Unfair Bosses Linked to Increased Cardiac Risks

LONDON, May 17 -- Unfair bossy government bureaucrats may be coronary risk factors, according to researchers here.

Low-level civil servants who perceived unfair treatment from their superiors were more likely to have heart attacks than co-workers who perceived fairness, reported Robert De Vogli, Dr.Psy., of University College London, and colleagues, in the Journal of Epidemiology and Community Health.

Clerical workers on the lowest rung of the ladder were most likely to feel unfairly slighted by their bosses, and that perception was associated with a 55% increase in risk of an incident coronary event.

That finding emerged from an analysis of data collected by the Whitehall II Study, a prospective cohort study of London civil service workers. Specifically the researchers analyzed data collected from 8,298 government workers in interviews conducted from 1991 to 1993.

Participants were asked to respond to this statement, "I often have the feeling that I am being treated unfairly," on a likely scale with 1 indicating "strongly disagree" and 6 indicating "strongly agree".

The authors sorted the six responses into six categories of unfairness: responses. Of them, 1-2 were null, 3 was low, 4 moderate, and 5-6 were high.

During a mean follow-up of 10.9 years there were 528 incident coronary events including fatal myocardial infarction, non-fatal MI, and angina among 8,041 participants who were free of coronary events at baseline.

Among the findings:

• Low employment grade was strongly associated with unfairness.
• Workers who reported a high level of unfairness were more likely to be smokers, hypertensives, obese, sedentary, and non-drinkers.
• When adjusted for age, gender, physical functioning at baseline, employment grade, coronary risk factors and psychosocial factors, moderate-not high-unfairness was associated with the highest risk for poor physical functioning (OR 1.46 (95% CI 1.20-1.77).
• Female gender increased the risk of reporting unfair treatment.

The authors said possible mechanisms responsible for the observed relationship between perceived unfair treatment and coronary events include emotional reactions that "include humiliation that may, in turn, result in inward-focused and/or outward-focused negative emotions."

Both inward and outward focused negative emotions have been "found to influence coronary heart disease," they wrote.

More research, they said, will determine whether perceived unfairness is an independent marker for coronary events and to identify mediating mechanisms.

The study was limited by the use of a self-reported measure and the lack of a standard to classify the degree of unfairness. Moreover, because information on covariates was missing from 25% of the baseline sample, these participants were eliminated from the analysis, which was a potential source of bias. And, the authors pointed out, British civil servants may not be representative of society as a whole.