Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals

Mika Kivimäki; Marianna Virtanen; Ichiro Kawachi; Solja T Nyberg; Lars Alfredsson; G David Batty; Jakob B Bjorner; Marianne Borritz; Eric J Brunner; Hermann Burr; Nico Dragano; Jane E Ferrie; Eleonor I Fransson; Mark Hamer; Katriina Heikkilä; Anders Knutsson; Markku Koskenvuo; Ida E H Madsen; Martin L. Nielsen; Maria Nordin; Tuula Oksanen; Jan H Pejtersen; Jaana Pentti; Reiner Rugulies; Paula Salo; Johannes Siegrist; Andrew Steptoe; Sakari Suominen; Töres Theorell; Jussi Vahtera; Peter J M Westerholm; Hugo Westerlund; Archana Singh-Manoux; Markus Jokela

doi:10.1016/S2213-8587(14)70178-0

Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals

Mika Kivimäki, Marianna Virtanen, Ichiro Kawachi, Solja T Nyberg, Lars Alfredsson, G David Batty, Jakob B Bjorner, Marianne Borritz, Eric J Brunner, Hermann Burr, Nico Dragano, Jane E Ferrie, Eleonor I Fransson, Mark Hamer, Katriina Heikkilä, Anders Knutsson, Markku Koskenvuo, Ida E H Madsen, Martin L. Nielsen, Maria NordinTuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Johannes Siegrist, Andrew Steptoe, Sakari Suominen, Töres Theorell, Jussi Vahtera, Peter J M Westerholm, Hugo Westerlund, Archana Singh-Manoux, Markus Jokela

122 Citations (Scopus)

Abstract

BACKGROUND: Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.

METHODS: We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.

FINDINGS: During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35-40 h) was 1·07 (95% CI 0·89-1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I²=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06-1·57, difference in incidence 13 per 10 000 person-years, I²=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80-1·25, incidence difference zero per 10 000 person-years, I(2)=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.

INTERPRETATION: In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.

FUNDING: Medical Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.

Original language	English
Journal	The Lancet Diabetes & Endocrinology
Volume	3
Issue number	1
Pages (from-to)	27-34
Number of pages	8
ISSN	2213-8587
DOIs	https://doi.org/10.1016/S2213-8587(14)70178-0
Publication status	Published - 1 Jan 2015

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Kivimäki, M., Virtanen, M., Kawachi, I., Nyberg, S. T., Alfredsson, L., Batty, G. D., Bjorner, J. B., Borritz, M., Brunner, E. J., Burr, H., Dragano, N., Ferrie, J. E., Fransson, E. I., Hamer, M., Heikkilä, K., Knutsson, A., Koskenvuo, M., Madsen, I. E. H., Nielsen, M. L., ... Jokela, M. (2015). Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals. The Lancet Diabetes & Endocrinology, 3(1), 27-34. https://doi.org/10.1016/S2213-8587(14)70178-0

Kivimäki, M, Virtanen, M, Kawachi, I, Nyberg, ST, Alfredsson, L, Batty, GD, Bjorner, JB, Borritz, M, Brunner, EJ, Burr, H, Dragano, N, Ferrie, JE, Fransson, EI, Hamer, M, Heikkilä, K, Knutsson, A, Koskenvuo, M, Madsen, IEH, Nielsen, ML, Nordin, M, Oksanen, T, Pejtersen, JH, Pentti, J, Rugulies, R, Salo, P, Siegrist, J, Steptoe, A, Suominen, S, Theorell, T, Vahtera, J, Westerholm, PJM, Westerlund, H, Singh-Manoux, A & Jokela, M 2015, 'Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals', The Lancet Diabetes & Endocrinology, vol. 3, no. 1, pp. 27-34. https://doi.org/10.1016/S2213-8587(14)70178-0

