• Marianna Virtanen, Solja T Nyberg, G David Batty, Markus Jokela, Katriina Heikkilä, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Marko Elovainio, Raimund Erbel, Jane E Ferrie, Mark Hamer, Karl-Heinz Jöckel, France Kittel, Anders Knutsson, Markku Koskenvuo, Aki Koskinen, Thorsten Lunau, Ida E H Madsen, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Krista Pahkin, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Martin J Shipley, Johannes Siegrist, Andrew Steptoe, Sakari B Suominen, Töres Theorell, Salla Toppinen-Tanner, Ari Väänänen, Jussi Vahtera, Peter J M Westerholm, Hugo Westerlund, Natalie Slopen, Ichiro Kawachi, Archana Singh-Manoux, Mika Kivimäki, and IPD-Work Consortium.
• Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland. marianna.virtanen@ttl.fi
• BMJ. 2013 Jan 1;347:f4746.

ObjectiveTo determine the association between self reported job insecurity and incident coronary heart disease.DesignA meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review.Data SourcesWe obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches.Review MethodsProspective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models.ResultsThe literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174,438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v ≥ 50 years), national unemployment rate, welfare regime, or job insecurity measure.ConclusionsThe modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.

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