Journal
OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Volume 70, Issue 9, Pages 663-669Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/oemed-2012-101331
Keywords
socioeconomic position; work characteristics; job strain; effort-reward imbalance
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Funding
- European Commission [HEALTH-F3-2011-278350 (DRIVERS)]
- Faculty of Medicine, Heinrich Heine University of Duesseldorf
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Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.
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