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Work stress and health in Western European and post-communist countries: an East–West comparison study
  1. G Salavecz1,
  2. T Chandola2,
  3. H Pikhart2,
  4. N Dragano3,
  5. J Siegrist3,
  6. K-H Jöckel4,
  7. R Erbel5,
  8. A Pajak6,
  9. S Malyutina7,
  10. R Kubinova8,
  11. M Marmot2,
  12. M Bobak2,
  13. M Kopp1
  1. 1
    Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
  2. 2
    International Institute for Society and Health, Department of Epidemiology and Public Health, University College of London, London, UK
  3. 3
    Department of Medical Sociology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
  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, Krakow, Poland
  7. 7
    Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
  8. 8
    Centre for Environmental Health, National Institute of Public Health, Prague, Czech Republic
  1. Correspondence to Dr G Salavecz, Institute of Behavioral Sciences, Semmelweis University, Nagyvarad ter 4, Budapest, Hungary H-1089; salgyon{at}


Background: There is evidence that psychosocial factors at work influence the 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: Data from four epidemiological studies were used: 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 (UK). The overall sample consisted of 18 494 male and female workers aged 35–65 years.

Results: High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for 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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  • Funding The HAPIEE study has been funded by grants from the Wellcome Trust (reference numbers 064947/Z/01/Z and 081081/Z/06/Z), the US National Institute on Aging (1R01 AG23522-01) and the MacArthur Foundation. The HEP study was supported by the National Research Fund (OTKA) projects (73754/2008) and the Scientific Committee of Health Sciences (ETT 100/2006). The Whitehall II study has been supported by grants from the Medical Research Council; Economic and Social 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. The Heinz Nixdorf Recall Study was supported by the German Ministry of Education and Science. Assessment of psychosocial factors and neighbourhood level information is funded by the German Research Council (DFG; Project SI 236/8-1 and SI 236/9-1).

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.