Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study

Autoři: Kuan-Yu Pan aff001;  Weili Xu aff001;  Francesca Mangialasche aff001;  Rui Wang aff001;  Serhiy Dekhtyar aff001;  Amaia Calderón-Larrañaga aff001;  Laura Fratiglioni aff001;  Hui-Xin Wang aff001
Působiště autorů: Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden aff001;  Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden aff002;  Stockholm Gerontology Research Center, Stockholm, Sweden aff003;  Stress Research Institute, Stockholm University, Stockholm, Sweden aff004
Vyšlo v časopise: Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study. PLoS Med 16(9): e32767. doi:10.1371/journal.pmed.1002899
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002899



Unfavorable psychosocial working conditions have been associated with cognitive decline and chronic diseases, both of which may subsequently accelerate functional dependence. This study aimed to investigate the association between job demand–control–support combinations and trajectories of disability in later life and to further explore the role of cognitive decline and the co-occurrence of chronic diseases in mediating this association.

Methods and findings

In this cohort study, 2,937 community dwellers aged 60+ years (mean age 73 ± 10.6; 62.9% female) residing in the Kungsholmen District of Stockholm, Sweden, participated in the baseline survey (2001–2004) and were followed up to 12 years. Lifelong occupational history was obtained through a standardized interview; job demands, job control, and social support at work in the longest-held occupation were graded with a psychosocial job–exposure matrix. Job control, demands, and social support were dichotomized using the median values from the matrix, respectively, to further generate demand–control–support combinations. Disability was measured by summing the number of impaired basic and instrumental activities of daily living. Global cognitive function was assessed by Mini-Mental State Examination. Chronic conditions were ascertained by clinical examinations, medical history, and patient clinical records; the total number of chronic diseases was summed. Data were analyzed using linear mixed-effects models and mediation analysis. Age, sex, education, alcohol consumption, smoking, leisure activity engagement, early-life socioeconomic status, occupational characteristic and physical demands, and baseline cognitive function and number of chronic diseases were adjusted for in the analyses. Compared with active jobs (high control/high demands; n = 1,807), high strain (low control/high demands; n = 328), low strain (high control/low demands; n = 495), and passive jobs (low control/low demands; n = 307) were all associated with a faster rate of disability progression (β = 0.07, 95% CI 0.02–0.13, p = 0.01; β = 0.10, 95% CI 0.06–0.15, p < 0.001; β = 0.11, 95% CI 0.05–0.18, p < 0.001). The association between high strain and disability progression was only shown in people with low social support at work (β = 0.13, 95% CI 0.07–0.19, p < 0.001), but not in those with high social support (β = 0.004, 95% CI −0.09 to 0.10, p = 0.93). Moreover, we estimated that the association between demand–control status and disability trajectories was mediated 38.5% by cognitive decline and 18.4% by accumulation of chronic diseases during the follow-up period. The limitations of this study include unmeasured confounding, self-reported work experience, and the reliance on a psychosocial job–exposure matrix that does not consider variabilities in individuals’ perception on working conditions or job characteristics within occupations.


Our findings suggest that negative psychosocial working conditions during working life may accelerate disability progression in later life. Notably, social support at work may buffer the detrimental effect of high strain on disability progression. Cognitive decline and chronic-disease accumulation, and especially the former, partially mediate the association of psychosocial working conditions with trajectories of disability. Further studies are required to explore more mechanisms that underlie the association between psychosocial working conditions and disability trajectories.

Klíčová slova:

Social sciences – Economics – Labor economics – Employment – Jobs – Medicine and health sciences – Public and occupational health – Disabilities – Socioeconomic aspects of health – Health care – Quality of life – Activities of daily living – Psychological and psychosocial issues – Neurology – Cognitive neurology – Cognitive impairment – Alcohol consumption – Biology and life sciences – Neuroscience – Cognitive science – Cognitive neuroscience – Nutrition – Diet – People and places – Population groupings – Professions


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