Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Research

Job insecurity and risk of diabetes: a meta-analysis of individual participant data

Jane E. Ferrie, Marianna Virtanen, Markus Jokela, Ida E.H. Madsen, Katriina Heikkilä, Lars Alfredsson, G. David Batty, Jakob B. Bjorner, Marianne Borritz, Hermann Burr, Nico Dragano, Marko Elovainio, Eleonor I. Fransson, Anders Knutsson, Markku Koskenvuo, Aki Koskinen, Anne Kouvonen, Meena Kumari, Martin L. Nielsen, Maria Nordin, Tuula Oksanen, Krista Pahkin, Jan H. Pejtersen, Jaana Pentti, Paula Salo, Martin J. Shipley, Sakari B. Suominen, Adam Tabák, Töres Theorell, Ari Väänänen, Jussi Vahtera, Peter J.M. Westerholm, Hugo Westerlund, Reiner Rugulies, Solja T. Nyberg and Mika Kivimäki; for the IPD-Work Consortium
CMAJ December 06, 2016 188 (17-18) E447-E455; DOI: https://doi.org/10.1503/cmaj.150942
Jane E. Ferrie
Department of Epidemiology and Public Health (Ferrie, Batty, Shipley, Tabák, Kivimäki), University College London, London, UK; School of Community and Social Medicine (Ferrie), University of Bristol, Bristol, UK; Finnish Institute of Occupational Health (Virtanen, Heikkilä, Koskinen, Oksanen, Pahkin, Pentti, Salo, Väänänen, Vahtera, Nyberg, Kivimäki), Helsinki, Tampere and Turku, Finland; Institute of Behavioural Sciences (Jokela, Kivimäki), University of Helsinki, Helsinki, Finland; National Research Centre for the Working Environment (Madsen, Bjorner, Rugulies), Copenhagen, Denmark; Institute of Environmental Medicine (Alfredsson, Fransson), Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine (Alfredsson, Theorell, Westerlund), Stockholm County Council, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (Batty), University of Edinburgh, Edinburgh, Scotland; Department of Occupational and Environmental Medicine (Borritz), Bispebjerg University Hospital, Copenhagen, Denmark; Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin) (Burr), Berlin, Germany; Institute for Medical Sociology, Medical Faculty (Dragano), University of Düsseldorf, Düsseldorf, Germany; National Institute for Health and Welfare (Elovainio), Helsinki, Finland; School of Health Sciences (Fransson), Jönköping University, Jönköping, Sweden; Stress Research Institute (Fransson), Stockholm University, Stockholm, Sweden; Department of Health Sciences (Knutsson), Mid Sweden University, Sundsvall, Sweden; Departments of Public Health (Koskenvuo) and Social Research (Kouvonen), University of Helsinki, Helsinki, Finland; Institute for Social and Economic Research (Kumari), University of Essex, Colchester, UK; Unit of Social Medicine (Nielsen), Frederiksberg University Hospital, Copenhagen, Denmark; Department of Psychology (Nordin), Umeå University, Umeå, Sweden; The Danish National Centre for Social Research (Pejtersen), Copenhagen, Denmark; Departments of Psychology (Salo) and Public Health (Suominen, Vahtera), University of Turku, Turku, Finland; Folkhälsan Research Center (Suominen), Helsinki, Finland; University of Skövde (Suominen), Skövde, Sweden; 1st Department of Medicine (Tabák), Semmelweis University Faculty of Medicine, Budapest, Hungary; Turku University Hospital (Vahtera), Turku, Finland; Department of Medical Sciences (Westerholm), Uppsala University, Uppsala, Sweden; Departments of Public Health and Psychology (Rugulies), University of Copenhagen, Copenhagen, Denmark
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: jane.ferrie@bristol.ac.uk
Marianna Virtanen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Markus Jokela
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ida E.H. Madsen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Katriina Heikkilä
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lars Alfredsson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
G. David Batty
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jakob B. Bjorner
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marianne Borritz
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hermann Burr
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nico Dragano
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marko Elovainio
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eleonor I. Fransson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anders Knutsson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Markku Koskenvuo
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Aki Koskinen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne Kouvonen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Meena Kumari
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin L. Nielsen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maria Nordin
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tuula Oksanen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Krista Pahkin
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jan H. Pejtersen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jaana Pentti
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paula Salo
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin J. Shipley
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sakari B. Suominen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adam Tabák
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Töres Theorell
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ari Väänänen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jussi Vahtera
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter J.M. Westerholm
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hugo Westerlund
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Reiner Rugulies
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Solja T. Nyberg
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mika Kivimäki
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Abstract

Background: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.

