Table 1: List of observational studies of the Demand-Control Model in relation to stroke.

StudyCountryPopulationFollowup (years)DCM exposureStroke outcomeSignificant positive associationsReported nonsignificant, null, or negative associationsConclusion

[23]JapanProspective cohort of treated hypertensive workers, (908 men, 707 women) and 40–65 years of age7Self-reported at baseline by a simple questionnaire with reference to Karasek’s modelIncidence of cardiovascular event (CVE): cerebral haemorrhage, cerebral infarction, subarachnoid haemorrhage, myocardial infarction, heart failure, aortic aneurysmal rupture, or sudden death
Events diagnosed by computer tomography
38 events (29 in men, 9 in women). These included 6 ICH, 3 SAH, 14 MI, 1 heart failure, and 1 sudden death
Hazard ratios and 95% confidence intervals
Women: Job strain 9.05 (1.17–69.86)
Men: High demands 2.88 (1.36–6.12), and active job 2.94 (1.29–6.73); HR adjusted for mean SBP, BMI, total cholesterol, HDL-cholesterol, proteinuria, family history of stroke, left ventricular hypotrophy, ischemic ST-T change, atrial fibrillation, and current smoking
Hazard ratios and 95% confidence intervals
Women:
High demands 3.33 (0.79–13.93), low control 3.00 (0.72–12.46), passive 3.15 (0.55–18.05), and active job 3.97 (0.34–46.88)
Men:
low control 0.68 (0.25–1.80), passive 0.61 (0.14–2.73), and job strain 1.86 (0.51–6.75)
Job strain in women and active job and high demands in men associated with increased risk of CVE in treated hypertensive workers

[24]SwedenThe Women's Lifestyle and Health Cohort Study and
and 30–50 years of age at baseline 1991-1992
~10Self-reported by Swedish version of the Demand-Control Questionnaire (DCQ)Incident stroke: ischemic stroke (ICD-9: 434; ICD-10: I63.3 to I63.9), intracerebral haemorrhage (ICD-9: 431; ICD-10: I61), and undefined type (ICD-9: 436; ICD-10: I64)
Events linked from hospital discharge and cause of death registers
200 events (121 ischemic stroke, 47 intracerebral haemorrhage, and
32 undefined stroke)
No significant associations reportedHazard ratios and 95% confidence intervals
High demands:
All stroke 0.9 (0.6–1.3); ischemic 0.9 (0.5–1.4); haemorrhage 0.9 (0.4–1.9)
Low job control
All stroke 1.0 (0.7–1.5); ischemic 1.4 (0.9–2.4); haemorrhage 1.1 (0.5–2.4).
Job strain
All stroke 1.2 (0.8–1.9); ischemic 1.6 (0.9–3.0); haemorrhage 1.2 (0.5–3.1)
Passive: ischemic 1.3 (0.7–2.4)
Job strain, job demands, and job control unrelated to risk of stroke

[25]SwedenCase-control study, 65 cases recruited from four hospitals in 2000–2002, 103 random population controls, and 30–65 years of age Self-reported by the Swedish Job Content Questionnaire (JCQ)First-ever stroke cases ( ): intracerebral haemorrhage (ICD-10: I61), cerebral infarction (ICD-10: I63), and undetermined pathological type (ICD-10: I64)Odds ratio and 90% confidence interval
Active job 0.37 (0.14–0.97); OR adjusted for sex, age, and traditional
medical risk factors
Odds ratios and 90% confidence intervals
Passive job 1.42 (0.50–4.01), job strain 1.89 (0.66–5.38)
The likelihood of stroke was lower for people in active job situations

[27]SwedenRegister-based total population cohort,  438 502 million working people and 25–64 years of age at baseline 1990.
5Job control measured at baseline by a job exposure matrix (JEM) based on occupational titlesStroke mortality: haemorrhagic stroke (ICD-9: 430 to 432); ischemic or unspecified type (ICD-9: 433 to 438)
Events linked from cause of death register; 2147 fatal events (788 in women, 1359 in men) These included 1454 haemorrhagic strokes and 693 ischemic or unspecified types
Rate ratios and 95% confidence intervals
Women:
Low job control
All strokes 1.54 (1.10–2.17); haemorrhagic stroke 1.50 (1.11–2.03)
RR adjusted for marital status, education level, and occupational class
Rate ratios and 95% confidence intervals
Low job control
Women:
Ischemic stroke 1.39 (0.73–2.64)
Men:
All strokes 0.91 (0.73–1.14); haemorrhagic stroke 0.94 (0.71–1.26); ischemic stroke 0.87 (0.61–1.25)
Job control significantly related to haemorrhagic and all stroke mortality in women but not in men
Class-specific analyses indicated a consistent effect of job control for most classes (significant for female lower nonmanuals)

