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Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II study
  1. H Kuper,
  2. M Marmot
  1. International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to:
 Hannah Kuper, Trachoma Initiative in Monitoring and Evaluation, Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;


Study objectives: To investigate the association between job strain and components of the job strain model and coronary heart disease (CHD) risk.

Design: Prospective cohort study (Whitehall II study). At the first phase of the study (1985–1988), data on self reported psychosocial work characteristics were collected from all participants. Participants were followed up until the end of phase 5 (1997–2000), with mean length of follow up of 11 years.

Setting: London based office staff in 20 civil service departments.

Participants: 6895 male and 3413 female civil servants aged 35–55.

Outcome measures: Incident validated CHD.

Main results: People with concurrent low decision latitude and high demands (job strain) were at the highest risk for CHD. High job demands, and, less consistently, low decision latitude, predicted CHD incidence. The effect of job strain on CHD incidence was strongest among younger workers, but there was no effect modification by social support at work, or employment grade.

Conclusions: Job strain, high job demands, and, to some extent, low decision latitude, are associated with an increased risk of CHD among British civil servants.

  • job strain
  • coronary heart disease
  • cohort

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  • Funding: The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. MM is supported by an MRC Research Professorship.

  • Conflicts of interest: none.

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