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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working hours and risk of coronary heart disease and stroke: A systematic review and meta-analysis of published and unpublished data for 603 838 individuals

Kivimäki, M and Jokela, M and Nyberg, ST and Singh-Manoux, A and Fransson, EI and Alfredsson, L and Bjorner, JB and Borritz, M and Burr, H and Casini, A and Clays, E and De Bacquer, D and Dragano, N and Erbel, R and Geuskens, GA and Hamer, M and Hooftman, WE and Houtman, IL and Jöckel, KH and Kittel, F and Knutsson, A and Koskenvuo, M and Lunau, T and Madsen, IEH and Nielsen, ML and Nordin, M and Oksanen, T and Pejtersen, JH and Pentti, J and Rugulies, R and Salo, P and Shipley, MJ and Siegrist, J and Steptoe, A and Suominen, SB and Theorell, T and Vahtera, J and Westerholm, PJM and Westerlund, H and O'Reilly, D and Kumari, M and Batty, GD and Ferrie, JE and Virtanen, M (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working hours and risk of coronary heart disease and stroke: A systematic review and meta-analysis of published and unpublished data for 603 838 individuals.' The Lancet, 386 (10005). 1739 - 1746. ISSN 0140-6736

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Abstract

© 2015 Kivimäki et al. Open Access article distributed under the terms of CC BY. 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 We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.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 w orking hours or more per week compared with standard working hours (p trend < 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.

Item Type: Article
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > R Medicine (General)
Divisions: Faculty of Social Sciences > Institute for Social and Economic Research
Depositing User: Jim Jamieson
Date Deposited: 21 Aug 2015 19:04
Last Modified: 15 Nov 2017 01:15
URI: http://repository.essex.ac.uk/id/eprint/14684

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