Methods: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.

Results: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09–1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01–1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04–1.35).

Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

The increasing use of temporary contracts, zero-hours contracts and other forms of flexible employment have made job insecurity a feature of much previously secure employment in high-income countries.1 In addition to impacts on social circumstances, the health consequences of job insecurity are becoming recognized.2 Most evidence to date has relied on self-reported health outcomes, such as mental and physical health symptoms.3–5 In addition, an association has been reported between job insecurity and cardiovascular risk factors, such as dyslipidemia and weight gain,6 and a recent meta-analysis of individual data for 170 000 workers showed an association between job insecurity and clinically verified incident coronary events.7

The prevalence of diabetes has increased steadily over recent decades, mostly owing to rising rates of overweight and obesity, and aging populations.8,9 There is indirect evidence to suggest an association between job insecurity and incident diabetes because previous work has shown an association between job insecurity and a subsequent increase in body mass index (BMI).6 A high BMI, in turn, is a strong risk factor for diabetes.10,11 However, a comprehensive search of the literature (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150942/-/DC1) revealed no published studies examining the association between job insecurity and diabetes.

To address this gap in the literature, we undertook a meta-analysis of individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations Consortium (IPD-Work Consortium). This approach allowed us to quantify the prospective association between job insecurity and subsequent incident diabetes in a large data set that included a wide variety of workers and countries.

Methods

Study population

We used individual-level data on job insecurity and incident diabetes for participants in 19 prospective cohort studies. Eight studies had open-access data and were identified from collections at the Interuniversity Consortium for Political and Social Research (www.icpsr.umich.edu/icpsrweb/ICPSR) and the UK Data Service (http://ukdataservice.ac.uk/).12–19 Six of these studies involved general population samples.12–17 The other 2 included random samples of graduates from Wisconsin high schools and their siblings.18,19

The other 11 were European cohort studies20–30 participating in the IPD-Work Consortium.31 Four of the 11 studies included general population samples, 20–22,24 and the rest involved either workers in the public sector or employees in private companies.23,25–30 Further details about the studies are available in Appendix 2 (www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150942/-/DC1).

For our meta-analysis, we included all women and men from the cohort studies who were in employment and free of diabetes at baseline and for whom complete data on job insecurity were available.

Measurement of job insecurity

Job insecurity was measured once at baseline in all 19 studies (Table 1). In the 8 studies from the open-access data sets, a question was asked about the level of insecurity in the person’s current job or about satisfaction with job security. In the other 11 studies, a question was asked about the level of insecurity in the person’s current job or about fear of layoff or unemployment. In all of the studies, the exposure was dichotomized into high or low job insecurity, as described previously.7

View this table:
  • View inline
  • View popup
Table 1:

Measurement and prevalence of self-reported job insecurity in the included cohort studies

Outcome measure

The primary outcome was incident diabetes. The 8 studies from the open-access data sets defined incident diabetes over the follow-up period as the first self-report of diabetes. Of the 11 studies from the IPD-Work Consortium, the Whitehall II study32 used the gold-standard World Health Organization criteria (a 75-g oral glucose tolerance test, with diabetes defined as a fasting glucose level of at least 7.0 mmol/L, or a 2-hour post-load glucose level of at least 11.1 mmol/L, except for patients who had physician-diagnosed diabetes or who were using diabetes medication). The other studies from IPD-Work Consortium defined incident diabetes as the first record of diabetes, diagnosed according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision code E11. This information was collected from hospital admission, hospital discharge and mortality registers that had a mention of diabetes in any of the diagnostic codes. In addition, in the Finnish studies,23,24,27 participants were defined as having incident diabetes the first time they were eligible for diabetes medication in the national drug reimbursement register. The date of diabetes diagnosis was defined as the date of the first record in any of the above-mentioned sources over the study follow-up period.

Participants with evidence of prevalent diabetes at baseline were excluded. Prevalent diabetes was defined on the basis of information from any of the following: hospital records, baseline oral glucose tolerance test results, self-report from the baseline questionnaire or drug reimbursement register (Finnish studies only).

Assessment of covariates

Confounders of the association between job insecurity and incident diabetes include age, sex, socioeconomic position, obesity, and reporting or common-method bias for studies in which both exposure and outcome are self-reported.

