Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study

Tianwei Xu; Linda L. Magnusson Hanson; Theis Lange; Liis Starkopf; Hugo Westerlund; Ida Elisabeth Huitfeldt Madsen; Reiner Ernst Rugulies; Jaana Pentti; Sari Stenholm; Jussi Vahtera; Åse Marie Hansen; Marianna Virtanen; Mika Kivimäki; Naja Hulvej Rod

doi:10.1093/eurheartj/ehy683

Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study

Tianwei Xu, Linda L. Magnusson Hanson, Theis Lange, Liis Starkopf, Hugo Westerlund, Ida Elisabeth Huitfeldt Madsen, Reiner Ernst Rugulies, Jaana Pentti, Sari Stenholm, Jussi Vahtera, Åse Marie Hansen, Marianna Virtanen, Mika Kivimäki, Naja Hulvej Rod

13 Citations (Scopus)

Abstract

Aims: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). Methods and results: Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (P _trend < 0.001). There was only negligible heterogeneity in study-specific estimates. Conclusion: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.

Original language	English
Journal	European Heart Journal
Volume	40
Issue number	14
Pages (from-to)	1124-1134
Number of pages	11
ISSN	1522-9645
DOIs	https://doi.org/10.1093/eurheartj/ehy683
Publication status	Published - 7 Apr 2019

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Xu, T., Magnusson Hanson, L. L., Lange, T., Starkopf, L., Westerlund, H., Madsen, I. E. H., Rugulies, R. E., Pentti, J., Stenholm, S., Vahtera, J., Hansen, Å. M., Virtanen, M., Kivimäki, M., & Rod, N. H. (2019). Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. European Heart Journal, 40(14), 1124-1134. https://doi.org/10.1093/eurheartj/ehy683

Xu, T, Magnusson Hanson, LL, Lange, T, Starkopf, L, Westerlund, H, Madsen, IEH, Rugulies, RE, Pentti, J, Stenholm, S, Vahtera, J, Hansen, ÅM, Virtanen, M, Kivimäki, M & Rod, NH 2019, 'Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study', European Heart Journal, vol. 40, no. 14, pp. 1124-1134. https://doi.org/10.1093/eurheartj/ehy683

@article{0e38819c91604d988a77e3c513a9754e,

title = "Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study",

abstract = " Aims: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). Methods and results: Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (P trend < 0.001). There was only negligible heterogeneity in study-specific estimates. Conclusion: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD. ",

author = "Tianwei Xu and {Magnusson Hanson}, {Linda L.} and Theis Lange and Liis Starkopf and Hugo Westerlund and Madsen, {Ida Elisabeth Huitfeldt} and Rugulies, {Reiner Ernst} and Jaana Pentti and Sari Stenholm and Jussi Vahtera and Hansen, {{\AA}se Marie} and Marianna Virtanen and Mika Kivim{\"a}ki and Rod, {Naja Hulvej}",

year = "2019",

month = apr,

day = "7",

doi = "10.1093/eurheartj/ehy683",

language = "English",

volume = "40",

pages = "1124--1134",

journal = "European Heart Journal",

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publisher = "Oxford University Press",

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TY - JOUR

T1 - Workplace bullying and workplace violence as risk factors for cardiovascular disease

T2 - a multi-cohort study

AU - Xu, Tianwei

AU - Magnusson Hanson, Linda L.

AU - Lange, Theis

AU - Starkopf, Liis

AU - Westerlund, Hugo

AU - Madsen, Ida Elisabeth Huitfeldt

AU - Rugulies, Reiner Ernst

AU - Pentti, Jaana

AU - Stenholm, Sari

AU - Vahtera, Jussi

AU - Hansen, Åse Marie

AU - Virtanen, Marianna

AU - Kivimäki, Mika

AU - Rod, Naja Hulvej

PY - 2019/4/7

Y1 - 2019/4/7

N2 - Aims: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). Methods and results: Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (P trend < 0.001). There was only negligible heterogeneity in study-specific estimates. Conclusion: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.

AB - Aims: To assess the associations between bullying and violence at work and cardiovascular disease (CVD). Methods and results: Participants were 79 201 working men and women, aged 18-65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28-1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12-1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose-response relations were observed for both workplace bullying and violence (P trend < 0.001). There was only negligible heterogeneity in study-specific estimates. Conclusion: Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.

U2 - 10.1093/eurheartj/ehy683

DO - 10.1093/eurheartj/ehy683

M3 - Journal article

C2 - 30452614

SN - 0195-668X

VL - 40

SP - 1124

EP - 1134

JO - European Heart Journal

JF - European Heart Journal

IS - 14

ER -

Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study

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