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Knutsson, Anders
Publications (10 of 130) Show all publications
du Prel, J.-B., Runeson-Broberg, R., Westerholm, P., Alfredsson, L., Fahlen, G., Knutsson, A., . . . Peter, R. (2018). Work overcommitment: Is it a trait or a state?. International Archives of Occupational and Environmental Health, 91(1), 1-11.
Open this publication in new window or tab >>Work overcommitment: Is it a trait or a state?
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 1, p. 1-11Article in journal (Refereed) Published
Abstract [en]

Effort-reward imbalance (ERI) is a well-tested work-related stress model with three components, the two extrinsic components "efforts" and "rewards" and the one intrinsic component "overcommitment". While an imbalance between "efforts" and "rewards" leads to strain reactions, "work-related overcommitment" (OC) has been described as a personal characteristic with a set of attitudes, behaviours, and emotions reflecting excessive striving combined with a strong desire for approval. However, the question whether OC is a personality trait or a response pattern sensitive to changes in the work context (state) is still open. 2940 Swedish industrial employees were included in this longitudinal analysis of the WOLF-Norrland data over 5 years. A change of OC index or its subscales were regressed against a change of freedom of choice at work, extra work, and ERI adjusted for age, sex, and education. While OC was insensitive to changes in freedom of choice at work and extra work, it was clearly associated with changes of work-related stress over time. Three of four OC subscales exhibited statistically significant associations with ERI. For the first time, we studied fundamental characteristics of OC as an independent personality variable (trait) or an outcome variable subject to changes in the work environment (state). The association between external ERI and OC over time supports our hypothesis of OC being a state. Further investigations are needed to establish OC as a trait or a state.

National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-32743 (URN)10.1007/s00420-017-1253-8 (DOI)000419350600001 ()28801694 (PubMedID)2-s2.0-85027327139 (Scopus ID)
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-02-22Bibliographically approved
Runeson-Broberg, R., du Prel, J.-B., Westerholm, P., Nordin, M., Knutsson, A., Alfredsson, L., . . . Peter, R. (2017). Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective. Work: A journal of Prevention, Assesment and rehabilitation, 57(2), 269-279.
Open this publication in new window or tab >>Age-related associations between work over-commitment and zest for work among Swedish employees from a cross-sectional and longitudinal perspective
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2017 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 57, no 2, p. 269-279Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In aging societies, zest for work may be pivotal when deciding to stay occupationally active longer. Psychosocial work stress is a prevalent public health problem and may have an impact on zest for work. Work over-commitment (WOC) is a personal coping strategy for work stress with excessive striving and a health risk. However, the long-term effect of WOC on zest for work is poorly understood. OBJECTIVE: To investigate the age-related associations of work over-commitment with zest for work. METHODS: During 1996-1998 and 2000-2003, predominantly industrial workers (n = 2940) participated in the WOLF-Norrland study and responded to a questionnaire referring to socio-demographics, WOC, zest for work, effort-reward imbalance proxies, and mental health. Age-adjusted multiple logistic regressions were performed with original and imputed datasets. RESULTS: Cross-sectionally, work overcommitted middle-aged employees had an increased prevalence of poor zest for work compared to their contemporaries without WOC (OR: 3.74 [95%-CI 2.19; 6.40]). However, in a longitudinal analysis associations between onset of 'poor zest for work' and the WOC subscales 'need for approval' (OR: 3.29 [95%-CI 1.04; 10.37]) and 'inability to withdraw from work' (OR: 5.14 [95%-CI 1.32; 20.03]) were observed. CONCLUSION: The longitudinal findings among older employees could be relevant regarding the expected need to remain occupationally active longer.

Keyword
Work stress, WOC, ERI, coping
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-31350 (URN)10.3233/WOR-172555 (DOI)000404774400013 ()28582947 (PubMedID)2-s2.0-85021818266 (Scopus ID)
Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2017-08-11Bibliographically approved
Kivimäki, M., Luukkonen, R., Batty, G. D., Ferrie, J. E., Pentti, J., Nyberg, S. T., . . . Jokela, M. (2017). Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals. Alzheimer's & Dementia.
Open this publication in new window or tab >>Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals
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2017 (English)In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279Article in journal (Refereed) Published
Abstract [en]

Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. 

