Job strain and incident cardiovascular disease: the confounding and mediating effects of lifestyle habits. An overview of systematic reviews

Abstract

This overview of systematic reviews (SR) aims to determine how the potential confounding and/or mediating effects of lifestyle habits were taken into consideration in SR examining the job strain effect on cardiovascular disease (CVD) incidence. Thirteen SR were identified. Lifestyle habits were often considered as confounders (n = 8). Authors reported that the job strain and CVD association remained after adjusting for lifestyle habits (n = 6); discussed lifestyle habits as potential mediators (n = 8) and postulated a total effect underestimation due to over-adjustment (n = 4). None investigated the magnitude of this bias.

The effect of job strain on CVD is independent of lifestyle habits, supporting its causal effect on CVD. Lifestyle habits are also potential mediators. The current practice of adjusting for lifestyle habits can therefore lead to an underestimation of the total effect. Research using meditation methods is needed.

Keywords:

• Alcohol
• heart diseases
• intermediary pathway
• mediation analyses
• physical inactivity
• psychosocial work stressors
• smoking

Acknowledgments

This work is part of Canadian Institutes of Health Research (CIHR) funded research projects lead by C.B. on work stressors and cardiovascular health; M.G.O. was supported by a CIHR postdoctoral training award when this work was conducted; D.T. is a Fonds de recherche du Québec – Santé (FRQS) chercheur-boursier; and M.L.R is supported by a FRQS training award.

Disclosure statement

Authors have no conflict of interest to declare.