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  • 1.
    Dragano, Nico
    et al.
    Univ Dusseldorf, Dusseldorf, Germany.
    Siegrist, Johannes
    Univ Dusseldorf, Dusseldorf, Germany.
    Nyberg, Solja T.
    Univ Helsinki, Helsinki, Finland.
    Lunau, Thorsten
    Univ Dusseldorf, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Karolinska Inst, Stockholm; Jönköping Univ, Jönköping; Stockholm Univ, Stockholm.
    Alfredsson, Lars
    Karolinska Inst, Stockholm; Stockholm City Council, Stockholm.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Frederiksberg Univ Hosp, Copenhagen, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Erbel, Raimund
    Univ Duisburg Essen, Essen, Germany.
    Fahlen, Goran
    Natl Agcy Special Needs Educ & Sch, Härnösand.
    Goldberg, Marcel
    Paris Descartes Univ, Paris, France.
    Hamer, Mark
    UCL, London, England; Univ Loughborough, Loughborough, Leics, England.
    Heikkila, Katriina
    London Sch Hyg & Trop Med, London, England; Royal Coll Surgeons England, London, England.
    Joeckel, Karl-Heinz
    Univ Duisburg Essen, Essen, Germany.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Viby J, Denmark.
    Nordin, Maria
    Stockholm Univ, Stockholm; Umeå Univ, Umeå.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland; Finnish Inst Occupat Hlth, Tampere, Finland; Finnish Inst Occupat Hlth, Turku, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland; Finnish Inst Occupat Hlth, Tampere, Finland; Finnish Inst Occupat Hlth, Turku, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark; Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark; Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland; Finnish Inst Occupat Hlth, Tampere, Finland; Finnish Inst Occupat Hlth, Turku, Finland; Univ Turku, Dept Psychol, Turku, Finland.
    Schupp, Juergen
    German Inst Econ Res, Berlin, Germany.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Theorell, Tores
    Stockholm Univ, Stockholm, Sweden.
    Vahtera, Jussi
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter J. M.
    Uppsala Univ, Uppsala.
    Westerlund, Hugo
    Stockholm Univ, Stockholm, Sweden.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland; Finnish Inst Occupat Hlth, Tampere, Finland; Finnish Inst Occupat Hlth, Turku, Finland.
    Zins, Marie
    Paris Descartes Univ, Paris, France; Univ Paris Saclay, Paris, France.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London , England.
    Kivimäki, Mika
    Univ Helsinki, Fac Med, Helsinki, Finland; UCL, London, England; Finnish Inst Occupat Hlth, Helsinki, Finland; Finnish Inst Occupat Hlth, Tampere, Finland; Finnish Inst Occupat Hlth, Turku, Finland.
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals2017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

    Methods: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

    Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

    Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  • 2.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, England.
    Nyberg, Solja T.
    Univ Helsinki, Helsinki, Finland.
    Batty, G. David
    UCL, England.
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Boston, USA.
    Jokela, Markus
    Univ Helsinki, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Stockholm.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen O, Denmark.
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Copenhagen NV, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Dragano, Nico
    Univ Dusseldorf, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Jönköping Univ, Jönköping.
    Heikkilä, Katriina
    London Sch Hyg & Trop Med, London, England.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Helsinki, Finland.
    Kumari, Meena
    Univ Essex, Essex, England.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen O, Denmark.
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Denmark.
    Nordin, Maria
    Stockholm Univ, Stockholm.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen K, Denmark.
    Pentti, Jaana
    Univ Helsinki, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen O, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Shipley, Martin J.
    UCL, London, England.
    Suominen, Sakari
    Univ Skövde, Skövde.
    Theorell, Töres
    Stockholm Univ, Stockholm.
    Vahtera, Jussi
    Univ Turku, Turku, Finland.
    Westerholm, Peter
    Uppsala Univ, Uppsala.
    Westerlund, Hugo
    Stockholm Univ, Stockholm.
    Steptoe, Andrew
    UCL, London, England.
    Singh-Manoux, Archana
    Hop Paul Brousse, Villejuif, France.
    Hamer, Mark
    Loughborough Univ Technol, Leics, England.
    Ferrie, Jane E.
    Univ Bristol, Avon, England.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Tabak, Adam G.
    UCL, London, England.
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week.

    Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association.

    Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

  • 3.
    Kivimäki, Mika
    et al.
    Univ Helsinki, Helsinki, Finland; UCL, London, England.
    Pentti, Jaana
    Univ Helsinki, Helsinki, Finland; Univ Turku, Turku, Finland.
    Ferrie, Jane E.
    UCL, London, England; Univ Bristol, Avon, England.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England..
    Nyberg, Solja T.
    Univ Helsinki, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala Univ, Uppsala.
    Alfredsson, Lars
    Stockholm Cty Council, Stockholm; Karolinska Inst, Stockholm.
    Dragano, Nico
    Univ Dusseldorf, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Stockholm Cty Council, Stockholm; Jönköping Univ, Jönköping; Stockholm Univ, Stockholm.
    Goldberg, Marcel
    INSERM, Populat Based Epidemiol Cohorts Unit, Villejuif, France; Versailles St Quentin Univ, Villejuif, France.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Helsinki, Finland; SWPS Univ Social Sci & Humanities Wroclaw, Wroclaw, Poland; Queens Univ Belfast, Belfast, North Ireland.
    Luukkonen, Ritva
    Univ Helsinki, Helsinki, Finland.
    Oksanen, Tuula
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark; Univ Copenhagen, Copenhagen, Denmark.
    Siegrist, Johannes
    Univ Dusseldorf, Dusseldorf, Germany.
    Singh-Manoux, Archana
    UCL, London, England; Ctr Res Epidemiol & Populat Hlth, INSERM, Villejuif, France.
    Suominen, Sakari
    Univ Turku, Turku, Finland; Folkhälsan Res Ctr, Helsinki, Finland; Univ Skövde, Skövde; Univ Kent, Canterbury, Kent, England.
    Theorell, Tores
    Stockholm Univ, Stockholm; Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vaananen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vahtera, Jussi
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter J. M.
    Uppsala Univ, Uppsala.
    Westerlund, Hugo
    Stockholm Univ, Stockholm.
    Zins, Marie
    INSERM, Populat Based Epidemiol Cohorts Unit, Villejuif, France; Versailles St Quentin Univ, Villejuif, France.
    Strandberg, Timo
    Univ Helsinki, Helsinki, Finland; Helsinki Univ Hosp, Helsinki, Finland; Univ Oulu, Oulu, Finland.
    Steptoe, Andrew
    UCL, London, England..
    Deanfield, John
    UCL, London, England.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713Article in journal (Refereed)
    Abstract [en]

    Background Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease. Methods In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease. Results We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41). Interpretation In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

  • 4.
    Kivimäki, Mika
    et al.
    UCL, London, England; Univ Helsinki, Helsinki, Finland; Univ Helsinki, Helsinki, Finland.
    Singh-Manoux, Archana
    UCL, London, England; INSERM, Paris, France.
    Pentti, Jaana
    Univ Helsinki, Helsinki, Finland; Univ Turku, Turku, Finland.
    Sabia, Severine
    UCL, London, England; INSERM, Paris, France.
    Nyberg, Solja T.
    Univ Helsinki, Helsinki, Finland.
    Alfredsson, Lars
    Karolinska Inst, Stockholm.
    Goldberg, Marcel
    INSERM, Villejuif, France.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Helsinki, Finland; SWPS Univ Social Sci & Humanities Wroclaw, Wroclaw, Poland; Queens Univ Belfast, Belfast, Antrim, North Ireland.
    Nordin, Maria
    Stockholm Univ, Stockholm; Umeå Univ, Umeå.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Strandberg, Timo
    Univ Helsinki, Helsinki, Finland; Helsinki Univ Hosp, Helsinki, Finland; Univ Oulu, Oulu, Finland.
    Suominen, Sakari B.
    Univ Turku, Turku, Finland; Univ Skövde, Skövde.
    Theorell, Töres
    Stockholm Univ, Stockholm.
    Vahtera, Jussi
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Väänänen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Virtanen, Marianna
    Univ Eastern Finland, Joensuu, Finland.
    Westerholm, Peter
    Uppsala Univ, Uppsala.
    Westerlund, Hugo
    Stockholm Univ, Stockholm.
    Zins, Marie
    INSERM, Villejuif, France.
    Seshadri, Sudha
    Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX USA; Framingham Heart Dis Epidemiol Study, Framingham, MA USA.
    Batty, G. David
    UCL, London, England.
    Sipilä, Pyry N.
    Univ Bristol, Bristol, Avon, England.
    Shipley, Martin J.
    UCL, London, England.
    Lindbohm, Joni V.
    Univ Helsinki, Helsinki, Finland.
    Ferrie, Jane E.
    UCL, London, England; Univ Bristol, Bristol, Avon, England.
    Jokela, Markus
    Univ Helsinki, Helsinki, Finland.
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia.

