Social Inequalities, Work, and Chronic Disease: Pathways Linking Sociological with Biomedical Research
Main Article Content
Abstract
An important contribution of new knowledge linking sociology with medicine concerns the development of chronic diseases within societies. For a majority of chronic diseases, a social gradient of their distribution has been documented, leaving population groups with lower socioeconomic position at higher risk. While explanations of indirect effects of these social inequalities point to factors such as unhealthy behaviours and delayed or lacking medical care, direct effects explore the pathways from exposure to disadvantageous social conditions to chronic disease development via enhanced stress-related neuronal, neuroendocrine and immune processes. This contribution discusses current evidence on these pathways, based on epidemiologic and naturalistic, quasi-experimental study designs. A robust base of knowledge demonstrates associations of adverse stress-related work and employment conditions with elevated risks of two highly prevalent chronic disorders, ischaemic heart disease and depression. These conditions are more prevalent among lower socioeconomic groups, and they can contribute to the explanation of the social gradient. Importantly, findings point to new preventive strategies, targeting disadvantageous socio-environmental contexts and vulnerable population groups.
Keywords:
Health inequalities, ischaemic heart disease, depression, psychosocial work environment, demand-control model, effort-reward imbalance model
Article Details
How to Cite
SIEGRIST, Johannes.
Social Inequalities, Work, and Chronic Disease: Pathways Linking Sociological with Biomedical Research.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6808>. Date accessed: 14 nov. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6808.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Engel GL The need for a new medical model: a challenge for biomedicine. Science. 1977; 196: 129-136.
2. Weiner H. Perturbing the organism: The biology of stressful experience. 1992. Chicago: University of Chicago Press.
3. Cassel JC, Tyroler HA. Epidemiological studies of social change: health status and recency of industrialization. Arch Environ Health. 1961; 3: 25-33.
4. Henry JP, Cassel JC. Psychosocial factors in essential hypertension: recent epidemiological and animal experimental evidence. Am J Epidemiol. 1969: 171-200.
5. Syme SL, Hyman MM, Enterline PE. Some social and cultural factors associated with the occurrence of coronary heart disease. J Chron Disease. 1964; 17: 277-289.
6. Antonovsky, A. Social class, life expectancy and overall mortality. The Milbank Memorial Fund Quarterly. 1967; 45(2): 31-73.
7. Mackenbach JP. Health inequalities. 2019. Oxford: Oxford University Press.
8. Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology. 1973. Cambridge, Mass.: Harvard University Press.
9. Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemio Community Health. 1978; 32(4): 244-249.
10. Lampert T, Hoebel J, Kroll LE. Soziale Unterschiede in der Mortalität und Lebenserwartung in Deutschland- Aktuelle Situation und Trends (Social inqulities in mortality and life expectancy in Germany- actual situation and trends). J Health Monitor. 2019; 4(1): 3-11.
11. Marmot MG. Fair society, healthy lives: strategic review of health inequalities in England post 2010. The Marmot Review 2010. London: Institute of Health Equity.
12. Deary IJ, Johnson W, Houlihan LM. Genetic foundations of human intelligence. Human
1. Genetics. 2009; 126(1): 215-232.
13. IHME-CHAIN collaborators. Effects of education on adult mortality: a global systematic review and meta-analysis. Lancet Public Health. 2024; 9(3): e155-e165.
14. Devaux M, De Looper M. Income-related inequalities in health service utilisation in 19 OECD countries. 2012. Paris: OECD Publishing.
15. Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, Cota G, Martikainen P, Borrell C, Deboosere P, Kalediene P, Rychtarikova J, Artnik B, Mackenbach JP. Educational inequalities in avoidable mortality in Europe. J Epidemiol Community Health. 2010; 64(10): 913-920.
16. Aldabe B, Anderson R, Lyly-Yrjännäinen M, Parent-Thirion A, Vermeylen G, Kelleher CC, Niedhammer I. Contribution of material, occupational and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. J Epidemiol Community Health. 2010; 65(12):1123-1131.
17. Bartley M. Health inequality (2nd ed.). 2017. Cambridge: Polity Press.
18. Pillas D, Marmot M, Naicker K, Goldblatt P, Morrison J, Pikhart H. Social inequalities in early childhood health and development: a European-wide systematic review. Pediatric Res. 2014; 76(5): 418.