We were able to obtain the following data from almost all of the studies: participants’ age, sex, socioeconomic status (based on participants’ highest occupational grade or educational qualification and classified as low, intermediate or high) and obesity (defined as a BMI above 30). Other risk factors for diabetes, which may be associated with job insecurity and so act as potential confounders of the association, were physical activity (low, intermediate or high), smoking (current, former or never) and alcohol use (none, moderate, intermediate or heavy); these risk factors were similarly predefined and harmonized across the studies.

Data were not available on obesity from 2 studies;14,27 on alcohol use from 1 study;26 and on obesity, physical activity and alcohol use from another study.20 These 4 studies were excluded from the multivariable-adjusted models.

Statistical analysis

Our analyses included 19 prospective cohort studies in which job insecurity was measured once at baseline and subsequent incident diabetes was measured over the follow-up period. Because not all of the studies included an exact date of diabetes diagnosis, we used logistic regression in all studies to calculate study-specific odds ratios (ORs) and 95% confidence intervals (CIs) as the measure of association between job insecurity and subsequent incident diabetes.33

Meta-analysis was used to produce a common risk estimate.34 Because there was no significant heterogeneity between the study-specific estimates, we conducted the meta-analyses using fixed-effect models. Heterogeneity of the study-specific estimates was examined using the I2 statistic (higher values denote greater heterogeneity).35

In the preliminary analysis, we calculated age-and sex-adjusted study-specific effect estimates of the association between job insecurity and incident diabetes. In the main analysis, we used multivariable models that were further adjusted for socioeconomic status, obesity, physical activity, alcohol use and smoking. To examine whether the association between job insecurity and incident diabetes differed between subgroups of studies and participants, we stratified the analyses by method of diabetes diagnosis (self-reported, electronic medical records or clinical examination), study quality (assessed as low or high using the Cochrane risk-of-bias tool for cohort studies,36 see Appendix 3, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150942/-/DC1), age (< 50 yr or ≥ 50 yr), sex, socioeconomic status (low, intermediate or high) and study location (Europe or United States).

We used Stata/MP version 13.1 (StataCorp) to analyze data from the open-access data archives and to compute the results of all the meta-analyses. We used SAS version 9.2 (SAS Institute Inc.) to analyze study-specific data from the IPD-Work studies.

Results

Sample characteristics

The 8 studies from the open-access data sets included a total of 44 770 working women and men with data on age, sex, socioeconomic status, job insecurity and diabetes. The 11 studies from the IPD-Work Consortium included a further 96 055 working women and men with suitable data, bringing the total study population to 140 825 (mean age 42.2 yr; 81 816 [58.1%] women) (Table 2). Overall, 3954 incident cases of diabetes occurred over a mean follow-up of 9.4 (range 4.0–21.1) years. Although 2 studies were started in 1986,12,27 baseline assessment for the remaining studies was between 1991 and 2009. Studies were from Australia, Denmark, Finland, Sweden, the United Kingdom and the US (Table 1, Appendix 2).

View this table:
  • View inline
  • View popup
Table 2:

Characteristics of participants and assessment of incident diabetes in the included cohort studies

Association between job insecurity and incident diabetes

The prevalence of high job insecurity ranged from 6.3% to 40.3% (Table 1). The mean incidence of diabetes per 10 000 person-years ranged from 9.0 to 85.2 (Table 2).

Age- and sex-adjusted estimates of the association between job insecurity and incident diabetes for the 19 studies are presented in Figure 1A. The multivariable-adjusted analyses, additionally adjusted for socioeconomic status, obesity, physical activity, alcohol use and smoking, are presented in Figure 1B for the 15 studies with data on all covariates (n = 108 525; 2850 incident diabetes cases).

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

Study-specific analyses of association between job insecurity and incident diabetes (A) after adjustment for age and sex and (B) after adjustment for age, sex, socioeconomic status, obesity, physical activity, alcohol use and smoking. Values greater than 1.0 indicate an increased risk of incident diabetes. CI = confidence interval, OR = odds ratio. See Table 1 for full study names.

