Shift Work and the Risk of Cardiometabolic Multimorbidity Among Patients With Hypertension: A Prospective Cohort Study of UK Biobank

Abstract

Background Although the association between shift work and individual cardiometabolic diseases has been well studied, its role in the progression to cardiometabolic multimorbidity (CMM) remains unclear. In this study, we investigate the association between shift work and the incidence of CMM in patients with hypertension. Methods and Results This study is a population-based and prospective cohort study on 36 939 UK Biobank participants. We used competing risk models to examine the association between shift work and the risk of CMM, which was defined as coexistence of hypertension and diabetes, coronary heart disease, or stroke in our study. We also investigated the association between the frequency and duration of shift work and CMM risks. In addition, we conducted a cross-classification analysis with the combination of frequency and duration of shift work, chronotype and sleep duration as the exposure metrics. During a median follow-up of 11.6 years, a total of 5935 participants developed CMM. We found that usually/always night shift workers were associated with a 16% higher risk of CMM compared with day workers (hazard ratio [HR], 1.16 [95% CI, 1.02-1.31]). We also found that a higher frequency of night shifts (>10/month) was associated with increased risk of CMM (HR, 1.19 [95% CI, 1.06-1.34]) that was more pronounced for >10/month in combination with a morning chronotype or <7 hours or >8 hours of sleep duration (HR, 1.26 [95% CI, 1.02-1.56]; HR, 1.43 [95% CI, 1.19-1.72], respectively). Conclusions We find that night shift work is associated with higher CMM risk in patients with hypertension.

Keywords: biological specimen banks; follow‐up studies; incidence; multimorbidity; prospective studies; shift work schedule.

Figure 1. Current night shift work and cardiometabolic multimorbidity risk among patients with hypertension in the UK Biobank stratified by potential risk factors.

Associations of shift work and risk of cardiometabolic multimorbidity were stratified by body mass index, sex, sleep duration, chronotype, alcohol consumption, smoking status, and physical activity. The model was adjusted for age, sex, race or ethnicity, smoking status, alcohol consumption, Townsend Deprivation Index, physical activity, body mass index, education, sleep duration, chronotype, antihypertensive medication use, lipid‐lowering medication use, and aspirin use. BMI indicates body mass index; and HR, hazard ratio.