1. Perception of high job insecurity was more likely to be associated with developing adult-onset asthma.
2. Adjustment for unhealthy habits did not change the positive correlation between asthma incidence and job insecurity.
Evidence Rating Level: 2 (Good)
Study Rundown: It is well-established that excessive psychological stressors can increase the incidence of many diseases, including asthma. In particular, high job insecurity has been associated with a higher incidence of neurological, psychiatric, and cardiac conditions. While work related stress has been associated with greater asthma incidence, it has yet to be studied whether job insecurity increases asthma risk. In this prospective study of a sample of the German population, the authors found increasing asthma risk with increasing self-reported job insecurity. Though unhealthy habits were associated with high job insecurity, accounting for these confounding variables did not change the positive correlation between asthma risk and job insecurity. It did, however, lower the overall significance of the effect.
While the study findings were well-focused, there are many limitations to be considered. First, job insecurity was measured based on patient perception, suggesting a potential confounder of negative emotional states on asthma risk. Further, relative risk measurements showed high variability, making the effect size difficult to interpret. Finally, models that included potential confounders, such as age, sex, education, income level, smoking status, and alcohol consumption, were barely statistically significant. Despite these limitations this study supports literature associating job insecurity to poor health outcomes and is the first to link job insecurity to asthma.
In-Depth [prospective cohort]: Participants were chosen from the German Socio-Economic Panel (GSOEP), a study that has been collecting information from face-to-face interviews since 1984. This study analyzed data from 2009 and 2011, the only years asthma information was collected, from 7031 participants who were free of asthma in 2009. Job insecurity levels were self-reported using 10% increments from 0% (no job insecurity) to 100% (highest job insecurity), and patients were grouped into no job insecurity (0%), low job insecurity (10-50%), and high job insecurity (60-100%) subpopulations. For every 1 standard deviation increase in job insecurity, the risk of asthma increased 24% (risk ratio 1.24, CI95% 1.05-1.46). However, the significance of this finding was of borderline significance (p~0.05) when adjusted for either 1) age and sex, 2) marital status, education, income, asthma high-risk profession, contact-type, and overweight obesity, or 3) smoking, alcohol consumption, physical exercise, and overweight/obesity.
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