Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study

Nuria Matilla-Santander; Carles Muntaner; Bertina Kreshpaj; Virginia Gunn; Johanna Jonsson; Lauri Kokkinen; Jenny Selander; Sherry L. Baron; Cecilia Orellana; Per Olof Östergren; Tomas Hemmingsson; David H. Wegman; Theo Bodin

doi:10.1016/j.lanepe.2022.100314

Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study

Nuria Matilla-Santander^*
, Carles Muntaner
, Bertina Kreshpaj
, Virginia Gunn
, Johanna Jonsson
, Lauri Kokkinen
, Jenny Selander
, Sherry L. Baron
, Cecilia Orellana
, Per Olof Östergren
, Tomas Hemmingsson
, David H. Wegman
, Theo Bodin

^*Corresponding author for this work

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

38 Citations (Scopus)

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Abstract

Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

Original language	English
Article number	100314
Journal	The Lancet Regional Health - Europe
Volume	15
DOIs	https://doi.org/10.1016/j.lanepe.2022.100314
Publication status	Published - Apr 2022
Publication type	A1 Journal article-refereed

Funding

The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226. Ethical permission was granted for the study by the Regional Ethics Board of Stockholm with no. 2017/1224-31/2 and 2018/1675-32. Funding of the study was obtained by TB, TH, CM, CO, DW, JS, SLB, PO. All authors contributed to the design of the study. Data management and analysis was performed by NMS and TB. All authors contributed to the interpretation of the findings. NMS prepared the original draft, and all other authors critically revised the work. All authors approved the contents of the final manuscript, The data underlying the results of this study is available from Statistics Sweden and the Swedish National Board of Health and Welfare and was used by the current study under license after ethical review. Hence, the data is not publicly available. For questions pertaining this data, contact the corresponding author of this study. The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 8 Decent Work and Economic Growth

Keywords

Cardiovascular
Collective bargaining agreements
Group-based model trajectories
Income
Multiple job holding
Temporary agency work
Unstable employment

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Health Policy
Oncology
Internal Medicine

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10.1016/j.lanepe.2022.100314Licence: CC BY

1-s2.0-S2666776222000072-mainFinal published version, 548 KBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202203232699Licence: CC BY

Cite this

Matilla-Santander, N., Muntaner, C., Kreshpaj, B., Gunn, V., Jonsson, J., Kokkinen, L., Selander, J., Baron, S. L., Orellana, C., Östergren, P. O., Hemmingsson, T., Wegman, D. H., & Bodin, T. (2022). Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study. The Lancet Regional Health - Europe, 15, Article 100314. https://doi.org/10.1016/j.lanepe.2022.100314

@article{f8bf5a0c581a4c61bed4fdae0cf98dab,

title = "Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study",

abstract = "Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95\%:1·05-1·11 and RR:1·13, CI95\%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95\%: 1·10-1·18 and HR:1·24, CI95\%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95\%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95\%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.",

keywords = "Cardiovascular, Collective bargaining agreements, Group-based model trajectories, Income, Multiple job holding, Temporary agency work, Unstable employment",

author = "Nuria Matilla-Santander and Carles Muntaner and Bertina Kreshpaj and Virginia Gunn and Johanna Jonsson and Lauri Kokkinen and Jenny Selander and Baron, \{Sherry L.\} and Cecilia Orellana and {\"O}stergren, \{Per Olof\} and Tomas Hemmingsson and Wegman, \{David H.\} and Theo Bodin",

note = "Funding Information: The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226. Funding Information: Ethical permission was granted for the study by the Regional Ethics Board of Stockholm with no. 2017/1224-31/2 and 2018/1675-32. Funding of the study was obtained by TB, TH, CM, CO, DW, JS, SLB, PO. All authors contributed to the design of the study. Data management and analysis was performed by NMS and TB. All authors contributed to the interpretation of the findings. NMS prepared the original draft, and all other authors critically revised the work. All authors approved the contents of the final manuscript, The data underlying the results of this study is available from Statistics Sweden and the Swedish National Board of Health and Welfare and was used by the current study under license after ethical review. Hence, the data is not publicly available. For questions pertaining this data, contact the corresponding author of this study. The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = apr,

doi = "10.1016/j.lanepe.2022.100314",

language = "English",

volume = "15",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier",

}

Matilla-Santander, N, Muntaner, C, Kreshpaj, B, Gunn, V, Jonsson, J, Kokkinen, L, Selander, J, Baron, SL, Orellana, C, Östergren, PO, Hemmingsson, T, Wegman, DH & Bodin, T 2022, 'Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study', The Lancet Regional Health - Europe, vol. 15, 100314. https://doi.org/10.1016/j.lanepe.2022.100314

Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study. / Matilla-Santander, Nuria; Muntaner, Carles; Kreshpaj, Bertina et al.
In: The Lancet Regional Health - Europe, Vol. 15, 100314, 04.2022.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden

T2 - A register-based cohort study

AU - Matilla-Santander, Nuria

AU - Muntaner, Carles

AU - Kreshpaj, Bertina

AU - Gunn, Virginia

AU - Jonsson, Johanna

AU - Kokkinen, Lauri

AU - Selander, Jenny

AU - Baron, Sherry L.

AU - Orellana, Cecilia

AU - Östergren, Per Olof

AU - Hemmingsson, Tomas

AU - Wegman, David H.

AU - Bodin, Theo

N1 - Funding Information: The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226. Funding Information: Ethical permission was granted for the study by the Regional Ethics Board of Stockholm with no. 2017/1224-31/2 and 2018/1675-32. Funding of the study was obtained by TB, TH, CM, CO, DW, JS, SLB, PO. All authors contributed to the design of the study. Data management and analysis was performed by NMS and TB. All authors contributed to the interpretation of the findings. NMS prepared the original draft, and all other authors critically revised the work. All authors approved the contents of the final manuscript, The data underlying the results of this study is available from Statistics Sweden and the Swedish National Board of Health and Welfare and was used by the current study under license after ethical review. Hence, the data is not publicly available. For questions pertaining this data, contact the corresponding author of this study. The project was funded by FORTE, The Swedish Research Council for Health, Working Life and Welfare, with no. 2019-01226. Publisher Copyright: © 2022 The Author(s)

PY - 2022/4

Y1 - 2022/4

N2 - Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

AB - Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

KW - Cardiovascular

KW - Collective bargaining agreements

KW - Group-based model trajectories

KW - Income

KW - Multiple job holding

KW - Temporary agency work

KW - Unstable employment

U2 - 10.1016/j.lanepe.2022.100314

DO - 10.1016/j.lanepe.2022.100314

M3 - Article

AN - SCOPUS:85123941199

SN - 2666-7762

VL - 15

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100314

ER -

Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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