Long Working Hours, Socioeconomic Status, and the Risk of Incident Type 2 Diabetes: a Meta-analysis of Published and Unpublished Data from 222 120 Individuals

Overview

Journal Lancet Diabetes Endocrinol

Specialty Endocrinology

Date 2014 Sep 29

PMID 25262544

Citations 97

Authors

Mika Kivimaki

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 Heikkila

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

Tores Theorell

Jussi Vahtera

Peter J M Westerholm

Hugo Westerlund

Archana Singh-Manoux

Markus Jokela

Affiliations

Soon will be listed here.

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 Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access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 Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.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 (I(2)=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, I(2)=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.

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