Do long working hours increase the risk of cardiovascular disease mortality? Evidence from the U.S. National Health Interview Survey 1997-2015

摘要 心血管疾病(心血管疾病，包括心脏病和中风)是全世界主要的死亡原因， 在美国，仅2018年就有280万人死亡，患病率接近50%。1，2 与此相关的是工作时间长，与其他国家相比，美国的工作时间仍然相当高。 最近，一系列的系统评价和荟萃分析已经确定了一种稳健的和剂量依赖的 长时间工作与心血管疾病的关系5-9这些审查报告称，工作时间超过55小时 在欧洲劳动力中，一周与心血管疾病死亡率的高风险相关。然而，这个协会 尚未在美国工作人口中进行系统调查，这构成了一个关键的研究空白 要求解决。我们的目标是根据PAR-18-798进行二次数据分析，以更好地 使用获得的数据，了解美国长时间工作与心血管疾病死亡风险之间的关系 来自国家健康访谈调查(NHIS)的一系列研究。NHIS是每年更新的、大型的、 具有全国代表性和丰富的数据集，包含详细的人口统计信息、工作条件、 以及健康和疾病状况。NHIS数据集代表着调查 长时间工作对心血管疾病死亡率过高的贡献。我们建议使用1997年的NHIS样本数据- 2014年和截至2015年的NHIS死亡率数据，以检查长时间工作与心血管疾病之间的联系 死亡率，累计随访18年。我们的具体目标是(1)调查 长时间工作与心血管疾病总死亡率的关系；(2)调查长时间工作与心脏病的关系 死亡率和中风死亡率；以及(3)人口状况(年龄、性别、种族、地区、 和社会经济地位(SES)在长时间工作与心血管疾病总死亡率、心脏 疾病死亡率和中风死亡率。我们假设Long和Long之间存在剂量-反应关系 美国工作人口的工作时间和心血管疾病死亡率，这一关联将被修改 根据社会和人口统计特征。我们在中期的预期产出和结果 预期特定目标的成功实现，构成提供高质量、稳健的 在美国，评估长时间工作与心血管疾病死亡率之间关系的科学证据。 国家和全球相关性，并解决国家职业研究议程(NORA)设定的目标 卫生工作设计和福利部门和Nora癌症、生殖、心血管和其他 跨行业的慢性病预防。该项目最终的长期社会影响和贡献 将是利用这些数据来形成和告知与限制 工作时间，以预防心血管疾病。这代表着应用研究的最关键的机会 实施(R2P)方法降低心血管疾病的职业死亡负担。

ABSTRACT Cardiovascular disease (CVD, including heart disease and stroke) is the leading cause of death worldwide and in the United States (U.S.), accounting for 2.8 million deaths in 2018 alone and with a prevalence nearing 50%.1,2 Related to this are long working hours, which remain quite high in the U.S. when compared to other countries.3,4 Recently, a series of systematic reviews and meta-analyses have identified a robust and dose-dependent relationship between long working hours and CVD.5–9 These reviews reported that working more than 55 hours a week was associated with a higher risk of CVD mortality in the European workforce. However, this association has not yet been systematically investigated in U.S. working populations, constituting a critical research gap that demands address. Our objective is to conduct secondary data analysis, in response to PAR-18-798, to better understand the relationship between long working hours and CVD mortality risk in the U.S., using data obtained from the National Health Interview Survey (NHIS) series of studies. The NHIS is an annually updated, large, nationally representative, and rich dataset featuring detailed information on demographics, working conditions, and health and disease status. The NHIS dataset represents a premiere opportunity to investigate the contribution of long working hours to excess CVD mortality. We propose to use the NHIS sample data from 1997- 2014 and the NHIS mortality data up to 2015 to examine associations between long working hours and CVD mortality, with a cumulative total of 18 years of follow-up. Our specific aims are to (1) investigate associations of long working hours with total CVD mortality; (2) investigate associations of long working hours with heart disease mortality as well as stroke mortality; and (3) test effect modification of demographic status (age, sex, race, region, and socioeconomic status (SES)) in the associations of long working hours with total CVD mortality, heart disease mortality, and stroke mortality, respectively. We hypothesize a dose-response relationship between long working hours and CVD mortality amongst the U.S. working population, and that this association will be modified by social and demographic characteristics. Our expected outputs and outcomes in the intermediate term anticipate the successful achievement of the specific aims, constituting the provision of high-quality, robust scientific evidence assessing the association of long working hours to CVD mortality in the U.S. This project has national and global relevance, and addresses goals set by the National Occupational Research Agenda (NORA) Health Work Design and Well-being sector and the NORA Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention cross-sectors. The ultimate long-term societal impact and contribution of this project would be to leverage such data to shape and inform interventional policy directives related to the limitation of working hours for the sake of CVD prevention. This represents a most critical opportunity in applying a Research to Practice (r2p) approach in reducing the occupational mortality burden of CVD.