OBJECTIVE: To analyze the distribution of effort-reward imbalance (ERI) and to investigate its impact on self-rated health in a representative sample of the Danish workforce. METHODS: We studied 4977 employees who responded to a questionnaire in 2000, of which 3470 responded to a follow-up survey in 2005. RESULTS: The highest (ie, most unfavorable) ERI ratio was found in executives in the public sector, social workers, managing clerks in the public sector, and medical secretaries. A one standard deviation increase of the ERI ratio predicted a 12% (95% confidence intervals = 1.01 to 1.24) decline in self-rated health after adjustment for all covariates. CONCLUSIONS: This is the first study that identified job groups with a high exposure to ERI in a representative sample of a national workforce. ERI was a risk factor for a decline in self-rated health.
