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Emotional demands at work and risk of long-term sickness Continuation........
(JEMPAD) cohort—a nationwide, register-based cohort with information on employment, psychosocial factors at work, health, labor market attachment, and socio-demographics.12 JEMPAD included all employed individuals (excluding self-employed individuals) who were residing in Denmark in 2000, aged 30–59 years, who had complete data on age, sex, and migration background. Individuals with long-term sickness absence (≥6 weeks of consecutive sickness absence) were excluded between Jan 1, 1998, and Dec 31, 2000. JEMPAD did not include individual-level data on working conditions. We ascertained data on emotional demands, influence, possibilities for development, role conflicts, and physical demands at work with job exposure matrices that we created in the Danish Work Environment Cohort Study (DWECS).13,14 Outcome and covariates were ascertained with individual-level register-based data. All variables were ascertained at baseline in 2000. The outcome was ascertained from Jan 1, 2001, to Dec 31, 2010. The study was approved by the Danish Data Protection Agency through the joint notification of the National Research Centre for the Working Environment (2015-57-0074).
All data are stored in a protected server environment hosted by Statistics Denmark. In Denmark, studies that are based on questionnaires and register data only do not require approval from the National Committee on Health Research Ethics. In DWECS, informed consent was provided by the participants when filling in the questionnaire. In JEMPAD, which was register-based, informed consent was not required. Procedures We measured emotional demands at work at baseline in 2000 in the JEMPAD cohort with a job-exposure matrix that we created in DWECS (appendix pp 2–5). DWECS is a survey on working conditions and health in a randomly selected sample of the workforce in Denmark from 1990 to 2010.13,14 Pooling data from the 2000 and 2005 waves of DWECS, we included the three items on emotional demands at work and constructed a scale by calculating the mean of the items (appendix pp 4–5). Using multilevel modeling, we constructed the job-exposure matrix based on the mean values of emotional demands at work as the predicted level of emotional demands for the given occupational group (coded according to DISCO-88, the Danish version of the International Standard Classification of Occupations [ISCO]-88 system),15 sex, age, and DWECS year (2000 or 2005). Using the year 2000-specific job-exposure matrix, we assigned the predicted level of emotional demands to all individuals in the JEMPAD study population at baseline in 2000, according to an occupational group, sex, and age. We categorized individuals into four exposure groups on the basis of the quartiles of the distribution of the exposure. We defined individuals in the highest quartile as exposed to high emotional demands and individuals in the three remaining quartiles as exposed to low emotional demands. More information on DWECS items, scale, and job-exposure matrix construction is provided in the appendix (pp 2–5). We measured influence, possibilities for development, and physical demands at work as effect modifiers in JEMPAD in 2000 with job-exposure matrices, based on information from DWECS and constructed using the same approach as was used for the job-exposure matrix on emotional demands. We constructed the job exposure matrix for role conflicts on the basis of one DWECS item that was dichotomized and then modeled as the predicted probability of role conflicts for the given occupational group, sex, age, and DWECS year.
For each variable, we dichotomized individuals as either no exposure or as adversely exposed, meaning exposed to low influence (lowest quartile), low possibilities for development (lowest quartile), high role conflicts (highest quartile), and high physical demands (highest quartile; appendix p 3). As measures for interaction on an additive scale16 were developed for risk factors rather than for preventive factors, we defined low values of the two preventive factors (influence and possibilities for development) as risk factors.17 Thus, the stratum with the lowest risk became the reference category when considering two factors jointly17—ie, low emotional demands combined with high influence, high possibilities for development, low role conflicts, or low physical demands, respectively (double-unexposed groups). By contrast, the double-exposed groups were high emotional demands combined with low influence, low possibilities for development, high role conflicts, or high physical demands, respectively.
To assess long-term sickness absence, we linked JEMPAD to the Danish Register for Evaluation of Marginalization,18 which includes weekly information on all social transfer payments in Denmark since 1991. We defined long-term sickness absence as 6 weeks or longer of consecutive sickness absence. We assessed long-term sickness absence during a 10-year period from Jan 1, 2001, to Dec 31, 2010. Potential confounders were measured in JEMPAD at baseline in 2000 and included sex, age, cohabitation, migration background, and income, retrieved from population-based registers,19,20 as these variables have shown associations with long-term sickness absence in previous studies.21–23 Cohabitation was measured as single versus married or cohabiting. For migration background, we used the classification of Statistics Denmark’s population register, distinguishing between Danish origin (the whole population except immigrants and descendants of immigrants), immigrants (born abroad and none of the parents were either Danish citizens or born in Denmark), and descendants of immigrants (born in Denmark and none of the parents were either Danish citizens or born in Denmark).
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