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Is Incomplete Recovery From Work a Risk Marker of Cardiovascular Death? Prospective Evidence From Industrial Employees

From the Finnish Institute of Occupational Health, Helsinki, Finland (M.K., P.L.-A., L.K.-K., R.L., J.V., M.H.); the University of Helsinki, Helsinki, Finland (M.K., M.E.); University of Jyväskylä, Jyväskylä, Finland (J.K.).

Address correspondence and reprint requests to Prof. Mika Kivimäki, the Department of Psychology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FI-00250 Helsinki, Finland. E-mail: mika.kivimaki{at}ttl.fi

Objective: A chronic lack of recovery from work during leisure time is hypothesized to indicate a health risk among employees. We examined whether incomplete recovery from work predicted cardiovascular mortality.

Methods: This prospective cohort study involved 788 industrial employees (534 men, 254 women, mean age 37.3, SD = 12.0) who were initially free from cardiovascular diseases. The baseline examination in 1973 determined cases of cardiovascular disease, cardiovascular risk factors, and the extent of recovery from work. Data on mortality in 1973 to 2000 were derived from the national mortality register.

Results: Sixty-seven cardiovascular deaths and 102 deaths from noncardiovascular causes occurred during the mean follow-up of 25.6 years. Employees who seldom recovered from work during free weekends had an elevated risk of cardiovascular death (p = .007) but not of other mortality (p = .82). The association between incomplete recovery and cardiovascular death remained after adjustment for age, sex, and 16 conventional risk factors, including occupational background, cholesterol, systolic pressure, body mass index, smoking, alcohol consumption, physical inactivity, depressive symptoms, fatigue, lack of energy, and job stress. The association was not explained by deaths that occurred close to the assessment of recovery from work.

Conclusions: This study suggests that incomplete recovery from work is an aspect of the overall risk profile of cardiovascular disease mortality among employees.

Key Words: cardiovascular • mortality • psychosocial factors • risk factors

Abbreviations: BMI = body mass index; CHD = coronary heart disease; CI = confidence interval; ICD = International Classification of Diseases.

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