High job insecurity at baseline was associated with an increased risk of diabetes in the age- and sex-adjusted analysis compared with low job insecurity (pooled OR 1.19, 95% CI 1.09–1.30). The effect was attenuated in the multivariable-adjusted analysis but remained statistically significant (pooled OR 1.12, 95% CI 1.01–1.24). Heterogeneity between the study-specific estimates was low to moderate (age- and sex-adjusted analysis: I2 = 24%, p = 0.2; multivariable-adjusted analysis: I2 = 27%, p = 0.2). Sequential adjustment of the association between job insecurity and incident diabetes for socioeconomic status and the lifestyle covariates are presented in Appendix 4 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150942/-/DC1).

The results of the subgroup analyses are shown in Figure 2. We found no statistically significant differences in the association between job insecurity and incident diabetes in the multivariable-adjusted analyses when stratified by method of diabetes diagnosis, study quality, age, sex, socioeconomic status or study location (p value > 0.1 for all subgroup differences). Odds ratios for the subgroups divided by diagnosis method and study quality were identical because the diagnosis of diabetes is a key feature of high-quality (electronic medical records or clinical examination [oral glucose tolerance test]) and low-quality (self-report) studies. Although the correlation between diabetes identified by self-report and medical records is relatively high37 and the difference between the high- and low-quality studies was not statistically significant, these analyses provide stronger evidence in support of an association between job insecurity and incident diabetes in the high-quality studies (pooled OR 1.19, 95% CI 1.04–1.35).

Figure 2:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2:

Subgroup analyses of association between job insecurity and incident diabetes after adjustment for age, sex, socioeconomic status, obesity, physical activity, alcohol use and smoking (15 cohorts, n = 108 525; 2850 incident cases of diabetes). Values greater than 1.0 indicate an increased risk of incident diabetes. CE = clinical examination (oral glucose tolerance test), CI = confidence interval, EMR = electronic medical record, OR = odds ratio.

Loss to follow-up ranged from less than 5% to 34%, and length of follow-up from 4 to 21 years (Appendix 2), but neither factor had an effect on the association between job insecurity and incident diabetes (Appendix 4). The rate of unemployment at baseline varied from 4.6% to 11.3% (Appendix 2), but there was no evidence that the association between job insecurity and incident diabetes differed between the cohorts (Appendix 4).

Interpretation

In our meta-analysis of individual-level data from 19 prospective cohort studies involving more than 140 000 participants and close to 4000 incident cases of diabetes, we observed a 19% increase in the age- and sex-adjusted odds of incident diabetes among workers who reported high levels of job insecurity. In the 15 studies with complete covariate data, the multivariable-adjusted association was attenuated to 12%, but it remained statistically significant. Most of this attenuation resulted from adjustment for the lower socioeconomic status among the workers who reported job insecurity.

Because we were unable to find previous studies, either cross-sectional or longitudinal, that examined the association between job insecurity and incident diabetes, our study appears to be the first to report on this association. Our findings are congruent with those from studies showing an association between job insecurity and weight gain,6 a risk factor for diabetes, and between job insecurity and incident coronary artery disease,7 a complication of diabetes. In the latter meta-analysis of cohort studies from the IPD-Work Consortium,7 employees who reported job insecurity had a 19% increase in the multivariable-adjusted odds of incident myocardial infarction or coronary death. The strength of the association was the same as for incident diabetes in high-quality studies in the current analysis.

Limitations

Our study needs to be considered in view of several limitations. Although we were able to adjust our analyses for age, sex, socioeconomic status and obesity at baseline, data on other potential confounders and mediators, such as anxiety and weight gain over the follow-up period, were not available in most of the data sets.

We cannot claim that our analysis included all possible data. However, we were able to include a large, diverse sample of workers from 19 well-characterized prospective cohort studies that together cover the US, Australia and several European countries. Therefore, our findings are likely to apply more widely to workers in other high-income countries.

Job insecurity was measured with the use of single questions that were not uniform across the studies. In common parlance, job insecurity is understood to refer to employed workers who feel threatened by unemployment, a broad concept around which the single-item measures in our meta-analyses appear to coalesce.38,39 Low to moderate heterogeneity, as indicated by the I2 statistics suggests effects that differ little between the studies. However, the use of single, rather than multi-item questionnaires at one point in time only to measure job insecurity may result in an underestimation of the association between job insecurity and health-related outcomes,40 a limitation which may also apply to our study. Previous work has also shown that chronic or repeated exposure to job insecurity is more harmful to health than exposure to job insecurity at one point in time.41

Ascertainment of diabetes varied between the studies. Only the Whitehall II study administered a repeated oral glucose tolerance test, the gold standard. This enabled the study to detect both diagnosed and undiagnosed diabetes. The remaining studies, based on health records or self-reports, will have missed undiagnosed diabetes cases. In Whitehall II, the age and sex-adjusted odds ratio for the association between job insecurity and diabetes was 1.19; the same as the overall estimate for all the studies (1.19).

