The Lancet: Risk of cardiovascular death surges by 52% before retirement!

Although overtime has gradually become a "must have literacy" for migrant workers, more and more evidence shows that it is harmful to health
.

According to the World Health Organization (WHO) , 450 million people worldwide work more than 55 hours a week, resulting in 745,000 deaths from heart disease and stroke each year

Coronary heart disease in the World Health Organization (WHO) cohort study

Current evidence on working hours and disease risk has at least three limitations
.

First, while there are many studies on specific health outcomes, few studies examine multiple diseases simultaneously to comprehensively assess the association of poor health with long working hours

high atherosclerotic plaque

To address these limitations, this study will investigate the association of long working hours with 46 common physical and mental health conditions and 4 mortality outcomes
.

To more accurately estimate exposure time, we restricted disease and mortality monitoring to age 65 (the universal legal retirement age)

This study pooled individual participant data from two Finnish prospective cohort studies : the Finnish Public Sector (FPS, N = 44 635) study and the Health and Social Support (HeSSup, N = 14 964) study
.

The sample selection is shown in Figure 1 .

Individual participant data from two Finnish prospective cohort studies were pooled: the Finnish Public Sector (FPS, N = 44 635) study and the Health and Social Support (HeSSup, N = 14 964) study

In the primary analysis, 2747 (4 6%) of 59599 participants were classified as working long hours (≥55 h/week)
.

Among them, long-time work accounted for 9.
6% of men and 2.
9% of women, and was more common in relatively low socioeconomic groups

The mean follow-up time for disease onset was 13.

8 (SD = 2 8) years, and the time to death was 15.
3 (SD = 3 5) years

For 14 of the 50 diseases (28%), higher morbidity and mortality risks were associated with long working hours

Evidence of dose-response associations across work-hour categories was observed for infections, sleep disturbances, rheumatoid arthritis, sciatica, circulatory and respiratory symptoms, injuries and falls ( Figure 2)
.

When we examined interactions, these relationships did not differ according to gender or socioeconomic status, with one exception: low socioeconomic status compared with high socioeconomic status (1.

Evidence of dose-response associations across work-hour categories was observed for infections, sleep disturbances, rheumatoid arthritis, sciatica, circulatory and respiratory symptoms, injuries and falls ( Figure 2)
.
Figure 2)
.
When we examined interactions, these relationships did not differ according to gender or socioeconomic status, with one exception: low socioeconomic status compared with high socioeconomic status (1.
12; 0 86-1 46; p<0.
03 for each other) The association of long working hours with bacterial infection was more pronounced among participants with economic status (2.
09; 1.
49-2 93)
.
The PAF of long working hours for 14 health outcomes was between 0.
7% for musculoskeletal disease and 3.
3% for cardiovascular death (Table 2)
.
The PAF of long working hours for 14 health outcomes was between 0.
7% for musculoskeletal disease and 3.
3% for cardiovascular death (Table 2)
.

As shown in Figure 3 , long working hours were associated with all-cause mortality (follow-up to age 65: 1.
04, 0.
84-1.
29; maximum follow-up: 1.
01, 0.
84-1.
20), cancer-related deaths ( 0.
78; 0.
54-1.
14 and 0.
85; 0.
64-1.
13) or death from cardiovascular disease or all causes other than cancer (1.
05; 0.
75-1.
47 and 0·99; 0·74-1·32) are irrelevant
.
In absolute terms, all differences in mortality outcomes between long-worked and standard-time participants were small
.
Early cardiovascular mortality was 2.
5 per 10,000 person-years in participants who worked long hours and 1.
7 per 10,000 person-years in participants who worked long hours
.
All-cause mortality was similar in these groups
.
In analyses with maximum follow-up, no differences in cause-specific or overall mortality were observed between long and regular working hours
.
Cumulative hazard of death by age, sex and working hours confirmed that there was no difference in mortality between participants working long hours and standard hours
.

As shown in Figure 33 , long working hours were associated with all-cause mortality (follow-up to age 65: 1.
04, 0.
84-1.
29; maximum follow-up: 1.
01, 0.
84-1.
20), cancer-related deaths (0.
78; 0.
54-1.
14 and 0.
85; 0.
64-1.
13) or death from cardiovascular disease or all causes other than cancer (1.
05; 0.
75-1.
47 and 0·99; 0·74-1·32)
.
In absolute terms, all differences in mortality outcomes between long-worked and standard-time participants were small
.
Early cardiovascular mortality was 2.
5 per 10,000 person-years in participants who worked long hours and 1.
7 per 10,000 person-years in participants who worked long hours
.
All-cause mortality was similar in these groups
.
In analyses with maximum follow-up, no differences in cause-specific or overall mortality were observed between long and regular working hours
.
Cumulative hazard of death by age, sex and working hours confirmed that there was no difference in mortality between participants working long hours and standard hours
.

