All-cause mortality and the time-varying effects of psychosocial work stressors: A retrospective cohort study using the HILDA survey

https://doi.org/10.1016/j.socscimed.2020.113452Get rights and content

Highlights

  • Repeated exposure to poor-quality work may result in work-related stress.

  • Exposure to psychosocial work stressors may impact on health.

  • Not clear whether exposure over time translates into an increased risk of mortality.

  • Low job control and job insecurity were associated with increased risk of mortality.

  • Associations were stronger for men than women.

Abstract

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn’t clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality.

Objective

We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships.

Methods

Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality.

Results

Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively.

Conclusions

Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality.

Section snippets

Authors’ contributions

Yamna Taouk designed the study, performed the statistical analyses and wrote the manuscript. Matthew J. Spittal contributed to the study design and reviewd the manuscript. Allison J. Milner provided logistic support at all stages of the study and reviewed the manuscript. Anthony D. LaMontagne contributed to the conception and design of the work, provided support and reviewed the manuscript.

Study population

Data from the Household, Income and Labour Dynamics in Australia (HILDA) survey were used in the analyses. Commenced in 2001, HILDA is a nationally representative longitudinal study of Australian households following over 17,000 Australian lives annually (Wilkins, 2017). The HILDA survey contains extensive data on employment and labour-force characteristics of working Australians with over 15 annual waves of data and has been linked to the National Death Index. Households comprise the source of

Results

The analytic sample consisted of 20,423 participants and 154,634.2 person-years. During the median follow-up of six years, 247 deaths were observed (mortality rate 16.0 (14.1–18.1) per 10,000 person-years), and 70% of deaths occurred in males. The mean age at study entry was 33.4 (SD = 13.9) years. There were 34% of participants aged 15–24 years, 22% 25–34 years, 20% 35–44 years, and 24% aged ≥45 years. Half of the participants were male (50%), and most were born in Australia (80%), resided in

Discussion

Our results suggest that when a person has a lack of control over their job, they are at an increased risk of death. Participants exposed to low job control had a 39% increased risk of all-cause mortality relative to participants with high job control, even when controlling for periods of unemployment and the effect of NILF/retirement on mortality. The excess mortality risk did not change appreciably after adjustment for sociodemographic information, which included measures of socioeconomic

Conclusions

The current study suggests that long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics, as well as simultaneous adjustment for all psychosocial work stressors exposures. The results strongly suggest that, over time, exposure to low job control and low job security have independent effects on mortality. Due to the

Acknowledgement

This study was supported in part by an Australian Government Research Training Program Scholarship provided by the Australian Commonwealth Government to Yamna Taouk. Allison J. Milner was funded by a Victorian Health and Medical Research Fellowship. Matthew J. Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. The funding sources had no role in the design or conduct of the study; collection, management,

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