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Work Stress and Health in Western European and Post-Communist Countries: an East-West Comparison Study
  1. Gyöngyvér Salavecz1,
  2. Tarani Chandola2,
  3. Hynek Pikhart2,
  4. Nico Dragano3,
  5. Johannes Siegrist3,
  6. Karl-Heinz Jöckel4,
  7. Raimund Erbel5,
  8. Andrzej Pajak6,
  9. Sofia Malyutina7,
  10. Ruzena Kubinova8,
  11. Micheal Marmot2,
  12. Martin Bobak2,
  13. Maria Kopp9
  1. 1 Institute of Behavioral Sciences, Semmelweis University, Hungary;
  2. 2 Department of Epidemiology and Public Health, University College of London, United Kingdom;
  3. 3 Department of Medical Sociology, Heinrich-Heine-University, Duesseldorf, United Kingdom;
  4. 4 Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Germany;
  5. 5 Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany;
  6. 6 Department of Epidemiology and Population Studies, Jagiellonian University, Germany;
  7. 7 Institute of Internal Medicine, Russian Academy of Medical Sciences, Germany;
  8. 8 Centre for Environmental Health, National Institue of Public Health, Poland;
  9. 9 Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Russian Federation
  1. * Corresponding author; email: salgyon{at}


Background: There is an evidence that psychosocial factors at work influence risk of poor health in Western societies but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries.

Methods: We used data from four epidemiological studies: the HAPIEE Study (Poland, Russia, and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall Study (Germany) and the Whitehall II Study (United Kingdom). The overall sample consisted 18 494 male and female workers aged 35-65.

Results: High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest vs. lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9-7.7) in Hungary, 3.6 (95% CI 2.3-5.7) in the Czech Republic, 2.5 (95% CI 1.5-4.1) in the UK, 2.3 (95% CI 1.6-3.5) in Germany, 1.5 (95% CI 1.0-2.1) in Poland and 1.4 (95% CI 1.1-1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed with regard to the effect of overcommitment on poor health.

Conclusion: The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.

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