Tianwei Xu1,2,3, Linda L Magnusson Hanson2, Theis Lange4,5, Liis Starkopf4, Hugo Westerlund2, Ida E H Madsen3, Reiner Rugulies1,3,6, Jaana Pentti7, Sari Stenholm7, Jussi Vahtera7, Åse M Hansen3,8, Marianna Virtanen2,9,10, Mika Kivimäki9,11,12, Naja H Rod1,2. 1. Section of Epidemiology, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark. 2. Division for Epidemiology, Stress Research Institute, Stockholm University, SE-10691, Stockholm, Sweden. 3. National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark. 4. Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark. 5. Centre for Statistical Science, Peking University, No. 5 Yiheyuan Road, Beijing CN-100871, China. 6. Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark. 7. Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland. 8. Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, DK-1123 Copenhagen, Denmark. 9. Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, FI-00250 Helsinki, Finland. 10. Department of Public Health and Caring Sciences, University of Uppsala, Husargatan 3, Uppsala, Sweden. 11. Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK. 12. Clinicum, Faculty of Medicine, PO Box 63, FI-00014 University of Helsinki, Helsinki, Finland.
Abstract
AIMS: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). METHODS AND RESULTS: Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates. CONCLUSION: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). METHODS AND RESULTS:Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates. CONCLUSION: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD. Published on behalf of the European Society of Cardiology. All rights reserved.
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