Job strain and the cortisol diurnal cycle in MESA: Accounting for between- and within-day variability

Kara E. Rudolph, Brisa N. Sánchez, Elizabeth A. Stuart, Benjamin Greenberg, Kaori Fujishiro, Gary S. Wand, Sandi Shrager, Teresa Seeman, Ana V.Diez Roux, Sherita H. Golden

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Evidence of the link between job strain and cortisol levels has been inconsistent. This could be due to failure to account for cortisol variability leading to underestimated standard errors. Our objective was to model the relationship between job strain and the whole cortisol curve, accounting for sources of cortisol variability. Our functional mixed-model approach incorporated all available data - 18 samples over 3 days - and uncertainty in estimated relationships. We used employed participants from the Multi-Ethnic Study of Atherosclerosis Stress I Study and data collected between 2002 and 2006. We used propensity score matching on an extensive set of variables to control for sources of confounding. We found that job strain was associated with lower salivary cortisol levels and lower total area under the curve. We found no relationship between job strain and the cortisol awakening response. Our findings differed from those of several previous studies. It is plausible that our results were unique to middle- to older-aged racially, ethnically, and occupationally diverse adults and were therefore not inconsistent with previous research among younger, mostly white samples. However, it is also plausible that previous findings were influenced by residual confounding and failure to propagate uncertainty (i.e., account for the multiple sources of variability) in estimating cortisol features.

Original languageEnglish (US)
Pages (from-to)497-506
Number of pages10
JournalAmerican journal of epidemiology
Issue number5
StatePublished - Mar 1 2016


  • functional mixed model
  • job strain
  • salivary cortisol

ASJC Scopus subject areas

  • Epidemiology


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