APH 2003, 61, 75-90:

Job stress and prevalence of diabetes: results from the belstress study.

F. Leynen, M. Moreau, E. Pelfrene, E. Clays, G. De Backer, M. Kornitzer

Keywords: Job characteristics, job stress, stress models, demands-control-support model, diabetes, cardiovascular

Objectives: In search for explanatory pathways linking job stress to cardiovascular disease, the relationship between job stress and diabetes, one of the main coronary risk factors, was assessed in a cross-sectional way in a large Belgian cohort.

Methods: 16,335 male and 5084 female workers, aged 35-59 years, and working in a wide range of different occupations, volunteered to participate in the study. The participants completed a questionnaire and underwent a clinical examination. Non-insulin dependent type II diabetes was assessed through a question on existence of hyperglycaemia and a question on medication use; job stress was defined according to the Karasek Demand-Control model, by means of the Job Content Questionnaire (JCQ). Logistic regression analyses were performed for the scales on Psychological Job Demands (PJD), Job Control (JC) and Social Support at Work (SSW) as well as for the combined Demand-Control scale (Job Strain). Adjustments were made for those covariates that were significantly related to diabetes prevalence, insulin dependent diabetes cases were excluded from the analyses.

Results: Overall type II diabetes prevalence was 2.6% in males and 2.1 % in females.
Our study provides some arguments for an inverse relationship between JC and diabetes in males (OR (95% Cl) Q4/Q1: 1.50 (1.11-2.03) and in females (OR (95% Cl) Q4/Q1: 1.50 (1.15-4.01)) and for a positive association between job strain and diabetes in females (OR (95% Cl): 1.92 (1.17-3.13)). In order to minimise the "self-reporter bias", sensitivity analyses were done on the relationship between these scales and consumption of oral antidiabetic medication; for males the inverse association with job control persisted as did the association with job strain for females.

Conclusions: Even if self-reported diabetes was used in present analyses, taking into consideration the biological plausibility, these results support the idea that there is an association between job stress, defined as either a combination of high psychological job demands and low job control as well as a lack of job control alone and the prevalence of diabetes.