Conclusion

Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. These findings are most appropriately interpreted in a public health context in which small long-term effects on common disease outcomes can have high relevance. Ideally in such situations, policy responses should take a population-level approach to reducing exposure to job insecurity. Also, health care personnel should be aware of that workers reporting job insecurity may be at modest increased risk of diabetes.

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • Contributors: All of the authors contributed to the study concept and design and to the analysis and interpretation of data. Jane Ferrie and Marianna Virtanen undertook the literature search, and Markus Jokela searched the relevant open-access data sets. Markus Jokela and Ida Madsen performed the statistical analysis. Mika Kivimäki, TÖres Theorell, Reiner Rugulies and Nico Dragano obtained funding for the IPD-Work Consortium. Jane Ferrie, Marianna Virtanen and Mika Kivimäki drafted the manuscript. All of the authors revised the manuscript critically for important intellectual content, approved the final version to be published and agreed to be guarantors of the work.

  • Funding: The IPD-Work Consortium is supported by Nord-Forsk (grant no. 75021), the Nordic Programme on Health and Welfare; the EU New OSH ERA Research Programme (funded by the Finnish Work Environment Fund; the Swedish Research Council for Health, Working Life and Welfare; the German Social Accident Insurance; and the Danish National Research Centre for the Working Environment); the Academy of Finland (grant nos. 132944 and 258598); and the Bupa UK Foundation (grant no. 22094477). Mika Kivimäki is supported by the Medical Research Council (grant no. K013351) and the Economic and Social Research Council, UK. Funding bodies for the participating cohort studies are listed on their websites. The study sponsors had no role in the design of the study, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the article for publication.

  • Accepted August 2, 2016.

