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Long working hours and risk of coronary heart disease and stroke
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Long working hours and risk of coronary heart disease and stroke

a systematic review and meta-analysis of published and unpublished data for 603,838 individuals


BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

Kivimäki, M., Jokela, M., Nyberg, S. T., Singh-Manoux, A., Fransson, E. I., Alfredsson, L., ... IPD-Work Consortium (2015). Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet (London, England), 386(10005), 1739-46. DOI: 10.1016/S0140-6736(15)60295-1
Author(s) Mika Kivimäki
Markus Jokela
Solja T Nyberg
Archana Singh-Manoux
Eleonor I Fransson
Lars Alfredsson
Jakob B Bjorner
Marianne Borritz
Hermann Burr
Annalisa Casini
Els Clays
Dirk De Bacquer
Nico Dragano
Raimund Erbel
Goedele A Geuskens
Mark Hamer
Wendela E Hooftman
Irene L Houtman
Karl-Heinz Jöckel
France Kittel
Anders Knutsson
Markku Koskenvuo
Thorsten Lunau
Ida E H Madsen
Martin L Nielsen
Maria Nordin
Tuula Oksanen
Jan H Pejtersen, SFI
Jaana Pentti
Reiner Rugulies
Paula Salo
Martin J Shipley
Johannes Siegrist
Andrew Steptoe
Sakari B Suominen
Töres Theorell
Jussi Vahtera
Peter J M Westerholm
Hugo Westerlund
Dermot O'Reilly
Meena Kumari
G David Batty
Jane E Ferrie
Marianna Virtanen
Year of publishing 2015
Published in Lancet (London, England)
Language English
Nr. of pages 8
Department Social Policy and Welfare
keywords Societal and employment-related aspects of health

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