Keyword
Bias, Body mass index, Cohort study, Dementia, Obesity
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-32715 (URN)10.1016/j.jalz.2017.09.016 (DOI)
Note

Available online 21 November 2017

Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2018-01-19Bibliographically approved
Dragano, N., Siegrist, J., Nyberg, S. T., Lunau, T., Fransson, E. I., Alfredsson, L., . . . Kivimäki, M. (2017). Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals. Epidemiology, 28(4), 619-626.
Open this publication in new window or tab >>Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals
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2017 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

Methods: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-31343 (URN)10.1097/EDE.0000000000000666 (DOI)000402541400028 ()28570388 (PubMedID)
Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2017-08-08Bibliographically approved
Madsen, I. E., Nyberg, S. T., Magnusson Hanson, L. L., Ferrie, J. E., Ahola, K., Alfredsson, L., . . . Kivimäki, M. (2017). Job strain as a risk factor for clinical depression: Systematic review and meta-analysis with additional individual participant data. Psychological Medicine, 47(8), 1342-1356.
Open this publication in new window or tab >>Job strain as a risk factor for clinical depression: Systematic review and meta-analysis with additional individual participant data
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2017 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 8, p. 1342-1356Article in journal (Refereed) Published
Abstract [en]

Background Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Method We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. Results We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). Conclusions Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

Keyword
Observational studies, occupational health, work stress
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-31133 (URN)10.1017/S003329171600355X (DOI)000401293800002 ()28122650 (PubMedID)2-s2.0-85010872142 (Scopus ID)
Available from: 2017-07-03 Created: 2017-07-03 Last updated: 2017-11-29Bibliographically approved
Kivimäki, M., Nyberg, S. T., Batty, G. D., Kawachi, I., Jokela, M., Alfredsson, L., . . . Tabak, A. G. (2017). Long working hours as a risk factor for atrial fibrillation: a multi-cohort study. European Heart Journal, 38(34), 2621-2628.
Open this publication in new window or tab >>Long working hours as a risk factor for atrial fibrillation: a multi-cohort study
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2017 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed) Published
Abstract [en]

Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week.

Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association.

Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

Keyword
Atrial fibrillation, Life stress, Risk factors, Cohort study
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-31874 (URN)10.1093/eurheartj/ehx324 (DOI)000409542800012 ()28911189 (PubMedID)2-s2.0-85029764375 (Scopus ID)
Available from: 2017-10-17 Created: 2017-10-17 Last updated: 2017-12-04Bibliographically approved
Yang, F., Pedersen, N. L., Ye, W., Liu, Z., Norberg, M., Forsgren, L., . . . Wirdefeldt, K. (2017). Moist smokeless tobacco (Snus) use and risk of Parkinson's disease. International Journal of Epidemiology, 46(3), 872-880, Article ID dyw294.
Open this publication in new window or tab >>Moist smokeless tobacco (Snus) use and risk of Parkinson's disease
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2017 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 3, p. 872-880, article id dyw294Article in journal (Refereed) Published
Abstract [en]

Background: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease. Methods: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking. Results: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83). Conclusions: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

Keyword
Parkinson's disease, individual participant data, risk factors, epidemiology, nicotine
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-31833 (URN)10.1093/ije/dyw294 (DOI)000406242600021 ()2-s2.0-85027731926 (Scopus ID)
Available from: 2017-10-12 Created: 2017-10-12 Last updated: 2017-11-29Bibliographically approved
Knutsson, A. (2017). Mortality of shift workers. Scandinavian Journal of Work, Environment and Health, 43(2), 97-98.
Open this publication in new window or tab >>Mortality of shift workers
2017 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 2, p. 97-98Article in journal, Editorial material (Refereed) Published
Keyword
Circadian rhythm, Editorial, Incidence, Mortality, Night work, Shift work, Shift worker
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-30648 (URN)10.5271/sjweh.3622 (DOI)000395849200001 ()28121335 (PubMedID)2-s2.0-85014695510 (Scopus ID)
Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2017-11-29Bibliographically approved
Kivimäki, M., Kuosma, E., Ferrie, J. E., Luukkonen, R., Nyberg, S. T., Alfredsson, L., . . . Jokela, M. (2017). Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. The Lancet Public Health, 2(6), e277-e285.
Open this publication in new window or tab >>Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe
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2017 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 2, no 6, p. e277-e285Article in journal (Refereed) Published
Abstract [en]

Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (<20 kg/m2) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Findings Participants were 120 813 adults (mean age 51·4 years, range 35–103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease. Interpretation The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes. Funding NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-30996 (URN)10.1016/S2468-2667(17)30074-9 (DOI)2-s2.0-85019950348 (Scopus ID)
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2017-11-29Bibliographically approved
Araghi, M., Galanti, M. R., Lundberg, M., Liu, Z., Ye, W., Lager, A., . . . Magnusson, C. (2017). Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts. Scandinavian Journal of Public Health, 45(8), 741-748.
Open this publication in new window or tab >>Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts
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2017 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 741-748Article in journal (Refereed) Published
Abstract [en]

Aims: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association. Methods: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis. Conclusions: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention. 

Keyword
Colorectal cancer, incidence, survival, snus
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-32719 (URN)10.1177/1403494817714191 (DOI)000418185200002 ()28994648 (PubMedID)2-s2.0-85038388344 (Scopus ID)
Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2018-01-25Bibliographically approved
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