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Meta-Analysis
. 2012 Oct 1;176(7):586-96.
doi: 10.1093/aje/kws139. Epub 2012 Sep 5.

Long working hours and coronary heart disease: a systematic review and meta-analysis

Marianna Virtanen  1 , Katriina Heikkilä, Markus Jokela, Jane E Ferrie, G David Batty, Jussi Vahtera, Mika Kivimäki
Affiliations
Meta-Analysis

Long working hours and coronary heart disease: a systematic review and meta-analysis

Marianna Virtanen et al. Am J Epidemiol. .

Abstract

The authors aggregated the results of observational studies examining the association between long working hours and coronary heart disease (CHD). Data sources used were MEDLINE (through January 19, 2011) and Web of Science (through March 14, 2011). Two investigators independently extracted results from eligible studies. Heterogeneity between the studies was assessed using the I(2) statistic, and the possibility of publication bias was assessed using the funnel plot and Egger's test for small-study effects. Twelve studies were identified (7 case-control, 4 prospective, and 1 cross-sectional). For a total of 22,518 participants (2,313 CHD cases), the minimally adjusted relative risk of CHD for long working hours was 1.80 (95% confidence interval (CI): 1.42, 2.29), and in the maximally (multivariate-) adjusted analysis the relative risk was 1.59 (95% CI: 1.23, 2.07). The 4 prospective studies produced a relative risk of 1.39 (95% CI: 1.12, 1.72), while the corresponding relative risk in the 7 case-control studies was 2.43 (95% CI: 1.81, 3.26). Little evidence of publication bias but relatively large heterogeneity was observed. Studies varied in size, design, measurement of exposure and outcome, and adjustments. In conclusion, results from prospective observational studies suggest an approximately 40% excess risk of CHD in employees working long hours.

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Figures

Figure 1.
Figure 1.
Search strategy for published observational studies on the association between long working hours and coronary heart disease. Data sources used were MEDLINE (through January 19, 2011) and Web of Science (through March 14, 2011).
Figure 2.
Figure 2.
Minimally adjusted relative risk (RR) of coronary heart disease in employees working long hours among studies published through spring 2011. Bars, 95% confidence interval (CI). (CC, case-control; CS, cross-sectional; PC, prospective cohort; UK, United Kingdom; US, United States).
Figure 3.
Figure 3.
Relative risk (RR) of coronary heart disease in employees working long hours among studies published through spring 2011, according to type of statistical adjustment, study design, region, cutpoint used to define long hours, and sex. Bars, 95% confidence interval (CI). (SEP, socioeconomic position; UK, United Kingdom; US, United States).
Figure 4.
Figure 4.
Funnel plot of the relative risk (RR) of coronary heart disease according to long working hours, with pseudo-95% confidence intervals (dashed lines).
See this image and copyright information in PMC

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