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ObjectiveTo investigate the association between job control, job demands and their combination (job strain) and suicide attempts and deaths among male and female workers in Sweden.MethodsJob control and demands were measured separately for men and women using a job exposure matrix, which was linked to around three million individuals based on their occupational title in 2005. Suicide attempts and deaths were measured in the hospital and cause of death registers from 2006 to 2016. HRs were estimated using discrete proportional hazards models with annually updated age as the time axis. Models were adjusted for sociodemographic, family, health, labour market and childhood factors, as well as the time-varying effects of unemployment, sick leave and family factors during follow-up.ResultsLow job control was associated with an increased risk of suicide attempts and deaths among both men and women while high job demands tended to be associated with a decreased risk. The combination of job control and job demands (job strain) reflected the increased risk of low control jobs and the decreased risk of high demand jobs. Associations were attenuated but still present after adjustments.ConclusionsLow job control is related to suicide attempts and deaths, and this is only partially explained by important covariates measured both prebaseline and during follow-up. Attempts to increase job control among workers may be beneficial in preventing suicide.

Introduction The EPHOR project is constructing a mega cohort for pooled analysis of data from multiple European cohort studies of occupation and health. The objective is to provide new evidence of the impact of occupational exposures on the risk of major non-communicable diseases, through systematic and agnostic analyses across the life-course. Materials and Methods Cohorts are registered in an online inventory. Cohort data and occupational information are being harmonised and documented in an online variable catalogue, and will be linked with a newly developed European Job-Exposure Matrix (EuroJEM) characterising multiple: chemical and particle, ergonomic, physical, and psychosocial exposures and precariousness. Cohort information on working time will also be harmonised. Knowledge gaps on occupational exposures in relation to major non-communicable diseases were identified. Both meta-analysis and decentralized analysis approaches will be used, as appropriate. Ethics approval is provided by all relevant committees. Results Currently 29 European cohorts covering a broad range of countries as well as multi-country studies are participating, containing more than 20 million participants. Cohort designs range from smaller scale studies including hundreds to thousands of workers with detailed exposure and/or outcome characterisation, to large-scale general population cohorts including multiple millions of participants with occupational information captured using registry-based methods. Cohorts were largely established and followed-up during the 2000s through the current time, though some were established earlier. Occupational information primarily entails the working lifetime or follow-up period. Outcome information includes disease incidence, disability, and mortality. In some studies, information about genetics, epigenetics, other biomarkers and clinical/functional evaluations is available. Analysis will address knowledge gaps of cancer, respiratory, cardiovascular/metabolic, and neurodegenerative diseases, mental and musculoskeletal disorders, and work participation. Conclusions We expect the mega cohort will be a useful long-term resource to study relationships of occupations, work-related exposures and health in Europe to inform policy and prevention.

BackgroundIn Sweden, the proportion of the population that remains in paid employment until normal retirement age of 65 years is less than 50% in blue-collar groups, compared to 60%–75% in white-collar occupations. High physical workload has been associated with early exits from the labor market through disability pensions (DP) in many studies. However, identified risk factors for DP from early life may be more prevalent among men in heavy manual occupations than in others. The aim was to investigate the association between high physical work load in middle age and DP before age 59, adjusting for social background, physical ability, psychological characteristics, lifestyle and education measured before labour market entrance.MethodsThe study is based on a Swedish conscription cohort of 49 321 men born 1949–1951. At enlistment 1969/1970 information was collected about cardiorespiratory fitness, social background, psychological characteristics and health behaviours, e.g. smoking. Physical workload was estimated with a job exposure matrix based on questions concerning heavy lifting, strenuous work postures, repetitive work and physically strenuous work from the Swedish Work Environment Surveys 1989–97. Mean values for men of a composite physical exposure variable were grouped into quartiles; high, medium-high, medium-low and low physical workload, and assigned to occupational titles from the census 1990. The study group was followed regarding DP from age 40 to 59.ResultsExposure to high (HR 2.67, CI 95% 2.42–2.95), medium-high (HR 2.43, CI 95% 2.20–2.69) and medium-low (HR 1.31, CI 95% 1.18–1.47) physical workload, compared with low, were associated with DP up to age 59. The increased risks remained, but were clearly attenuated after adjustments for pre-labour market factors, especially psychological characteristics and education.ConclusionThe results are in line with a major effect of high physical work load on disability pension, even though adjustments for pre-labour market factors clearly attenuated the risks.

Background Although unemployment may be a stressful life event, its association with coronary heart disease (CHD) remains unclear. This study examines the association between unemployment and later hospitalisation due to CHD. Methods The study was based on a Swedish military conscription cohort of 18 to 20-year-old men from 1969/1970 (n=49 321) with information provided on health status and health behaviours. Information on unemployment in middle age was obtained from national registers. CHD information was obtained from hospital registers and the cause of death register. Cox proportional hazard analyses were run on the 39 243 individuals who were in paid employment in 1996 and 1997. Results It was found that ≥90 days of unemployment was associated with subsequent CHD during 8 years follow-up (crude HR=1.47, 95% CI 1.23 to 1.75). Controlling for known risk factors for CHD reduced the association but a significant association remained (HR=1.24, 95% CI 1.04 to 1.48); ≥90 days of unemployment was significantly associated with CHD during the first 4 years (HR adjusted for known risk factors=1.31, 95% CI 1.01 to 1.71). Conclusions Unemployment was associated with increased risk of CHD after adjustment for confounders. We interpret the increased risk of CHD associated with unemployment as potentially the somatic result of a process started by stress.