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

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.