Effect of Job Strain on Incident Cardiovascular Disease: Confounding and Mediation by Lifestyle Habits. An Overview of Systematic Reviews

Mathilde Lavigne-Robichaud , ULaval
Camille Riopel, McGill University
Xavier Trudel, ULaval
Alain Milot, ULaval
Mahee Gilbert-Ouimet, ULaval
Denis Talbot, ULaval
Karine Aubée, CRCHUQ-ULaval
Chantal Brisson, CRCHUQ-ULaval

Objective: This overview of systematic reviews (SR) aimed to examine how lifestyle habits have been considered in SR evaluating the effect of job strain and cardiovascular diseases incidence. The objectives were to determine how these SR discussed potential confounding and mediation effects by these lifestyle habits. Methods: SR assessing the effect of job strain on cardiovascular diseases incidence were identified through four databases (PubMed, OVID, Web of Science and CINHAL from 1979 to 2018). Information on lifestyle habits was retrieved from identified SR and critically evaluated. Results: We identified 13 SR, including four with meta-analyses. Lifestyle habits have been considered as potential confounders in ten out of the 13 SR identified. Five SR reports that an association between job strain and cardiovascular incidence remains after adjusting for lifestyle habits. Eight SR discussed lifestyle habits as potential mediators and five SR postulated a potential underestimation of effects due to overadjustment for lifestyle habits. None of these SR investigated the magnitude of this potential overadjustment bias. Conclusion: According to this overview of SR, the effect of job strain on CVD is independent of lifestyle habits. However, the presence of great heterogeneity in the way lifestyle habits are considered in SR do not allow to draw sound conclusions about their potential role as mediators in the relationship between job strain and cardiovascular disease. Overadjustment for lifestyle habits could lead to an underestimation of the magnitude of the true causal effect of job strain on CVD incidence.

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 Presented in Session P3. Poster Session Migration, Economics, Environment, Methods, History and Policy