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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals

被引：497

作者：

Kivimaki, Mika ^{[1
,3
]}

Jokela, Markus ^{[4
]}

Nyberg, Solja T. ^{[5
,6
,7
]}

Singh-Manoux, Archana ^{[1
,8
]}

Fransson, Eleonor I. ^{[9
,10
,11
]}

Alfredsson, Lars ^{[9
,12
]}

Bjorner, Jakob B. ^{[13
]}

Borritz, Marianne ^{[14
]}

Burr, Hermann ^{[15
]}

Casini, Annalisa ^{[16
]}

Clays, Els ^{[17
]}

De Bacquer, Dirk ^{[17
]}

Dragano, Nico ^{[18
]}

Erbel, Raimund ^{[19
]}

Geuskens, Goedele A. ^{[20
]}

Hamer, Mark ^{[1
]}

Hooftman, Wendela E. ^{[20
]}

Houtman, Irene L. ^{[20
]}

Jockel, Karl-Heinz ^{[21
]}

Kittel, France ^{[16
]}

Knutsson, Anders ^{[22
]}

Koskenvuo, Markku ^{[2
]}

Lunau, Thorsten ^{[18
]}

Madsen, Ida E. H. ^{[13
]}

Nielsen, Martin L. ^{[23
]}

Nordin, Maria ^{[11
,24
]}

Oksanen, Tuula ^{[5
,6
,7
]}

Pejtersen, Jan H. ^{[25
]}

Pentti, Jaana ^{[5
,6
,7
]}

Rugulies, Reiner ^{[13
,26
,27
]}

Salo, Paula ^{[5
,6
,7
,28
]}

Shipley, Martin J. ^{[1
]}

Siegrist, Johannes ^{[18
]}

Steptoe, Andrew ^{[1
]}

Suominen, Sakari B. ^{[29
,30
,31
]}

Theorell, Tores ^{[11
]}

Vahtera, Jussi ^{[5
,6
,7
,29
,32
]}

Westerholm, Peter J. M. ^{[33
]}

Westerlund, Hugo ^{[11
]}

O'Reilly, Dermot ^{[34
]}

Kumari, Meena ^{[1
,35
]}

Batty, G. David ^{[1
,36
,37
]}

Ferrie, Jane E. ^{[1
,38
]}

Virtanen, Marianna ^{[5
,6
,7
]}

机构：

[1] UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England

[2] Univ Helsinki, Dept Publ Hlth, Helsinki, Finland

[3] Univ Helsinki, Fac Med, Helsinki, Finland

[4] Univ Helsinki, Inst Behav Sci, Helsinki, Finland

[5] Finnish Inst Occupat Hlth, Helsinki, Finland

[6] Finnish Inst Occupat Hlth, Tampere, Finland

[7] Finnish Inst Occupat Hlth, Turku, Finland

[8] Ctr Res Epidemiol & Populat Hlth, INSERM, U1018, Villejuif, France

[9] Karolinska Inst, Inst Environm Med, S-10401 Stockholm, Sweden

[10] Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden

[11] Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden

[12] Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden

[13] Natl Res Ctr Working Environm, Copenhagen, Denmark

[14] Koege Hosp, Dept Occupat Med, Copenhagen, Denmark

[15] Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany

[16] Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium

[17] Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium

[18] Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany

[19] Univ Duisburg Essen, West German Heart Ctr Essen, Dept Cardiol, Essen, Germany

[20] TNO, Hoofddorp, Netherlands

[21] Univ Duisburg Essen, Fac Med, Inst Med Informat Biometry & Epidemiol, Essen, Germany

[22] Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden

[23] Frederiksberg Univ Hosp, Unit Social Med, DK-2000 Copenhagen, Denmark

[24] Umea Univ, Dept Psychol, S-90187 Umea, Sweden

[25] Danish Natl Ctr Social Res, Copenhagen, Denmark

[26] Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark

[27] Univ Copenhagen, Dept Psychol, Copenhagen, Denmark

[28] Univ Turku, Dept Psychol, Turku, Finland

[29] Univ Turku, Dept Publ Hlth, Turku, Finland

[30] Folkhalsan Res Ctr, Helsinki, Finland

[31] Univ Skovde, Skovde, Sweden

[32] Turku Univ Hosp, FIN-20520 Turku, Finland

[33] Uppsala Univ, Occupat & Environm Med, Uppsala, Sweden

[34] Queens Univ Belfast, Ctr Publ Hlth, Belfast, Antrim, North Ireland

[35] Univ Essex, Inst Social & Econ Res, Colchester CO4 3SQ, Essex, England

[36] Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Midlothian, Scotland

[37] Univ Edinburgh, Alzheimer Scotland Dementia Res Ctr, Edinburgh, Midlothian, Scotland

[38] Univ Bristol, Sch Community & Social Med, Bristol, Avon, England

来源：

LANCET | 2015年 / 386卷 / 10005期

基金：

芬兰科学院; 瑞典研究理事会; 美国国家卫生研究院; 英国经济与社会研究理事会; 英国医学研究理事会;

关键词：

FOLLOW-UP; JOB STRAIN; PHYSICAL-ACTIVITY; BASE-LINE; CARDIOVASCULAR-DISEASE; MYOCARDIAL-INFARCTION; HEALTH INEQUALITIES; MORTALITY; PROJECT; STRESS;

D O I：

10.1016/S0140-6736(15)60295-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (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. Copyright (C) Kivimaki et al. Open Access article distributed under the terms of CC BY.

引用

页码：1739 / 1746

页数：8

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