Social position appears to affect the risk of developing diabetes in middle-age, white-collar workers.
Psychosocial factors such as job strain, low social support and depression are recognized risk factors for coronary heart disease, Dr. Meena Kumari and colleagues at University College London note in their report. The interrelationship of these factors and the risk of diabetes are not well established, however.
Between 1985 and 1988, a total of 5,950 male and 2,680 female civil servants, ages 35 to 55 years, were recruited.
During the average follow-up of 10.5 years, four percent of the subjects were diagnosed with diabetes. The risk was associated with civil service employment grade; nine percent of the men and seven percent of the women in clerical and office support grades developed diabetes, compared with three percent of men and two percent of women in administrative grades.
Among the men, but not the women, the relationship between diabetes and employment grade remained significant even after accounting for other potential risk factors, such as ethnicity, family history, weight, physical activity and blood pressure, Kumari’s group found. The differences according to gender may be due to smaller numbers of women, the researchers add.
The risk among men was also increased by a higher "effort-reward imbalance," where high efforts were defined as competitiveness and work-related overcommitment or hostility, and low rewards were defined as poor promotion prospects or a blocked career.
The relationship between effort-reward imbalance was "robust" even after additional cardiovascular risk factors were considered, making it unlikely that it was influenced by changes in behaviors, such as diet or exercise, the investigators add.
Archives of Internal Medicine, September 27, 2004.