Association between effort-reward imbalance and self-reported diabetes mellitus in older US workers

Objective: Studies assessing the effects of work stress on health in older adults in the U.S. labor force are scarce. We examined the longitudinal association between work stress as measured by effort-reward imbalance (ERI) and incident diabetes over a 7-year period in U.S. working adults aged 50 years and older. Methods: We used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n = 1932). Cox proportional hazard regression was used to examine whether ERI significantly predicted diabetes incidence in older adults who were diabetes-free at baseline. Results: High stress level at work (ERI ratio > 1.0) was found in participants who worked 55 h or more a week (37.3%), had no insurance coverage (35.9%), and those working in blue collar jobs (34.4%). Participants with high ERI had a significantly higher risk of diabetes (HR = 1.33, 95%CI = 1.04-1.69) relative to those with low ERI, after adjustment for known predictors of adult-onset diabetes. Conclusion: Effort-reward imbalance was associated with increased risk of diabetes incidence after controlling for other known predictive factors, which suggests an independent non-mediated effect of work stressors. More research is required to better understand the effects of work stress in aging populations and how psychosocial disequilibrium in the work environment may impact susceptibility to chronic conditions, and in particular how change in self-assessed reward might vary toward the end of a working lifetime.