Job insecurity is associated with psychological distress, adverse 
physical symptoms, and poor self-rated health. But, whether job 
insecurity is associated with coronary heart disease (CHD) is unclear. 
Researchers analyzed data from 174,000 working adults who were 
participating in 17 prospective studies in the U.S. and Europe. 
Participants were free of CHD at baseline. Job insecurity was assessed 
using a global question regarding level of insecurity in the current 
job or with questions regarding fear of layoff or unemployment; 
answers were dichotomized as high versus low job insecurity. Incident 
CHD was ascertained from hospital records or death registries.

During mean follow-up of nearly 10 years, 1900 incident CHD-related 
events (e.g., myocardial infarction, coronary death) occurred. 
Adjusted for multiple variables (i.e., age, sex, socioeconomic status, 
smoking, alcohol use, physical activity, and CHD risk factors), high 
job insecurity was associated with significant 20% higher risk for CHD 
compared with low job insecurity.

COMMENT

In this meta-analysis, high self-reported job insecurity was 
associated with excess risk for incident CHD. However, the study has 
important limitations. First, as the authors note, job insecurity 
measured at a single point does not distinguish short-term from long-
term job insecurity, which might have different health effects. 
Second, the findings do not prove causality; residual confounders 
(e.g., psychiatric disorders) might account for some of the association.

Virtanen M et al. Perceived job insecurity as a risk factor for 
incident coronary heart disease: Systematic review and meta-analysis. 
BMJ 2013 Aug 8; 347:f4746. (http://dx.doi.org/10.1136/bmj.f4746) 
Abstract/FREE Full Text

Paul S. Mueller, MD, MPH, FACP reviewing Virtanen M et al. BMJ 2013 
Aug 8.