A selection from Stockholm University publication database

• Association of workplace violence and bullying with later suicide risk: a multicohort study and meta-analysis of published data

  2023. Linda Magnusson Hanson (et al.). The Lancet Public Health 8 (7), e494-E503

  Article

  Background Workplace offensive behaviours, such as violence and bullying, have been linked to psychological symptoms, but their potential impact on suicide risk remains unclear. We aimed to assess the association of workplace violence and bullying with the risk of death by suicide and suicide attempt in multiple cohort studies. Methods In this multicohort study, we used individual-participant data from three prospective studies: the Finnish Public Sector study, the Swedish Work Environment Survey, and the Work Environment and Health in Denmark study. Workplace violence and bullying were self-reported at baseline. Participants were followed up for suicide attempt and death using linkage to national health records. We additionally searched the literature for published prospective studies and pooled our effect estimates with those from published studies. Findings During 1 803 496 person-years at risk, we recorded 1103 suicide attempts or deaths in participants with data on workplace violence (n=205 048); the corresponding numbers for participants with data on workplace bullying (n=191 783) were 1144 suicide attempts or deaths in 1 960 796 person-years, which included data from one identified published study. Workplace violence was associated with an increased risk of suicide after basic adjustment for age, sex, educational level, and family situation (hazard ratio 1.34 [95% CI 1.15-1.56]) and full adjustment (additional adjustment for job demands, job control, and baseline health problems, 1.25 [1.08-1.47]). Where data on frequency were available, a stronger association was observed among people with frequent exposure to violence (1.75 [1.27-2.42]) than occasional violence (1.27 [1.04-1.56]). Workplace bullying was also associated with an increased suicide risk (1.32 [1.09-1.59]), but the association was attenuated after adjustment for baseline mental health problems (1.16 [0.96-1.41]). Interpretation Observational data from three Nordic countries suggest that workplace violence is associated with an increased suicide risk, highlighting the importance of effective prevention of violent behaviours at workplaces. Funding Swedish Research Council for Health, Working Life and Welfare, Academy of Finland, Finnish Work Environment Fund, and Danish Working Environment Research Fund.

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• Sex-related differences in the hypertriglyceridemic-waist phenotype in association with hyperuricemia: a longitudinal cohort study

  2023. Huihui He (et al.). Lipids in Health and Disease 22

  Article

  Background There is limited longitudinal evidence supporting the association between the hypertriglyceridemic-waist (HTGW) phenotype and hyperuricemia. This study aimed to examine the longitudinal relationship between hyperuricemia and the HTGW phenotype among males and females.

  Methods A total of 5562 hyperuricemia-free participants aged 45 or over from the China Health and Retirement Longitudinal Study (mean age: 59.0) were followed for 4 years. The HTGW phenotype was defined as having elevated triglyceride levels and enlarged waist circumference (cutoffs for males: 2.0 mmol/L and 90 cm; females: 1.5 mmol/L and 85 cm). Hyperuricemia was determined by uric acid cutoffs (males: 7 mg/dl; females: 6 mg/dl. Multivariate logistic regression models were used to assess the association between the HTGW phenotype and hyperuricemia. The joint effect of the HTGW phenotype and sex on hyperuricemia was quantified, and the multiplicative interaction was assessed.

  Results During the four-year follow-up, 549 (9.9%) incident hyperuricemia cases were ascertained. Compared with those with normal levels of triglycerides and waist circumference, participants with the HTGW phenotype had the highest risk of hyperuricemia (OR: 2.67; 95% CI: 1.95 to 3.66), followed by an OR of 1.96 (95% CI: 1.40 to 2.74) for only higher triglyceride levels and 1.39 (95% CI: 1.03 to 1.86) for only greater waist circumference. The association between HTGW and hyperuricemia was more prominent among females (OR = 2.36; 95% CI: 1.77 to 3.15) than males (OR = 1.29; 95% CI: 0.82 to 2.04), with evidence of a multiplicative interaction (P = 0.006).