19. Kuh D, Ben-Shlomo Y (eds.) A life course approach to chronic disease epidemiology. (2nd ed.). 2004. Oxford: Oxford University Press.
20. Galama TJ, Lleras-Muney A, Van Kippersluis H. The effect of education on health and mortality: A review of experimental and quasi-experimental evidence. 2018; Cambridge. Mass. National Bureau of Economic Research.
21. Stringhini S, Dugravot A, Shipley M, Goldberg M, Zins M, Kivimäki M, Marmot M, Sabia S, Singh-Manoux A. Health behaviours, socioeconomic status, and mortality: Further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Medicine. 2011; 8(2):e1000419.
22. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality. Perspect Psychol Sci. 2015; 10(2): 227-237.
23. Montano D. Social distribution of occupational hazards. In: Theorell T (ed.) Handbook of socioeconomic determinants of occupational health. 2020; 169- 189. Cham: Springer Nature.
24. Hoven H, Siegrist J. Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies. Occup Environ Med. 2013; 70(9): 663-669.
25. Merton RK. Social theory and social structure. 1968. Glencoe, ILL: Free Press.
26. McEwen CA, McEwen BS. Social structure, adversity, toxic stress and intergenerational poverty: An early childhood model. Ann Rev Sociol. 2015; 43: 445-472.
27. Power C, Kuh D. Life course development of unequal health. In: Siegrist J, Marmot M (eds.) Social inequalities in health. 2006; 27-53. Oxford: Oxford University Press.
28. Lapierre LM, Cooper C (eds.). The Cambridge Companion to Organizational Stress and Well-Being. 2023; Cambridge: Cambridge University Press.
29. Cunningham CJL, Black KJ. Essentials of occupational health psychology. 2021. New York, NY: Routledge.
30. Theorell T (ed). Handbook of socioeconomic determinants of occupational health. 2020. Cham: Springer Nature International Publishing.
31. Karasek RA. Job demands, job decision latitude, and mental strain: Implications for job redesign. Admin Sci Quart. 1979; 24(2): 285-308.
32. Johnson JV, Hall EM. Job strain, workplace social support and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Public Health. 1988; 78, 1336-1342.
33. Karasek R, Theorell T. Healthy work. 1990. New York: Basic Books.
34. Henry JP, Stephens P. Stress, health, and the social environment : A sociobiologic approach to medicine. 1977. New York: Springer.
35. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2018; 9(6):360-370.
36. Karasek RA, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998; 3 (4): 322-355.
37. Siegrist J. Adverse health effects of high effort-low reward conditions at work. J Occup Health Psychol. 1996; 1(1): 27–41.
38. Gouldner AW. The norm of reciprocity: A preliminary statement. Am Soc Rev. 1960; 161-178.
39. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58(8): 1483-1499.
40. Dragano N, Wahrendorf M. A social inequalities perspective on effort-reward imbalance at work. In: Siegrist J, Wahrendorf M (eds.) Work stress and health in a globalized economy: The model of effort-reward imbalance. 2016; 67-85. Cham: Springer Nature International Publications.
41. Schultz W. Behavioral theories and the neurophysiology of reward. Ann Rev Psychol. 2006; 57(1): 87-115.
42. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3): 171-179.
43. Siegrist, J., Li, J. Psychosocial Occupational Health: An Interdisciplinary Textbook. 2024. Oxford: Oxford University Press.
44. Kivimäki M, Batty GD, Ferrie JE, Kawachi I. Cumulative meta-analysis of job strain and CHD. Epidemiology. 2014; 25(3), 464-465.
45. Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular diseases. Nat Rev Cardiol. 2018; 15(4): 215-228.
46. Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Gilbert-Ouimet M, Vézina M, Laurin D, Dionne CE, Pearce N, Dagenais GR. Psychosocial stressors at work and coronary heart disease risk in men and women: 18-year prospective cohort study of combined exposures. Circulation: Cardiovasc Qual Outcomes. 2023; 16(10): e009700.
47. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vézina M. Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control support and effort-reward imbalance models. Scand J Work Environ Health. 2014; 40 (2):109-132.