References

  1. ↵
    OECD workers in the global economy: Increasingly vulnerable? In: OECD employment outlook 2007. Paris: Organisation for Economic Co-operation and Development; 2007:105–55.
  2. ↵
    1. Moynihan R
    . Job insecurity contributes to poor health. BMJ 2012;345:e5183.
    OpenUrlFREE Full Text
  3. ↵
    1. Ferrie JE
    . Is job insecurity harmful to health? J R Soc Med 2001;94:71–6.
    OpenUrlPubMed
    1. Laszló KD,
    2. Pikhart H,
    3. Kopp MS,
    4. et al
    . Job insecurity and health: a study of 16 European countries. Soc Sci Med 2010;70:867–74.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Kim IH,
    2. Muntaner C,
    3. Vahid Shahidi F,
    4. et al
    . Welfare states, flexible employment, and health: a critical review. Health Policy 2012;104:99–127.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Ferrie JE,
    2. Shipley MJ,
    3. Marmot MG,
    4. et al
    . An uncertain future: the health effects of threats to employment security in white-collar men and women. Am J Public Health 1998;88:1030–6.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Virtanen M,
    2. Nyberg ST,
    3. Batty GD,
    4. et al
    .; IPD-Work Consortium. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ 2013; 347:f4746.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Danaei G,
    2. Finucane MM,
    3. Lu Y,
    4. et al
    .; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011;378:31–40.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Finucane MM,
    2. Stevens GA,
    3. Cowan MJ,
    4. et al
    .; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557–67.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Colditz GA,
    2. Willett WC,
    3. Rotnitzky A,
    4. et al
    . Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481–6.
    OpenUrlCrossRefPubMed
  10. ↵
    1. Chan JM,
    2. Rimm EB,
    3. Colditz GA,
    4. et al
    . Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961–9.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. House JS,
    2. Lantz PM,
    3. Herd P
    . Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). J Gerontol B Psychol Sci Soc Sci 2005;60:15–26.
    OpenUrlCrossRefPubMed
    1. Elliott J,
    2. Shepherd P
    . Cohort profile: 1970 British Birth Cohort (BCS70). Int J Epidemiol 2006;35:836–43.
    OpenUrlCrossRefPubMed
  12. ↵
    1. Coxon APM
    . Sample design issues in a panel survey: the case of the British Household Panel Study. Essex (UK): Institute for Social and Economic Research; 1991.
    1. Butterworth P,
    2. Crosier T
    . The validity of the SF-36 in an Australian National Household Survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities. BMC Public Health 2004;4:44.
    OpenUrlCrossRefPubMed
    1. Brim OF,
    2. Ryff CD
    . How healthy are we? A national study of well-being at mid-life. University of Chicago Press; Chicago: 2004.
  13. ↵
    1. Power C,
    2. Elliott J
    . Cohort profile: 1958 British Birth Cohort (National Child Development Study). Int J Epidemiol 2006;35: 34–41.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Sewell WH,
    2. Houser R
    . Education, occupation, and earnings: achievement in the early career. New York: Academic Press; 1975.
  15. ↵
    1. Hauser RM,
    2. Sewell WH
    . Birth order and educational attainment in full sibships. Am Educ Res J 1985;22:1–23.
    OpenUrlCrossRef
  16. ↵
    1. Kristensen TS,
    2. Hannerz H,
    3. Hogh A,
    4. et al
    . The Copenhagen Psychosocial Questionnaire — a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health 2005;31:438–49.
    OpenUrlCrossRefPubMed
    1. Pejtersen JH,
    2. Kristensen TS,
    3. Borg V,
    4. et al
    . The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health 2010;38:8–24.
    OpenUrlCrossRefPubMed
  17. ↵
    1. Feveile H,
    2. Olsen O,
    3. Burr H,
    4. et al
    . Danish Work Environment Cohort Study 2005: from idea to sampling design. Stat Transit 2007;8:441–58.
    OpenUrl
  18. ↵
    1. Kivimäki M,
    2. Lawlor DA,
    3. Davey Smith G,
    4. et al
    . Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease: the Finnish Public Sector study. Am J Public Health 2007;97:874–9.
    OpenUrlCrossRefPubMed
  19. ↵
    1. Korkeila K,
    2. Suominen S,
    3. Ahvenainen J,
    4. et al
    . Non-response and related factors in a nation-wide health survey. Eur J Epidemiol 2001;17:991–9.
    OpenUrlCrossRefPubMed
  20. ↵
    1. Nielsen M,
    2. Kristensen T,
    3. Smith-Hansen L
    . The Intervention Project on Absence and Well-being (IPAW): design and results from the baseline of a 5-year study. Work Stress 2002;16:191–206.
    OpenUrlCrossRef
  21. ↵
    1. Borritz M,
    2. Rugulies R,
    3. Bjorner JB,
    4. et al
    . Burnout among employees in human service work: design and baseline findings of the PUMA study. Scand J Public Health 2006;34:49–58.
    OpenUrlCrossRefPubMed
  22. ↵
    1. Väänänen A,
    2. Murray M,
    3. Koskinen A,
    4. et al
    . Engagement in cultural activities and cause-specific mortality: prospective cohort study. Prev Med 2009;49:142–7.
    OpenUrlCrossRefPubMed
    1. Marmot M,
    2. Brunner E
    . Cohort Profile: the Whitehall II study. Int J Epidemiol 2005;34:251–6.
    OpenUrlCrossRefPubMed
    1. Alfredsson L,
    2. Hammar N,
    3. Fransson E,
    4. et al
    . Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work, lipids and fibrinogen. Scand J Work Environ Health 2002;28:238–48.
    OpenUrlCrossRefPubMed
  23. ↵
    1. Peter R,
    2. Alfredsson L,
    3. Hammar N,
    4. et al
    . High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study. J Epidemiol Community Health 1998;52:540–7.
    OpenUrlAbstract
  24. ↵
    1. Kivimäki M,
    2. Virtanen M,
    3. Kawachi I,
    4. et al
    . Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. Lancet Diabetes Endocrinol 2015;3:27–34.
    OpenUrlCrossRefPubMed
  25. ↵
    1. Tabák AG,
    2. Jokela M,
    3. Akbaraly TN,
    4. et al
    . Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009;373:2215–21.
    OpenUrlCrossRefPubMed
  26. ↵
    1. Szumilas M
    . Explaining odds ratios. J Can Acad Child Adolesc Psychiatry 2010;19:227–9.
    OpenUrlCrossRefPubMed
  27. ↵
    1. Deeks JJ,
    2. Higgins JPT,
    3. Altman DG
    , editors. Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Oxford: Cochrane Collaboration; 2011. Available: www.handbook.cochrane.org (accessed 2016 Feb. 15).
  28. ↵
    1. Higgins JP,
    2. Thompson SG,
    3. Deeks JJ,
    4. et al
    . Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.
    OpenUrlFREE Full Text
  29. ↵
    1. Higgins JPT,
    2. Green S
    , editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Oxford: Cochrane Collaboration; 2011. Available: www.handbook.cochrane.org (accessed 2016 Feb. 15).
  30. ↵
    1. Baker M,
    2. Stabile M,
    3. Deri C
    . What do self-reported, objective, measures of health measure? NBER Working Paper 8419. Cambridge (MA): National Bureau of Economic Research; 2001.
  31. ↵
    1. Ashford SJ,
    2. Lee C,
    3. Bobko P
    . Content, causes and consequences of job insecurity: a theory based measure and substantive test. Acad Manage J 1989;32:803–29.
    OpenUrlAbstract/FREE Full Text
  32. ↵
    1. Hartley J,
    2. Jacobson D,
    3. Klandermans B,
    4. et al
    . Job insecurity: coping with jobs at risk. London (UK): Sage Publications; 1991.
  33. ↵
    1. Sverke M,
    2. Hellgren J,
    3. Näswall K
    . No security: a meta-analysis and review of job insecurity and its consequences. J Occup Health Psychol 2002;7:242–64.
    OpenUrlCrossRefPubMed
  34. ↵
    1. Heaney CA,
    2. Israel BA,
    3. House JS
    . Chronic job insecurity among automobile workers: effects on job satisfaction and health. Soc Sci Med 1994;38:1431–7.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (17-18)
CMAJ
Vol. 188, Issue 17-18
6 Dec 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Job insecurity and risk of diabetes: a meta-analysis of individual participant data
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Job insecurity and risk of diabetes: a meta-analysis of individual participant data
Jane E. Ferrie, Marianna Virtanen, Markus Jokela, Ida E.H. Madsen, Katriina Heikkilä, Lars Alfredsson, G. David Batty, Jakob B. Bjorner, Marianne Borritz, Hermann Burr, Nico Dragano, Marko Elovainio, Eleonor I. Fransson, Anders Knutsson, Markku Koskenvuo, Aki Koskinen, Anne Kouvonen, Meena Kumari, Martin L. Nielsen, Maria Nordin, Tuula Oksanen, Krista Pahkin, Jan H. Pejtersen, Jaana Pentti, Paula Salo, Martin J. Shipley, Sakari B. Suominen, Adam Tabák, Töres Theorell, Ari Väänänen, Jussi Vahtera, Peter J.M. Westerholm, Hugo Westerlund, Reiner Rugulies, Solja T. Nyberg, Mika Kivimäki
CMAJ Dec 2016, 188 (17-18) E447-E455; DOI: 10.1503/cmaj.150942

