social
Work, Queen’s University Belfast, Belfast, U.K.
17
UKCRC Centre of Excellence for Public Health North-
ern Ireland, Queen’s University Belfast, Belfast, U.K.
18 Department of Psychology, Ume ̊a University,
Ume ̊a, Sweden
19 The Danish National Centre for Social Re-
search, Copenhagen, Denmark
20
Department of Public Health and Department
of Psychology, University of Copenhagen, Copen-
hagen, Denmark
21
Department of Psychology, University of Turku,
Turku, Finland
22
Folkh ̈alsan Research Center, Helsinki, Finland
23
Nordic School of Public Health, G ̈oteborg, Sweden
24 Department of Public Health, University of
Turku, Turku, Finland
25
Turku University Hospital, Turku, Finland
26 Occupational and Environmental Medicine,
Uppsala University, Uppsala, Sweden
27
Centre for Cognitive Ageing and Cognitive Epide-
miology, University of Edinburgh, Edinburgh, U.K.
28
School of Community and Social Medicine, Uni-
versity of Bristol, Bristol, U.K.
29 Hjelt Institute, Medical Faculty, University of
Helsinki, Helsinki, Finland
Corresponding authors: Solja T. Nyberg, solja.
nyberg@ttl.fi, and Mika Kivim ̈aki, m.kivimaki@
ucl.ac.uk.
Received 16 December 2013 and accepted 18
April 2014.
This article contains Supplementary Data online
at http://care.diabetesjournals.org/lookup/
suppl/doi:10.2337/dc13-2936/-/DC1.
© 2014 by the American Diabetes Association.
Readers may use this article as long as the work
is properly cited, the use is educational and not
for profit, and the work is not altered.
Solja T. Nyberg, 1 Eleonor I. Fransson, 2,3,4
Katriina Heikkil ̈a, 1 Kirsi Ahola, 1
Lars Alfredsson, 3,5 Jakob B. Bjorner, 6
Marianne Borritz, 7 Hermann Burr, 8
Nico Dragano, 9 Marcel Goldberg, 10,11
Mark Hamer, 12 Markus Jokela, 13
Anders Knutsson, 14 Markku Koskenvuo, 15
Aki Koskinen, 1 Anne Kouvonen, 16,17
Constanze Leineweber, 4 Ida E.H. Madsen, 6
Linda L. Magnusson Hanson, 4
Michael G. Marmot, 12 Martin L. Nielsen, 7
Maria Nordin, 18 Tuula Oksanen, 1
Jan H. Pejtersen, 19 Jaana Pentti, 1
Reiner Rugulies, 6,20 Paula Salo,1,21
Johannes Siegrist, 9 Andrew Steptoe, 12
Sakari Suominen, 22,23,24 T ̈ores Theorell, 4
Ari V ̈a ̈an ̈anen, 1 Jussi Vahtera, 1,24,25
Marianna Virtanen, 1
Peter J.M. Westerholm, 26
Hugo Westerlund, 4 Marie Zins, 10,11
G. David Batty, 12,27 Eric J. Brunner, 12
Jane E. Ferrie, 12,28
Archana Singh-Manoux, 11,12 and
Mika Kivim ̈aki, 1,12,29 for the IPD-Work
Consortium
2268 Diabetes Care Volume 37, August 2014
EPIDEMIOLOGY/HEALTH SERVICES RESEARCH

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Job Strain and Type 2 Diabetes Risk: Pooled Analysis of 124,808 Men and Women

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