48. Jarczok MN, Jarczok M, Mauss D, Koenig J, Li J, Herr RM, Thayer JF. Autonomic nervous system activity and workplace stressors – a systematic review. Neurosci Biobehav Rev. 2013; 37 (8): 1810-1823.
49. Eddy P, Wertheim EH, Kingsley M, Wright BJ. Associations between the effort-reward imbalance model of workplace stress and indices of cardiovascular health: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2017; 83: 252-266.
50. Magnusson Hanson LL, Westerlund H, Goldberg,M, Zins M, Vahtera J, Rod PH, Stenholm S, Steptoe A, Kivimäki M. Work stress, anthropometry, lung function, blood pressure, and blood-based biomarkers: a cross-sectional study of 43,593 French men and women. Sci Rep. 2017, 7(1): 9282.
51. Osborne MT, Shin LM, Mehta NN, Pitman RK, Fayad ZA, Tawakol A. Disentangling the links between psychosocial stress and cardiovascular disease. Circ Cardiovasc. 2020; 13 (8):e01093
52. Seidler A, Schubert M, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller S, Starke KR. Psychosocial occupational exposures and mental illness: a systematic review with meta-analyses. Deutsches Ärzteblatt International. 2022; 119(42): 709.
53. Pena Gralle APB, Talbot D, Trudel X, Milot A, Gilbert-Ouimet M, Lavigne-Robichaud M, Ndjaboué R, Lesage A, Lauzier S, Vézina M. Socioeconomic inequalities, psychosocial stressors at work and physician-diagnosed depression: Time-to-event mediation analysis inthe presence of time-varying confounders. Plos one. 2023; 18(10): e0293388.
54. Juvani A, Oksanen T, Virtanen M, Salo P, Pentti J, Kivimäki M, Vahtera J. Clustering of job strain, effort− reward imbalance, and organizational injustice and the risk of work disability: a cohort study. Scand J Work Environ Health 2018; 44(5): 485-495.
55. Nakata A. Psychosocial job stress and immunity: a systematic review. In Yan Q (ed.). Psychoneuroimmunology: methods and protocols. 2012; 39-75. Totowa, NJ: Humana Press.
56. Eddy P, Wertheim EH, Hale MW, Wright BJ. A systematic review and revised meta-analysis of the effort-reward imbalance model of workplace stress and hypothalamic-pituitary-adrenal axis measures of stress. Psychosom Med. 2023; 85(5): 450-460.
57. Penz M, Siegrist J, Wekenborg MK, Rothe N, Walther A, Kirschbaum C. Effort-reward imbalance at work is associated with hair cortisol concentrations: prospective evidence from the Dresden Burnout Study. Psychoneuroendocrinol. 2019; 109: 104399.
58. Freni-Sterrantino A, Fiorito G, d’Errico A, Virtanen M, Ala-Mursala L, Järvelin BR, Vineis P, Robinson O. Association between work characteristics and epigenetic age acceleration cross-sectional results from UK-Understanding Society study. Aging 2022; 14 (19): 7752-7759.
59. GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Global Health Metrics. 2018;10139:1739-1858.
60. Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: A meta-analysis. Am J Epidemiol. 2003;15 (2): 98-112.
61. Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997; 305(9073): 235-239.
62. Rugulies R, Aust B, Madsen IEH, Burr H, Siegrist J, Bültmann U. Adverse psychosocial working conditions and risk of severe depressive symptoms. Do effects differ by occupational grade? Eur J Public Health 2013; 23(3): 415–420.
63. Kuper H, Singh-Manoux, Siegrist J, Marmot M. When reciprocity fails: effort-reward imbalance in relation to CHD and health functioning within the Whitehall II study. Occup Environ Med. 2002; 59: 777-784.
64. Juvani A, Oksanen T, Salo P, Virtanen M, Kivimäki M, Pentti J, Vahtera M. Effort-reward imbalance as a risk factor for disability pension: the Finnish Public Sector Study. Scand J Work Environ Health. 2014; 40(3), 266–277.
65. Hanvold TN, Sterud T, Kristensen P, Mehlum IS. Mechanical and psychosocial work exposures: the construction and evaluation of a gender-specific job exposure matrix (JEM). Scand J Work Environ Health 2019; 45 (3), 239-247.
66. Brisson C, Gilbert-Ouimet MDC, Trudel X, Vézina M. Workplace interventions aiming to improve psychosocial work factors and related health. In Siegrist J,Wahrendorf M. (eds.), Work stress and health in a globalized economy. 2016; 333-63. Cham: Springer Nature International Publications.
67. Trudel X, Gilbert-Ouimet M, Vézina M, Talbot D, Mâsse B, Milot A, Brisson C. Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension. Occup Environ Med. 2021; 78(10): 738-744.
68. Siegrist J, Matthews TA, Li J. Failed reciprocity in core social roles and cardiovascular disease mortality: prospective results from the U.S. Health and Retirement Study. BMC Public Health. 2025; 25: 1090.
2. Weiner H. Perturbing the organism: The biology of stressful experience. 1992. Chicago: University of Chicago Press.
3. Cassel JC, Tyroler HA. Epidemiological studies of social change: health status and recency of industrialization. Arch Environ Health. 1961; 3: 25-33.
4. Henry JP, Cassel JC. Psychosocial factors in essential hypertension: recent epidemiological and animal experimental evidence. Am J Epidemiol. 1969: 171-200.
5. Syme SL, Hyman MM, Enterline PE. Some social and cultural factors associated with the occurrence of coronary heart disease. J Chron Disease. 1964; 17: 277-289.
6. Antonovsky, A. Social class, life expectancy and overall mortality. The Milbank Memorial Fund Quarterly. 1967; 45(2): 31-73.
7. Mackenbach JP. Health inequalities. 2019. Oxford: Oxford University Press.
8. Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology. 1973. Cambridge, Mass.: Harvard University Press.
9. Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemio Community Health. 1978; 32(4): 244-249.
10. Lampert T, Hoebel J, Kroll LE. Soziale Unterschiede in der Mortalität und Lebenserwartung in Deutschland- Aktuelle Situation und Trends (Social inqulities in mortality and life expectancy in Germany- actual situation and trends). J Health Monitor. 2019; 4(1): 3-11.
11. Marmot MG. Fair society, healthy lives: strategic review of health inequalities in England post 2010. The Marmot Review 2010. London: Institute of Health Equity.
12. Deary IJ, Johnson W, Houlihan LM. Genetic foundations of human intelligence. Human
1. Genetics. 2009; 126(1): 215-232.
13. IHME-CHAIN collaborators. Effects of education on adult mortality: a global systematic review and meta-analysis. Lancet Public Health. 2024; 9(3): e155-e165.
14. Devaux M, De Looper M. Income-related inequalities in health service utilisation in 19 OECD countries. 2012. Paris: OECD Publishing.
15. Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, Cota G, Martikainen P, Borrell C, Deboosere P, Kalediene P, Rychtarikova J, Artnik B, Mackenbach JP. Educational inequalities in avoidable mortality in Europe. J Epidemiol Community Health. 2010; 64(10): 913-920.
16. Aldabe B, Anderson R, Lyly-Yrjännäinen M, Parent-Thirion A, Vermeylen G, Kelleher CC, Niedhammer I. Contribution of material, occupational and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. J Epidemiol Community Health. 2010; 65(12):1123-1131.
17. Bartley M. Health inequality (2nd ed.). 2017. Cambridge: Polity Press.
18. Pillas D, Marmot M, Naicker K, Goldblatt P, Morrison J, Pikhart H. Social inequalities in early childhood health and development: a European-wide systematic review. Pediatric Res. 2014; 76(5): 418.
19. Kuh D, Ben-Shlomo Y (eds.) A life course approach to chronic disease epidemiology. (2nd ed.). 2004. Oxford: Oxford University Press.
20. Galama TJ, Lleras-Muney A, Van Kippersluis H. The effect of education on health and mortality: A review of experimental and quasi-experimental evidence. 2018; Cambridge. Mass. National Bureau of Economic Research.
21. Stringhini S, Dugravot A, Shipley M, Goldberg M, Zins M, Kivimäki M, Marmot M, Sabia S, Singh-Manoux A. Health behaviours, socioeconomic status, and mortality: Further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Medicine. 2011; 8(2):e1000419.
22. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality. Perspect Psychol Sci. 2015; 10(2): 227-237.
23. Montano D. Social distribution of occupational hazards. In: Theorell T (ed.) Handbook of socioeconomic determinants of occupational health. 2020; 169- 189. Cham: Springer Nature.
24. Hoven H, Siegrist J. Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies. Occup Environ Med. 2013; 70(9): 663-669.
25. Merton RK. Social theory and social structure. 1968. Glencoe, ILL: Free Press.
26. McEwen CA, McEwen BS. Social structure, adversity, toxic stress and intergenerational poverty: An early childhood model. Ann Rev Sociol. 2015; 43: 445-472.
27. Power C, Kuh D. Life course development of unequal health. In: Siegrist J, Marmot M (eds.) Social inequalities in health. 2006; 27-53. Oxford: Oxford University Press.
28. Lapierre LM, Cooper C (eds.). The Cambridge Companion to Organizational Stress and Well-Being. 2023; Cambridge: Cambridge University Press.
29. Cunningham CJL, Black KJ. Essentials of occupational health psychology. 2021. New York, NY: Routledge.
30. Theorell T (ed). Handbook of socioeconomic determinants of occupational health. 2020. Cham: Springer Nature International Publishing.
31. Karasek RA. Job demands, job decision latitude, and mental strain: Implications for job redesign. Admin Sci Quart. 1979; 24(2): 285-308.
32. Johnson JV, Hall EM. Job strain, workplace social support and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Public Health. 1988; 78, 1336-1342.
33. Karasek R, Theorell T. Healthy work. 1990. New York: Basic Books.
34. Henry JP, Stephens P. Stress, health, and the social environment : A sociobiologic approach to medicine. 1977. New York: Springer.
35. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2018; 9(6):360-370.
36. Karasek RA, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998; 3 (4): 322-355.
37. Siegrist J. Adverse health effects of high effort-low reward conditions at work. J Occup Health Psychol. 1996; 1(1): 27–41.
38. Gouldner AW. The norm of reciprocity: A preliminary statement. Am Soc Rev. 1960; 161-178.
39. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58(8): 1483-1499.
40. Dragano N, Wahrendorf M. A social inequalities perspective on effort-reward imbalance at work. In: Siegrist J, Wahrendorf M (eds.) Work stress and health in a globalized economy: The model of effort-reward imbalance. 2016; 67-85. Cham: Springer Nature International Publications.
41. Schultz W. Behavioral theories and the neurophysiology of reward. Ann Rev Psychol. 2006; 57(1): 87-115.
42. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3): 171-179.
43. Siegrist, J., Li, J. Psychosocial Occupational Health: An Interdisciplinary Textbook. 2024. Oxford: Oxford University Press.
44. Kivimäki M, Batty GD, Ferrie JE, Kawachi I. Cumulative meta-analysis of job strain and CHD. Epidemiology. 2014; 25(3), 464-465.
45. Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular diseases. Nat Rev Cardiol. 2018; 15(4): 215-228.
46. Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Gilbert-Ouimet M, Vézina M, Laurin D, Dionne CE, Pearce N, Dagenais GR. Psychosocial stressors at work and coronary heart disease risk in men and women: 18-year prospective cohort study of combined exposures. Circulation: Cardiovasc Qual Outcomes. 2023; 16(10): e009700.
47. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vézina M. Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control support and effort-reward imbalance models. Scand J Work Environ Health. 2014; 40 (2):109-132.
48. Jarczok MN, Jarczok M, Mauss D, Koenig J, Li J, Herr RM, Thayer JF. Autonomic nervous system activity and workplace stressors – a systematic review. Neurosci Biobehav Rev. 2013; 37 (8): 1810-1823.
49. Eddy P, Wertheim EH, Kingsley M, Wright BJ. Associations between the effort-reward imbalance model of workplace stress and indices of cardiovascular health: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2017; 83: 252-266.
50. Magnusson Hanson LL, Westerlund H, Goldberg,M, Zins M, Vahtera J, Rod PH, Stenholm S, Steptoe A, Kivimäki M. Work stress, anthropometry, lung function, blood pressure, and blood-based biomarkers: a cross-sectional study of 43,593 French men and women. Sci Rep. 2017, 7(1): 9282.
51. Osborne MT, Shin LM, Mehta NN, Pitman RK, Fayad ZA, Tawakol A. Disentangling the links between psychosocial stress and cardiovascular disease. Circ Cardiovasc. 2020; 13 (8):e01093
52. Seidler A, Schubert M, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller S, Starke KR. Psychosocial occupational exposures and mental illness: a systematic review with meta-analyses. Deutsches Ärzteblatt International. 2022; 119(42): 709.
53. Pena Gralle APB, Talbot D, Trudel X, Milot A, Gilbert-Ouimet M, Lavigne-Robichaud M, Ndjaboué R, Lesage A, Lauzier S, Vézina M. Socioeconomic inequalities, psychosocial stressors at work and physician-diagnosed depression: Time-to-event mediation analysis inthe presence of time-varying confounders. Plos one. 2023; 18(10): e0293388.
54. Juvani A, Oksanen T, Virtanen M, Salo P, Pentti J, Kivimäki M, Vahtera J. Clustering of job strain, effort− reward imbalance, and organizational injustice and the risk of work disability: a cohort study. Scand J Work Environ Health 2018; 44(5): 485-495.
55. Nakata A. Psychosocial job stress and immunity: a systematic review. In Yan Q (ed.). Psychoneuroimmunology: methods and protocols. 2012; 39-75. Totowa, NJ: Humana Press.
56. Eddy P, Wertheim EH, Hale MW, Wright BJ. A systematic review and revised meta-analysis of the effort-reward imbalance model of workplace stress and hypothalamic-pituitary-adrenal axis measures of stress. Psychosom Med. 2023; 85(5): 450-460.
57. Penz M, Siegrist J, Wekenborg MK, Rothe N, Walther A, Kirschbaum C. Effort-reward imbalance at work is associated with hair cortisol concentrations: prospective evidence from the Dresden Burnout Study. Psychoneuroendocrinol. 2019; 109: 104399.
58. Freni-Sterrantino A, Fiorito G, d’Errico A, Virtanen M, Ala-Mursala L, Järvelin BR, Vineis P, Robinson O. Association between work characteristics and epigenetic age acceleration cross-sectional results from UK-Understanding Society study. Aging 2022; 14 (19): 7752-7759.
59. GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Global Health Metrics. 2018;10139:1739-1858.
60. Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: A meta-analysis. Am J Epidemiol. 2003;15 (2): 98-112.
61. Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997; 305(9073): 235-239.
62. Rugulies R, Aust B, Madsen IEH, Burr H, Siegrist J, Bültmann U. Adverse psychosocial working conditions and risk of severe depressive symptoms. Do effects differ by occupational grade? Eur J Public Health 2013; 23(3): 415–420.
63. Kuper H, Singh-Manoux, Siegrist J, Marmot M. When reciprocity fails: effort-reward imbalance in relation to CHD and health functioning within the Whitehall II study. Occup Environ Med. 2002; 59: 777-784.
64. Juvani A, Oksanen T, Salo P, Virtanen M, Kivimäki M, Pentti J, Vahtera M. Effort-reward imbalance as a risk factor for disability pension: the Finnish Public Sector Study. Scand J Work Environ Health. 2014; 40(3), 266–277.
65. Hanvold TN, Sterud T, Kristensen P, Mehlum IS. Mechanical and psychosocial work exposures: the construction and evaluation of a gender-specific job exposure matrix (JEM). Scand J Work Environ Health 2019; 45 (3), 239-247.
66. Brisson C, Gilbert-Ouimet MDC, Trudel X, Vézina M. Workplace interventions aiming to improve psychosocial work factors and related health. In Siegrist J,Wahrendorf M. (eds.), Work stress and health in a globalized economy. 2016; 333-63. Cham: Springer Nature International Publications.
67. Trudel X, Gilbert-Ouimet M, Vézina M, Talbot D, Mâsse B, Milot A, Brisson C. Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension. Occup Environ Med. 2021; 78(10): 738-744.
68. Siegrist J, Matthews TA, Li J. Failed reciprocity in core social roles and cardiovascular disease mortality: prospective results from the U.S. Health and Retirement Study. BMC Public Health. 2025; 25: 1090.