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Job insecurity and risk of diabetes: a meta-analysis of individual participant data
Jane E. Ferrie, Marianna Virtanen, Markus Jokela, Ida E.H. Madsen, Katriina Heikkilä, Lars Alfredsson, G. David Batty, Jakob B. Bjorner, Marianne Borritz, Hermann Burr, Nico Dragano, Marko Elovainio, Eleonor I. Fransson, Anders Knutsson, Markku Koskenvuo, Aki Koskinen, Anne Kouvonen, Meena Kumari, Martin L. Nielsen, Maria Nordin, Tuula Oksanen, Krista Pahkin, Jan H. Pejtersen, Jaana Pentti, Paula Salo, Martin J. Shipley, Sakari B. Suominen, Adam Tabák, Töres Theorell, Ari Väänänen, Jussi Vahtera, Peter J.M. Westerholm, Hugo Westerlund, Reiner Rugulies, Solja T. Nyberg, Mika Kivimäki
CMAJ Dec 2016, 188 (17-18) E447-E455; DOI: 10.1503/cmaj.150942
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Interpretation
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights
  • PubMed
  • Google Scholar

Cited By...

  • Social Determinants of Health and Diabetes: A Scientific Review
  • Prospective associations of psychosocial work exposures with mortality in France: STRESSJEM study protocol
  • Effect of Changing Work Stressors and Coping Resources on the Risk of Type 2 Diabetes: The OHSPIW Cohort Study
  • Google Scholar

More in this TOC Section

  • Statin initiation and risk of incident kidney disease in patients with diabetes
  • Acute care related to cannabis use during pregnancy after the legalization of nonmedical cannabis in Ontario
  • Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes
Show more Research

Similar Articles

Collections

  • Topics
    • Diabetes

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire