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Meta-Analysis
. 2015 Jan 13:350:g7772.
doi: 10.1136/bmj.g7772.

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

Marianna Virtanen  1 , Markus Jokela  2 , Solja T Nyberg  3 , Ida E H Madsen  4 , Tea Lallukka  5 , Kirsi Ahola  3 , Lars Alfredsson  6 , G David Batty  7 , Jakob B Bjorner  4 , Marianne Borritz  8 , Hermann Burr  9 , Annalisa Casini  10 , Els Clays  11 , Dirk De Bacquer  11 , Nico Dragano  12 , Raimund Erbel  13 , Jane E Ferrie  14 , Eleonor I Fransson  15 , Mark Hamer  16 , Katriina Heikkilä  17 , Karl-Heinz Jöckel  18 , France Kittel  10 , Anders Knutsson  19 , Markku Koskenvuo  20 , Karl-Heinz Ladwig  21 , Thorsten Lunau  12 , Martin L Nielsen  22 , Maria Nordin  23 , Tuula Oksanen  3 , Jan H Pejtersen  24 , Jaana Pentti  3 , Reiner Rugulies  25 , Paula Salo  26 , Jürgen Schupp  27 , Johannes Siegrist  12 , Archana Singh-Manoux  28 , Andrew Steptoe  16 , Sakari B Suominen  29 , Töres Theorell  30 , Jussi Vahtera  31 , Gert G Wagner  32 , Peter J M Westerholm  33 , Hugo Westerlund  30 , Mika Kivimäki  34
Affiliations
Meta-Analysis

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

Marianna Virtanen et al. BMJ. .

Abstract

Objective: To quantify the association between long working hours and alcohol use.

Design: Systematic review and meta-analysis of published studies and unpublished individual participant data.

Data sources: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.

Review methods: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.

Results: Cross sectional analysis was based on 61 studies representing 333,693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100,602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥ 55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.

Conclusions: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work other than those mentioned above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Search strategy and selection of studies for meta-analysis of effect of long working hours on alcohol use
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Fig 2 Cross sectional associations between long working hours and alcohol use from individual participant data adjusted for sex, age, socioeconomic status, and ethnicity
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Fig 3 Cross sectional associations between long working hours and alcohol use from published data
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Fig 4 Funnel plot with pseudo 95% confidence limits stratified by whether long working hours and alcohol use was main or secondary research question
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Fig 5 Associations between long working hours and new onset risky alcohol use (individual participant data adjusted for sex, age, socioeconomic status, and ethnicity at baseline)
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Fig 6 Pooled associations between long working hours and new onset risky alcohol use by sex, age group, socioeconomic status, geographic region, sample type, and prevalence of risky alcohol use in cohort
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Fig 7 Pooled association between weekly working hours and new onset risky alcohol use, adjusted for sex, age, socioeconomic status, and ethnicity at baseline
See this image and copyright information in PMC

Comment in

References

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