Background. Many, but not all, studies have reported that job strain is related to cardiovascular morbidity and mortality. To date, this relationship has not been tested on an English full population sample. This study examines whether the demand–control model of job strain contributes to our understanding of the determinants of coronary heart disease.

Methods. The analysis uses data from 4350 working men aged 20–64 in the 1993 Health Survey for England. Job demand and control characteristics were determined by questionnaire. Several health outcomes were examined: self-rated health; psychiatric health; angina and possible myocardial infarction, measured by the Rose questionnaire; doctor-diagnosed heart disease; any heart disease. The relationship between job strain and the health outcomes was determined by logistic regression analyses after controlling for known confounders.

Results. Those in high strain jobs consistently reported poorer health on all measures than men with lower strain. Similarly, men reporting low job strain were least likely to report poor health in 5/6 health outcomes. Those with intermediate levels of strain tended to have intermediate prevalence rates for poor health. The pattern of association between job strain and the CHD was independent of coronary risk factors.

Conclusions. The analyses broadly support Karasek's demand–control model of job strain. Health selection into low strain jobs may account for the lack of an association between job strain and doctor diagnosed heart disease while independent associations between job strain and all CHD measures considered together indicate that job strain may have aetiological significance for heart disease.