When does work stress hurt? Testing the interaction with socioeconomic position in the Heinz Nixdorf Recall Study.

Study Objective: To study systematically the separate and combined effects of work stress and socioeconomic position on three measures of health in an unselected working population.

Design: Two exposures (high demand/low control ("job strain"); effort-reward imbalance at work) are related to angina pectoris, depression, and poor self-rated health in a cross-sectional study design in which socioeconomic position was measured by occupational position and educational level.

Setting: Baseline data of a prospective population-based cohort study in Germany, collected between 2000 and 2003.

Participants: 1749 employed or self-employed men and women (36.3% of total sample) aged 45-65 years.

Main Results: Effort-reward imbalance and job strain were associated with elevated odds ratios of all three health measures, using logistic regression analysis. The prevalence of poorer health was always highest in subgroups defined by high work stress and low socioeconomic position, with respective odds ratios ranging from 2.30 to 2.98 (95% CI 1.38 to 4.52) for self-rated health, 1.70 to 2.24 (95% CI 1.04 to 3.88) for angina and 2.61 to 8.20 (95% CI 1.53 to 14.15) for depression.

Conclusion: Although stress at work was related to poorer health in the total study group, the strongest associations were consistently observed in men and women with low educational level or low occupational position. Worksite health promotion should be directed primarily towards these target groups.