  Conclusions Middle-aged and older females with the HTGW phenotype may at the highest risk of hyperuricemia. Future hyperuricemia prevention interventions should be primarily targeted for females with the HTGW phenotype.

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• Association between subjective cognitive complaints, balance impairment and disability among middle-aged and older adults: Evidence from a population-based cohort study

  2022. Raoping Tu (et al.). Geriatrics & Gerontology International 22 (12), 1025-1031

  Article

  Aim: To quantify the association between subjective cognitive complaints and balance impairment in relation to the occurrence of disability.

  Methods: In total, 6885 adults aged ≥45 who participated in the China Health and Retirement Longitudinal Study (CHARLS) were followed for 7 years. Subjective cognitive complaints were evaluated by self-reported memory problems. Balance impairment was tested by side-by-side stand, semi-tandem stand and full tandem stand. Disability was measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). Multivariate logistic regression models were applied to test the joint effect between baseline subjective cognitive complaints and balance impairment on disability. The multiplicative interaction was examined.

  Results: A joint effect of experiencing both subjective cognitive complaints and balance impairment was identified, showing a 1.63-fold higher risk of ADL and IADL disability than those experienced by neither of the two (odds ratio = 1.63, 95% confidence interval: 1.36–1.95). There was evidence of multiplicative interaction (P = 0.004).

  Conclusions: Among middle-aged and older people, the coexistence of subjective cognitive complaints and balance impairment may lead to a higher disability risk, which is much higher than the simple sum of the two individual effects. Future interventions are required to target these symptoms simultaneously to reduce the risks of disability.

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• Characteristics of Workplace Psychosocial Resources and Risk of Diabetes: A Prospective Cohort Study 

  2022. Tianwei Xu (et al.). Diabetes Care 45 (1), 59-66

  Article

  OBJECTIVE

  To examine whether characteristics of workplace psychosocial resources are associated with the risk of type 2 diabetes among employees.

  RESEARCH DESIGN AND METHODS

  Participants were 49,835 employees (77% women, aged 40–65 years, and diabetes free at baseline) from the Finnish Public Sector cohort study. Characteristics of horizontal (culture of collaboration and support from colleagues) and vertical (leadership quality and organizational procedural justice) psychosocial resources were self-reported. Incident type 2 diabetes (n = 2,148) was ascertained through linkage to electronic health records from national registers. We used latent class modeling to assess the clustering of resource characteristics. Cox proportional hazards models were used to examine the relationship between the identified clusters and risk of type 2 diabetes during 10.9 years of follow-up, adjusting for age, sex, marital status, educational level, type of employment contract, comorbidity, and diagnosed mental disorders.

  RESULTS

  We identified four patterns of workplace psychosocial resources: unfavorable, favorable vertical, favorable horizontal, and favorable vertical and horizontal. Compared with unfavorable, favorable vertical (hazard ratio 0.87 [95% CI 0.78; 0.97]), favorable horizontal (0.77 [0.67; 0.88]), and favorable vertical and horizontal (0.77 [0.68; 0.86]) resources were associated with a lower risk of type 2 diabetes, with the strongest associations seen in employees at age ≥55 years (Pinteraction = 0.03). These associations were robust to multivariable adjustments and were not explained by reverse causation.

  CONCLUSIONS

  A favorable culture of collaboration, support from colleagues, leadership quality, and organizational procedural justice are associated with a lower risk of employees developing type 2 diabetes than in those without such favorable workplace psychosocial resources.

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• Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study

  2022. Ying Jiang (et al.). Frontiers in Nutrition 9

  Article

  Background: Body mass index (BMI) is the most widely used parameter to assess the body weight status. Both the increase of BMI (overweight and obesity) and decrease of BMI (underweight) has been associated with high risk of adverse outcome, such as stroke, disability, and even death. However, recent data on secular differences in BMI in the Chinese aged population are limited. The present study provides robust new evidence about the evolving epidemic of obesity among aged adults in China.

  Objective: Evaluating secular difference in BMI in a group of Chinese older adults.

