Open Access Highly Accessed Research article

Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study with over 20 years of follow-up

Charlotta Nilsen1*, Ross Andel23, Stefan Fors1, Bettina Meinow1, Alexander Darin Mattsson1 and Ingemar Kåreholt14

Author Affiliations

1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

2 School of Aging Studies, University of South Florida, Tampa, FL, USA

3 International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

4 Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden

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BMC Public Health 2014, 14:878  doi:10.1186/1471-2458-14-878

Published: 27 August 2014



People spend a considerable amount of time at work over the course of their lives, which makes the workplace important to health and aging. However, little is known about the potential long-term effects of work-related stress on late-life health. This study aims to examine work-related stress in late midlife and educational attainment in relation to serious health problems in old age.


Data from nationally representative Swedish surveys were used in the analyses (n = 1,502). Follow-up time was 20–24 years. Logistic regressions were used to examine work-related stress (self-reported job demands, job control, and job strain) in relation to serious health problems measured as none, serious problems in one health domain, and serious problems in two or three health domains (complex health problems).


While not all results were statistically significant, high job demands were associated with higher odds of serious health problems among women but lower odds of serious health problems among men. Job control was negatively associated with serious health problems. The strongest association in this study was between high job strain and complex health problems. After adjustment for educational attainment some of the associations became statistically nonsignificant. However, high job demands, remained related to lower odds of serious problems in one health domain among men, and low job control remained associated with higher odds of complex health problems among men. High job demands were associated with lower odds of complex health problems among men with low education, but not among men with high education, or among women regardless of level of education.


The results underscore the importance of work-related stress for long-term health. Modification to work environment to reduce work stress (e.g., providing opportunities for self-direction/monitoring levels of psychological job demands) may serve as a springboard for the development of preventive strategies to improve public health both before and after retirement.

Work-related stress; Psychosocial work environment; Socioeconomic position; Education; Multimorbidity; Complex health problems; Old age; Longitudinal; Sweden