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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
复制标题
DOI：
10.1016/s0140-6736(15)60295-1
复制
发表时间：
2015-10-31
期刊：
影响因子：
168.9
通讯作者：
Virtanen, Marianna
中科院分区：
文献类型：
--
作者：
Kivimaki, Mika;Jokela, Markus;Virtanen, Marianna
长时间工作可能会增加心血管疾病的风险，但前瞻性证据很少，不精确，而且大多数仅限于冠心病。我们的目的是评估长时间的工作时间作为冠心病和中风的危险因素，我们确定了通过系统回顾PubMed和Embase从成立到2014年8月20日发表的研究。我们从工作人群个体参与者数据荟萃分析（IPD-Work）联盟和开放获取数据档案中获得了20项队列研究的未发表数据。我们使用累积随机效应荟萃分析结合联合收割机效果估计从已发表和未发表的data.Findings我们包括25项研究，从24个队列在欧洲，美国和澳大利亚。冠心病的荟萃分析包括603 838例基线时无冠心病的男性和女性的数据;卒中的荟萃分析包括528 908例基线时无卒中的男性和女性的数据。冠心病的随访为510万人年（平均8.5年），其中记录了4768起事件，卒中的随访为380万人年（平均7.2年），其中记录了1722起事件。在根据年龄、性别和社会经济地位调整的累积荟萃分析中，（每周35-40小时），工作时间长（每周>= 55小时）与冠心病发病风险增加相关（相对风险[RR] 1.13，95% CI 1.02-1.26; p=0.02）和卒中事件（1.33，1.11-1.61; p=0.002）。在解决反向因果关系、其他风险因素的多变量调整以及不同的中风确定方法的分析中，中风的过度风险保持不变（RR估计范围为1.30-1.42）。我们记录了中风的剂量反应关系，RR估计值为1.10（95% CI 0.94-1.28; p=0.24）41-48工作小时，1.27与标准工时相比，每周工作49-54小时为1.03-1.56; p=0.03，每周工作55小时或以上为1.33（1.11-1.61; p=0.002）（p（趋势）
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 We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia.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)