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working hours and risk of coronary heart disease and stroke : a systematic review and meta-analysis of published and unpublished data for 603 838 individuals

(2015) LANCET. 386(10005). p.1739-1746
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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 We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.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 (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.
Keywords
PHYSICAL-ACTIVITY, JOB STRAIN, WHITEHALL-II, HEALTH INEQUALITIES, CARDIOVASCULAR-DISEASE, FOLLOW-UP, COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE, PARTICIPANT DATA, BASE-LINE, MYOCARDIAL-INFARCTION

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Chicago
Kivimäki, Mika, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, et al. 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 386 (10005): 1739–1746.
APA
Kivimäki, M., Jokela, M., Nyberg, S. T., Singh-Manoux, A., Fransson, E. I., Alfredsson, L., Bjorner, J. B., et al. (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, 386(10005), 1739–1746.
Vancouver
1.
Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al. 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. 2015;386(10005):1739–46.
MLA
Kivimäki, Mika, Markus Jokela, Solja T Nyberg, et al. “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 386.10005 (2015): 1739–1746. Print.
@article{6992656,
  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 ({\textrangle}= 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){\textlangle}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.},
  author       = {Kivim{\"a}ki, Mika and Jokela, Markus and Nyberg, Solja T and Singh-Manoux, Archana and Fransson, Eleonor I and Alfredsson, Lars and Bjorner, Jakob B and Borritz, Marianne and Burr, Hermann and Casini, Annalisa and Clays, Els and De Bacquer, Dirk and Dragano, Nico and Erbel, Raimund and Geuskens, Goedele A and Hamer, Mark and Hooftman, Wendela E and Houtman, Irene L and J{\"o}ckel, Karl-Heinz and Kittel, France and Knutsson, Anders and Koskenvuo, Markku and Lunau, Thorsten and Madsen, Ida EH and Nielsen, Martin L and Nordin, Maria and Oksanen, Tuula and Pejtersen, Jan H and Pentti, Jaana and Rugulies, Reiner and Salo, Paula and Shipley, Martin J and Siegrist, Johannes and Steptoe, Andrew and Suominen, Sakari B and Theorell, T{\"o}res and Vahtera, Jussi and Westerholm, Peter JM and Westerlund, Hugo and O'Reilly, Dermot and Kumari, Meena and Batty, G David and Ferrie, Jane E and Virtanen, Marianna},
  issn         = {0140-6736},
  journal      = {LANCET},
  keyword      = {PHYSICAL-ACTIVITY,JOB STRAIN,WHITEHALL-II,HEALTH INEQUALITIES,CARDIOVASCULAR-DISEASE,FOLLOW-UP,COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE,PARTICIPANT DATA,BASE-LINE,MYOCARDIAL-INFARCTION},
  language     = {eng},
  number       = {10005},
  pages        = {1739--1746},
  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},
  url          = {http://dx.doi.org/10.1016/S0140-6736(15)60295-1},
  volume       = {386},
  year         = {2015},
}

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