[26]SwedenRegister-based total population cohort,  945 078 million working people (48.7% women), and 30–64 years of age at baseline 1990
13Job control measured at baseline by a job exposure matrix (JEM) based on occupational titlesIncident first-ever stroke
Brain infarction (ICD-9: 434; ICD-10: I63),
intracerebral haemorrhage (ICD-9: 431; ICD-10: I61), and undetermined pathological type (ICD-9: 436; ICD-10: I64)
Events linked from hospital discharge and cause of death registers 50114 incident events (17 399 (9.8% fatal) in women, 32 715 (10.9% fatal) in men). These included in women ICH 2861 (30.3% fatal), BI 12 513 (4.2% fatal), and UND 2025 (8.9% fatal). In men, ICH 5395 (29.5% fatal), BI 23 637 (5.1% fatal), and UND 3683 (10.1% fatal)
Hazard ratios and 95% confidence intervals
Women:
Low job control and any stroke 1.07 (1.01–1.14);
ICH 1.22 (1.04–1.42)
Men:
Low job control and any stroke 1.08 (1.04–1.12);
ICH 1.12 (1.03–1.22); BI 1.08 (1.04–1.13)
HR adjusted for age, work hours, education level, marital status, and
Income level
Hazard ratios and 95% confidence intervals
Women:
BI 1.04 (0.97–1.12)
The relative risk of stroke was higher in low job control occupations for women and men. The association between job control and stroke subtypes varied as a function of gender. The relative risk of intracerebral haemorrhage was highest for the women in low job control occupations than for women in high control occupations

[28]FinlandFinnish Public Sector Study, personnel in government employment in 10 towns and 21 hospitals
women and 18–65 years at baseline 2000–2002
3.4 meanSelf-reported job demands and job control by established questionnaire for the DCMIncident events of cerebrovascular disease: (ICD-9: 430–438; ICD-10 I6)
Events linked from hospital discharge and cause of death registers
124 incident events
Hazard ratios and 95% confidence intervals
High demands 1.94 (1.2–3.1) and active job 2.32 (1.3–4.1)
HR adjusted for age and history of cerebrovascular disease
Hazard ratios and 95% confidence intervals
Lowest job control 1.03 (0.7–1.6); low job control 1.21 (0.8–1.9); job strain 1.62 (0.9–2.9); passive 1.57 (0.9–2.9)
Risk of cerebrovascular disease higher for women with high demands and active work

[29]JapanMulticentre community-based prospective cohort, (3363 women, 3190 men), and <65 years of age at baseline 1992–199511 meanSelf-reported by Japanese version of the job Demand-Control Questionnaire from the WHO-MONICA Psychosocial Study QuestionnaireIncident stroke, subarachnoid (ICD-10: I61-I60), intracerebral haemorrhage (ICD-10: I61-I62), and ischemic stroke (ICD-10: I63). Diagnosis based on hospital records
147 incident events (56 women, 91 men): 90 ischemic strokes (w 26, m 64), 33 intracerebral haemorrhage (w 12, m 21), and 24 subarachnoid haemorrhage (w 18, m 6)
Hazard ratios and 95% confidence intervals
Women:
No significant associations
Men:
Job strain 2.53 (1.08–5.95)
HR adjusted for age, educational attainment, occupation, smoking status, alcohol consumption, physical activity, study area, and biologic risk factors
Hazard ratios and 95% confidence intervals
Women:
Active 1.17 (0.53–2.59), passive 1.22 (0.54–2.74), job strain 1.46 (0.63–3.38)
Men:
Active 1.72 (0.73–4.05), passive 2.17 (0.93–5.06)
HR adjusted for age, educational attainment, occupation, smoking status, alcohol consumption, physical activity, study area, and biologic risk factors
Occupational stress related to job strain was associated with incident stroke among Japanese men

[30]JapanMulticentre community-based prospective cohort, (3363 women, 3190 men), <65 years of age at baseline 1992–1995
11Self-reported by Japanese version of the job Demand-Control Questionnaire from the WHO-MONICA Psychosocial Study QuestionnaireIncident stroke, subarachnoid (ICD-10: I61-I60), intracerebral haemorrhage (ICD-10: I61-I62), and ischemic stroke (ICD-10: I63). Diagnosis based on hospital records
147 incident events (56 women, 91 men): 90 ischemic strokes (w 26, m 64), 33 intracerebral haemorrhage (w 12, m 21), 24 subarachnoid haemorrhage (w 18, m 6)
Hazard ratios and 95% confidence intervals.
Women in managerial position: job strain 5.3 (1.0–28.6). Women, white collar: job strain 5.6 (1.0–32.1)
Men, blue collar: job strain 3.1 (1.0–9.3); Men, nonmanagerial: job strain 8.9 (1.1–69.1)
HR adjusted for age, educational attainment, smoking status, alcohol consumption, physical activity, and study area
Hazard ratios and 95% confidence intervals
Women, white collar: active 4.2 (0.8–21.6); passive 3.2 (0.6–18.7);
women, managerial position: active 2.3 (0.4–12.8); passive 2.6 (0.5–14.2)
men, white collar: active 2.1 (0.6–7.6); passive 2.1 (0.5–8.0); job strain 1.4 (0.3–5.6)
Men, blue collar: active 1.5 (0.5–5.0); passive 2.0 (0.7–6.0)
Men, managerial: active 1.4 (0.5–3.7); passive 1.4 (0.5–4.1); job strain 2.0 (0.7–5.3)
Men, nonmanagerial: active 5.4 (0.7–44.4); passive 6.7 (0.9–50.7)
Among women in high occupational classes (white collar or managerial), job strain associated with over five-fold excess risk for incident stroke
Among men in low occupational classes, job strain associated with a higher risk of stroke compared to men with low strain
No association between job strain and incident stroke among men in high occupational classes