Abstract
BACKGROUND: Several epidemiologic cohort studies documented increased risks of cardiovascular disease (CVD) resulting from exposure to psychosocial stress at work, as measured by theoretical models, such as the demand-control model and effort-reward imbalance (ERI) model. Few studies extended these concepts beyond paid work. With this study, we explore associations of ERI in family and household work, voluntary work and/or partnership with prospective CVD mortality risk, in addition to ERI at work. METHODS: In the frame of the U.S. Health and Retirement Study (HRS), 4,642 individuals with mean age 61.5 who were employed at baseline (2006-2008) provided full data on ERI at work and beyond work, sociodemographic factors, lifestyle behaviors, and health conditions. Mortality data through the end of 2018 were available through linkage to the National Death Index. Participants were dichotomized into 'low' and 'high' group for each ERI dimension. Prospective associations of the two types of ERI at baseline with CVD mortality during follow-up were estimated, using competing-risk Cox proportional hazards regression. RESULTS: Independ effects of work ERI and social ERI on CVD mortality risk were observed (HR: 1.66 [1.08; 2.53] and HR: 1.56 [1.02; 2.38], respectively). The hazard ratio of CVD mortality among participants with joint exposure was 2.58 [1.49; 4.45], compared to unexposed participants. This risk was further augmented (HR: 3.38 [1.45; 7.85]) in participants with cardiometabolic disease at baseline. CONCLUSION: Failed reciprocity in core social roles of adult life is associated with increased CVD mortality risk in this study of older employed persons in the U.S.