Job dissatisfaction as a possible risk factor in coronary heart disease.

IN RECENT years, various investigations have attempted to elucidate the relationship between social status and risk of death due to coronary heart disease. In general, the data presented in these studies have shown no consistent pattern. In some investigations [l-6] a positive relationship has been reported between status and coronary disease. In other studies [7-lo] a negative relationship has been noted between these variables. In still other investigations a curvilinear relationship-either U-shaped [ll-131 or inverted-U-shaped [14]-has been observed. In further studies [15-171 a lack of any appreciable relationship has been reported. This variety of results has surely contributed to the general impression held by writers of review articles [18-191 that social status and coronary disease are essentially unrelated in the population at large. The present authors, like many others, believe that the social environment can exert an important influence upon an individual’s risk of coronary disease. However, we do not feel that social status per se plays this role. Rather, we believe that social factors which may be associated with status exert such influence. In an earlier paper [20], the senior author suggested that particular forms of social stress may contribute to heightened risk of coronary disease. In the present report, we shall attempt to demonstrate that an individual’s dissatisfaction with his job has similar etiologic implications. We shall describe here three separate investigations designed to test this general hypothesis. Each of these studies involves a different set of subjects and slightly different methods; however, the general procedure is similar from study to study. In each investigation, we select various occupational groups for whom (a) mortality ratios due to coronary heart disease and (b) average levels of job satisfaction are known. We then relate these two variables to each other. The design of these studies