Work-unit organizational changes and risk of cardiovascular disease: a prospective study of public healthcare employees in Denmark

  • Johan Høy JensenEmail author
  • Esben Meulengracht Flachs
  • Janne Skakon
  • Naja Hulvej Rod
  • Jens Peter Bonde
  • Ichiro Kawachi
Original Article



The impact of organizational change at work on cardiovascular disease (CVD) among employees is poorly understood. We examined the longitudinal associations between different types of work-unit organizational changes and risk of CVD among employees.


We used multilevel mixed-effects parametric survival models to assess the risk of incident ischemic heart disease and stroke (72 events) during 2014 according to organizational changes in 2013 among 14,788 employees working in the same work unit from January through December 2013. We excluded employees with pre-existing CVD events between 2009 and 2013. Data on organizational changes defined as mergers, split-ups, relocations, change in management, employee layoffs, and budget cuts were obtained from work-unit managers (59% response).


There was an excess risk of CVD in the year following change in management (HR 2.04, 95% CI 1.10–3.78) and employee layoff (HR 2.44, 95% CI 1.29–4.59) in the work unit relative to no change. Exposure to any organizational change also suggested increased risk of CVD (HR 1.48, 95% CI 0.91–2.43). Including perceived stress as mediator in the regression models attenuated the point risk estimates only slightly, indicating no important mediation through this psychosocial factor.


Work-unit organizational change may be associated with excess risk of incident CVD among the employees relative to stable workplaces.


Coronary Downsizing Ischemic Reorganization Restructuring Stroke 



This work was supported by the Danish Working Environment Research Fund [13-2015-03]. JHJ thanks University Copenhagen, Julie Von Müllens Fond, Else and Mogens Wedell-Wedellsborgs Fond, and the Graduate School of Public Health (at University of Copenhagen) for their financial contribution to his stay as a visiting researcher in Department of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health during this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no potential conflict of interest.

Ethical standards

The Capital Region of Denmark approved the data handling for the present study [BFH-2016-020]. This study complies with the standards of the Regional Ethics Committee. The Regional Ethics Committee stated that ethical approval or informed consent were not required for this study.

Supplementary material

420_2019_1493_MOESM1_ESM.docx (218 kb)
Supplementary material 1 (DOCX 217 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Johan Høy Jensen
    • 1
    • 2
    Email author
  • Esben Meulengracht Flachs
    • 1
  • Janne Skakon
    • 3
  • Naja Hulvej Rod
    • 4
  • Jens Peter Bonde
    • 1
  • Ichiro Kawachi
    • 2
  1. 1.Department of Occupational and Environmental MedicineCopenhagen University Hospital, Bispebjerg HospitalCopenhagenDenmark
  2. 2.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public Health, Harvard UniversityBostonUSA
  3. 3.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
  4. 4.Section of Epidemiology, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

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