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title = "Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals",

abstract = "BACKGROUND: Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.METHODS: We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.FINDINGS: During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35-40 h) was 1·07 (95% CI 0·89-1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I2=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06-1·57, difference in incidence 13 per 10 000 person-years, I2=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80-1·25, incidence difference zero per 10 000 person-years, I(2)=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.INTERPRETATION: In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.FUNDING: Medical Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.",

author = "Mika Kivim{\"a}ki and Marianna Virtanen and Ichiro Kawachi and Nyberg, {Solja T} and Lars Alfredsson and Batty, {G David} and Bjorner, {Jakob B} and Marianne Borritz and Brunner, {Eric J} and Hermann Burr and Nico Dragano and Ferrie, {Jane E} and Fransson, {Eleonor I} and Mark Hamer and Katriina Heikkil{\"a} and Anders Knutsson and Markku Koskenvuo and Madsen, {Ida E H} and Nielsen, {Martin L.} and Maria Nordin and Tuula Oksanen and Pejtersen, {Jan H} and Jaana Pentti and Reiner Rugulies and Paula Salo and Johannes Siegrist and Andrew Steptoe and Sakari Suominen and T{\"o}res Theorell and Jussi Vahtera and Westerholm, {Peter J M} and Hugo Westerlund and Archana Singh-Manoux and Markus Jokela",

year = "2015",

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day = "1",

doi = "10.1016/S2213-8587(14)70178-0",

language = "English",

volume = "3",

pages = "27--34",

journal = "The Lancet Diabetes & Endocrinology",

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TY - JOUR

T1 - Long working hours, socioeconomic status, and the risk of incident type 2 diabetes

T2 - a meta-analysis of published and unpublished data from 222,120 individuals

AU - Kivimäki, Mika

AU - Virtanen, Marianna

AU - Kawachi, Ichiro

AU - Nyberg, Solja T

AU - Alfredsson, Lars

AU - Batty, G David

AU - Bjorner, Jakob B

AU - Borritz, Marianne

AU - Brunner, Eric J

AU - Burr, Hermann

AU - Dragano, Nico

AU - Ferrie, Jane E

AU - Fransson, Eleonor I

AU - Hamer, Mark

AU - Heikkilä, Katriina

AU - Knutsson, Anders

AU - Koskenvuo, Markku

AU - Madsen, Ida E H

AU - Nielsen, Martin L.

AU - Nordin, Maria

AU - Oksanen, Tuula

AU - Pejtersen, Jan H

AU - Pentti, Jaana

AU - Rugulies, Reiner

AU - Salo, Paula

AU - Siegrist, Johannes

AU - Steptoe, Andrew

AU - Suominen, Sakari

AU - Theorell, Töres

AU - Vahtera, Jussi

AU - Westerholm, Peter J M

AU - Westerlund, Hugo

AU - Singh-Manoux, Archana

AU - Jokela, Markus

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.METHODS: We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.FINDINGS: During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35-40 h) was 1·07 (95% CI 0·89-1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I2=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06-1·57, difference in incidence 13 per 10 000 person-years, I2=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80-1·25, incidence difference zero per 10 000 person-years, I(2)=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.INTERPRETATION: In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.FUNDING: Medical Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.

AB - BACKGROUND: Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.METHODS: We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.FINDINGS: During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35-40 h) was 1·07 (95% CI 0·89-1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I2=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06-1·57, difference in incidence 13 per 10 000 person-years, I2=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80-1·25, incidence difference zero per 10 000 person-years, I(2)=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.INTERPRETATION: In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.FUNDING: Medical Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.

U2 - 10.1016/S2213-8587(14)70178-0

DO - 10.1016/S2213-8587(14)70178-0

M3 - Review

C2 - 25262544

SN - 2213-8587

VL - 3

SP - 27

EP - 34

JO - The Lancet Diabetes & Endocrinology

JF - The Lancet Diabetes & Endocrinology

IS - 1

ER -

Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals

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