Title
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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
Author
Kivimäki, M.
Jokela, M.
Nyberg, S.T.
Singh-Manoux, A.
Fransson, E.I.
Alfredsson, L.
Bjorner, J.B.
Borritz, M.
Burr, H.
Casini, A.
Clays, E.
de Bacquer, D.
Dragano, N.
Erbel, R.
Geuskens, G.A.
Hamer, M.
Hooftman, W.E.
Houtman, I.L.
Jöckel, K.H.
Kittel, F.
Knutsson, A.
Koskenvuo, M.
Lunau, T.
Madsen, I.E.
Nielsen, M.L.
Nordin, M.
Oksanen, T.
Pejtersen, J.H.
Pentti, J.
Rugulies, R.
Salo, P.
Shipley, M.J.
Siegrist, J.
Steptoe, A.
Suominen, S.B.
Theorell, T.
Vahtera, J.
Westerholm, P.J.M.
O'Reilly, D.
Kumari, M.
Batty, G.D.
Ferrie, J.E.
Virtanen, M.
Publication year
2015
Abstract
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 We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.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
Subject
ELSS - Earth, Life and Social Sciences
Life
Healthy Living
Work and Employment
Hours
Stroke
Diseases
Working
Australia
Cardiovascular risk
Cerebrovascular accident
Cohort analysis
Europe
Human
Ischemic heart disease
Meta analysis
Social status
SAtandard
Systematic review
United States
WHC - Work, Health and Care
To reference this document use:
http://resolver.tudelft.nl/uuid:b1d0128e-49e7-4d11-b8b1-f3d56442d377
DOI
https://doi.org/10.1016/s0140-6736(15)60295-1
TNO identifier
527809
ISSN
0140-6736
Source
The Lancet, 386 (386), 1739-1746
Document type
article