  Materials and Methods: We analyzed 7 continuous survey years (2014–2020), including 50,192 Chinese aged participants (25,505 men and 24,687 women, aged 71.9 ± 6.1 years, age range: 65–99 years). Information on sex, age, height, and body weight, was collected based on medical history. Participants were classified into four groups: underweight (BMI < 18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI < 25 kg/m²), overweight (25 kg/m² ≤ BMI < 30 kg/m²), and obesity (BMI ≥ 30 kg/m²). Linear regressions were used to assess the secular difference in BMI. Sex and age differences were also evaluated by stratified analyses.

  Results: From 2014 to 2020, age-adjusted mean BMI increased by 0.3 kg/m² (95% CI: 0.1, 0.5 kg/m²) in men, and 0.5 kg/m² (95% CI: 0.2, 0.7 kg/m²) in women. Age-standardized prevalence of underweight decreased from 3.0 to 2.3% in men, and from 3.0 to 2.1% in women. Age-standardized prevalence of overweight increased in both men (from 40.1 to 41.7%) and women (from 37.8 to 39.8%), and so as obesity (men: from 4.1 to 6.1%; women: from 5.8 to 8.7%).

  Conclusion: Our results confirmed that BMI gradually increased from 2014 to 2020. The age-adjusted mean BMI increased by 0.3 kg/m² in older men, and 0.5 kg/m² in older women. The age- and sex-standardized prevalence of overweight and obesity significantly increased, especially in 70–79-year age group, while the prevalence of underweight decreased. The combination of a balanced-diet and physical exercise is needed to maintain optimal BMI range for the aged population.

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• The association between healthy aging index and trajectories of disability: a population-based cohort study

  2022. Raoping Tu (et al.). Aging Clinical and Experimental Research 34 (8), 1893-1900

  Article

  Background Healthy aging index (HAI) could predict adverse health consequences including mortality and disability independent of age and comorbidity. We investigated the role of HAI on trajectories of disability throughout later life based on a nationally representative sample.

  Methods We examined 1733 participants aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) followed for 7 years/4 waves repeatedly. Systolic blood pressure [SBP], cognitive function, cystatin C, peak expiratory flow [PEF], and fasting glucose were categorized using tertile or clinical reference range, and scored as 0 (healthiest), 1 (less healthy) and 2 (least healthy) respectively to further generate HAI summary scores (range 0–10). Disability was defined as the sum of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL). We used linear mixed-effects model to study the association between HAI and trajectories of disability.

  Results A total of 10.5% of participants represented in the healthiest group and 22.5% ended up as the least healthy. After adjusting for all potential confounders, disability progression was significantly faster (β = 0.27, 95% CI 0.11–0.42) in the least healthy group when comparing with the healthiest.

  Conclusion Our findings suggest that HAI is associated with disability progression among adults aged over 60 years old. It might be beneficial for future interventions to specifically target older adults with high HAI scores as a means of reducing disability.

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• Workplace psychosocial resources and risk of cardiovascular disease among employees: a multi-cohort study of 135 669 participants

  2022. Tianwei Xu (et al.). Scandinavian Journal of Work, Environment and Health 48 (8), 621-631

  Article

  Objective In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees.

  Methods We pooled data from three cohort studies of 135 669 employees (65% women, age 18–65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders.

  Results We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either intermediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.95] or high (HR 0.88, 95% CI 0.78–1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67–0.96).

  Conclusions Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease.

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• Organizational Justice and Long-term Metabolic Trajectories

  2022. Tibor V. Varga (et al.). Journal of Clinical Endocrinology and Metabolism 107 (2), 398-409

  Article

  Context: Organizational justice has been linked to lower risk of several chronic conditions among employees, but less is known about the long-term mechanisms underlying this risk reduction.

  Objective: To assess whether self-reported organizational justice is associated with individual and composite long-term metabolic trajectories.

  Design: Twenty-five-year follow-up of the Whitehall II prospective cohort study.

