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Workplace social capital and risk of chronic and severe hypertension: a cohort study

Oksanen, Tuulaa,b; Kawachi, Ichirob; Jokela, Markusa,c; Kouvonen, Anned; Suzuki, Etsujie; Takao, Soshie; Virtanen, Mariannaa; Pentti, Jaanaa; Vahtera, Jussia,f; Kivimäki, Mikaa,c,g

doi: 10.1097/HJH.0b013e32835377ed

Objective: The association between workplace factors and the development of hypertension remains uncertain. We examined the risk of hypertension as a function of workplace social capital, that is, social cohesion, trust and reciprocity in the workplace.

Methods: A total of 11 777 male and 49 145 female employees free of chronic hypertension at baseline in 2000–2004 were followed up for incident hypertension until the end of 2005 (the Finnish Public Sector Study). We used survey responses from the participants and their coworkers in the same work unit to assess workplace social capital at baseline. Follow-up for incident hypertension was based on record linkage to national health registers (mean follow-up 3.5 years, 1424 incident hypertension cases).

Results: Male employees in work units characterized by low workplace social capital were 40–60% more likely to develop chronic hypertension compared to men in work units with high social capital [age-adjusted hazard ratio 1.57, 95% confidence interval (CI) 1.15–2.14 for self-assessed social capital and 1.41, 95% CI 1.01–1.97 for coworkers’ assessment]. According to path analysis adjusted for covariates, the association between low self-reported social capital and hypertension was partially mediated by obesity (P for pathway = 0.02) and alcohol consumption (P = 0.03). For coworker-assessed social capital, the corresponding mediation pathways did not reach statistical significance (P = 0.055 and 0.22, respectively). No association between workplace social capital and hypertension was found for women.

Conclusion: These data suggest that low self-reported workplace social capital is associated with increased near-term risk of hypertension in men in part due to unhealthy lifestyle.

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aCentre of Expertise for Work Organizations, Finnish Institute of Occupational Health, Helsinki, Finland

bDepartment of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA

cDepartment of Psychology, Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland

dWarsaw School of Social Sciences and Humanities, Wroclaw Faculty, Wroclaw, Poland

eDepartment of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

fDepartment of Public Health, University of Turku and Turku University Hospital, Turku, Finland

gDepartment of Epidemiology and Public Health, University College London Medical School, London, UK

Correspondence to Tuula Oksanen, MD, PhD, Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18B, FI-20520 Turku, Finland. Tel: +358 30 4747 544; fax: +358 30 4747 556; e-mail:

Abbreviations: ATC, Anatomical Therapeutic Chemical classification; CI, confidence interval; HPA, hypothalamus-pituitary-axis; HR, hazard ratio; ICD-10, International Classification of Diseases, 10th Revision; MET, metabolic equivalent task; SE, standard error; SES, socioeconomic status; SII, the Social Insurance Institution of Finland

Received 7 September, 2011

Revised 7 February, 2012

Accepted 8 March, 2012

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© 2012 Lippincott Williams & Wilkins, Inc.