In the validation cohort, 44,262 participants experienced disease for 8.
1 years and death for 9.
4 years
.
It also verified that increased risk of bacterial infection, cardiovascular death, diabetes, injury, and musculoskeletal disease remains associated with long working hours (Figure 4)
.
The numbers in the validation cohort were insufficient to analyze epilepsy, sleep disturbance, sciatica, and rheumatoid arthritis
.

In the validation cohort, 44,262 participants experienced disease for 8.
1 years and death for 9.
4 years
.
It also verified that increased risk of bacterial infection, cardiovascular death, diabetes, injury, and musculoskeletal disease remains associated with long working hours (Figure 4)
.
The numbers in the validation cohort were insufficient to analyze epilepsy, sleep disturbance, sciatica, and rheumatoid arthritis
.

The sequence of disease occurrence was next analyzed, including bacterial infection, diabetes, injury, musculoskeletal disease, and cardiovascular death ( Fig.
5)
.
Diabetes was associated with cardiovascular death (2·87; 1·05-7·84) and bacterial infections (3·68; 2·19-6·17)
.
Bacterial infections are associated with diabetes (2·22; 1·20-4·09)
.

The sequence of disease occurrence was next analyzed, including bacterial infection, diabetes, injury, musculoskeletal disease, and cardiovascular death ( Fig.
5)
.
Diabetes was associated with cardiovascular death (2·87; 1·05-7·84) and bacterial infections (3·68; 2·19-6·17)
.
Bacterial infections are associated with diabetes (2·22; 1·20-4·09)
.
Figure 5)
.
Figure 5)
.

Furthermore, the associations between diabetes and musculoskeletal disease, bacterial infection, musculoskeletal disease and diabetes, and injury and musculoskeletal disease were weak (all hazard ratios <2.
0)
.
Despite these associations, workers who worked long hours had a higher risk of being more ill (at least two of the following: bacterial infections, diabetes, musculoskeletal disorders, injuries, early cardiovascular death) compared with these standard hours of work (1.
27 ; 1·11-1.
47) only slightly higher
.

Furthermore, the associations between diabetes and musculoskeletal disease, bacterial infection, musculoskeletal disease and diabetes, and injury and musculoskeletal disease were weak (all hazard ratios <2.
0)
.
Despite these associations, workers who worked long hours had a higher risk of being more ill (at least two of the following: bacterial infections, diabetes, musculoskeletal disorders, injuries, early cardiovascular death) compared with these standard hours of work (1.
27 ; 1·11-1.
47) only slightly higher
.
sickly

Taken together, long working hours were consistently associated with a range of health events in this full-outcome-scope multigroup study
.
Overall, strong associations were demonstrated for 6 (12%) of the 50 disease endpoints studied
.
People who worked more than 55 hours a week had a 52% increased risk of dying from cardiovascular disease before age 65, as well as an increased risk of bacterial infections, diabetes, and cardiovascular death
.
No evidence of gender differences in these associations was found, but the association between long working hours and infectious diseases was only observed among employees of lower socioeconomic status
.

Taken together, long working hours were consistently associated with a range of health events in this full-outcome-scope multigroup study
.
Overall, strong associations were demonstrated for 6 (12%) of the 50 disease endpoints studied
.
People who worked more than 55 hours a week had a 52% increased risk of dying from cardiovascular disease before age 65, as well as an increased risk of bacterial infections, diabetes, and cardiovascular death
.
No evidence of gender differences in these associations was found, but the association between long working hours and infectious diseases was only observed among employees of lower socioeconomic status
.
People who worked more than 55 hours per week had a 52% increased risk of dying from cardiovascular disease before age 65, and increased risk of death from bacterial infections, diabetes, cardiovascular disease, and those who worked more than 55 hours per week, before age 65 52% increased risk of dying from cardiovascular disease, and increased risk of bacterial infections, diabetes, cardiovascular death

 

Original source:

J.
Ervasti et al.
Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries.
The Lancet Regional Health - Europe 11 (2021) 100212

https://doi.
org/10.
1016/j.
lanepe.
2021.
100212

https://doi.
org/10.
1016/j.
lanepe.
2021.
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