  Setting: Middle-aged public servants from the United Kingdom.

  Participants: Data on 8182 participants were used.

  Main Outcome Measures: Levels of 11 anthropometric, glycemic, lipid, and blood pressure biomarkers were measured at 5 timepoints (1991–2013). We used generalized estimating equations and group-based trajectory modeling to investigate the relationship between organizational justice and biomarker trajectories.

  Results: High vs low organizational justice were associated with lower waist (−1.7 cm) and hip (−1 cm) circumference, body mass index (−0.6 kg/m2), triglycerides (−1.07 mmol/L), and fasting insulin (−1.08 µIU/mL) trajectories. Two latent metabolic trajectory clusters were identified: a high- and a low-risk cluster. High organizational justice (vs low) were associated with belonging to the low-risk cluster (pooled odds ratio = 1.47). The low-risk cluster demonstrated lower baseline levels of most biomarkers and better glycemic control, whereas the high-risk cluster showed higher baseline levels of most biomarkers, glycemic deterioration, but also greater improvements in lipid levels over time.

  Conclusions: People with high organizational justice had more favorable long-term cardiometabolic biomarker patterns than those with low organizational justice, indicating a potential mechanism contributing to the lower risk of chronic diseases in the first group. Further intervention studies are warranted to determine whether improvement of organizational justice might improve long-term health.

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• The relationship between onset of workplace violence and onset of sleep disturbances in the Swedish working population

  2021. Meike Heming (et al.). Journal of Sleep Research 30 (5)

  Article

  The study investigated the association between onset of workplace violence and onset of sleep disturbances. We used self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) collected in 2014, 2016, and 2018. A two-wave design was based on participants who had no exposure to workplace violence or sleep disturbances at baseline (n = 6,928). A three-wave design was based on participants who in addition were unexposed to sleep disturbances in the second wave (n = 6,150). Four items of the Karolinska Sleep Questionnaire were used to measure sleep disturbances and one question was used to measure the occurrence of workplace violence or threats of violence. Multivariate logistic regression analyses were performed. In the two-wave approach, onset of workplace violence was associated with onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status (adjusted odds ratio 1.41, 95% confidence interval 1.02-1.96). The association was no longer statistically significant after further adjustment for night/evening work, demands, control, and social support at work. In the three-wave approach, results were only suggestive of an association between onset of workplace violence and subsequent onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status. Onset of frequent exposure to workplace violence was associated with subsequent onset of sleep disturbances in the adjusted analyses, but these analyses were based on few individuals (13 exposed versus 5,907 unexposed). The results did not conclusively demonstrate that onset of workplace violence predicts development of sleep disturbances. Further research could elucidate the role of other working conditions.

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• Workplace discrimination as risk factor for long-term sickness absence

  2021. Alice Clark (et al.). PLOS ONE 16 (8)

  Article

  Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (>= 10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80-2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33-1.96 and adjusted odds ratio 1.02; 95% CI 0.83-1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred.

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• Workplace Violence and Long-term Sickness Absence Assessment of the Potential Buffering Effect of Social Support in Two Occupational Cohort Studies

  2020. Sofie Have Hoffmann (et al.). Journal of Occupational and Environmental Medicine 62 (10), 830-838

  Article

  Objectives:

  We aimed to determine the effect of workplace violence on long-term sickness absence, and whether social support from supervisors and colleagues buffer this effect.

  Methods:

  Information on workplace violence and social support were derived from the Danish Work Environment Cohort Study in 2000, 2005, and 2010 and the Swedish Longitudinal Occupational Survey of Health in 2006 and 2008. Individual- and joint-effects on register-based long-term sickness absence were determined using logistic regression models for repeated measurements. Cohort-specific estimates were combined in random effect meta-analyses.

  Results:

  Workplace violence and low social support were independently associated with a higher risk of long-term sickness absence, and we did not find evidence of an interaction.

  Conclusion:

  Exposure to workplace violence is a risk factor for long-term sickness absence while social support is associated with a lower risk of long-term sickness absence.

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