    DESIGN Meta-analysis of 19 prospective observational cohort studies.

    DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies.

    REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis.

    RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14).

    CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

  • 5.
    Nyberg, Solja T.
    et al.
    Univ Helsinki, Helsinki, Finland.
    Batty, G. David
    UCL, London, England.
    Pentti, Jaana
    Univ Helsinki, Helsinki, Finland; Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland; Uppsala Univ, Uppsala; Univ Stockholm, Stockholm.
    Alfredsson, Lars
    Stockholm Cty Council, Stockholm; Karolinska Inst, Stockholm.
    Fransson, Eleonor I.
    Univ Stockholm, Stockholm; Jönköping Univ, Jönköping.
    Goldberg, Marcel
    Paris Descartes Univ, Paris, France; INSERM, Villejuif, France.
    Heikkila, Katriina
    London Sch Hyg & Trop Med, London, England; Royal Coll Surgeons England, London, England.
    Jokela, Markus
    Univ Helsinki, Helsinki, Finland.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Helsinki, Finland.
    Lallukka, Tea
    Univ Helsinki, Helsinki, Finland; Finnish Inst Occupat Hlth, Helsinki, Finland.
    Leineweber, Constanze
    Univ Stockholm, Stockholm.
    Lindbohm, Joni V.
    Univ Helsinki, Helsinki, Finland.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Hanson, Linda L. Magnusson
    Univ Stockholm, Stockholm, Sweden.
    Nordin, Maria
    Univ Stockholm, Stockholm; Umeå Univ, Umeå.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pietilainen, Olli
    Univ Helsinki, Helsinki, Finland.
    Rahkonen, Ossi
    Univ Helsinki, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark; Univ Copenhagen, Copenhagen, Denmark.
    Shipley, Martin J.
    UCL, London, England; INSERM, Villejuif, France.
    Stenholm, Sari
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland; Univ Tampere, Tampere, Finland.
    Suominen, Sakari
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland; Univ Skövde, Skövde.
    Theorell, Tores
    Univ Stockholm, Stockholm.
    Vahtera, Jussi
    Univ Turku, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter J. M.
    Uppsala Univ, Uppsala; Univ Stockholm, Stockholm.
    Westerlund, Hugo
    Zins, Marie
    Paris Descartes Univ, Paris, France.
    Hamer, Mark
    Loughborough Univ Technol, Loughborough, Leics, England.
    Singh-Manoux, Archana
    UCL, London, England.
    Bell, Joshua A.
    Univ Bristol, MRC, Bristol, Avon, England.
    Ferrie, Jane E.
    UCL, London, England; Univ Bristol, Bristol, Avon, England.
    Kivimaki, Mika
    Univ Helsinki, Helsinki, Finland; UCL, London, England.
    Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study2018In: LANCET PUBLIC HEALTH, ISSN 2468-2667, Vol. 3, no 10, p. E490-E497Article in journal (Refereed)
    Abstract [en]

    Background Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991-2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18.5 kg/m(2)), overweight (>= 25 kg/m(2) to <30 kg/m(2)), and obesity (class I [mild] >= 30 kg/m(2) to < 35 kg/m(2); class II-III [severe] >= 35 kg/m(2)) compared with normal weight (>= 18.5 kg/m(2) to <25 kg/m(2)) were estimated. Findings Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0.4%) were underweight, 21 468 (45.6%) normal weight, 20 738 (44.0%) overweight, 3982 (8.4%) class I obese, and 728 (1.5%) class II-III obese. The corresponding numbers among the 73 054 women were 1493 (2.0%), 44 760 (61.3%), 19 553 (26.8%), 5670 (7.8%), and 1578 (2.2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11.5 years [range 6.3-18.6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29.3 (95% CI 28.8-29.8) in normal-weight men and 29.4 (28.7-30.0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1.8 (95% CI -1.3 to 4.9) for underweight, 1.1 (0.7 to 1.5) for overweight, 3.9 (2.9 to 4.9) for class I obese, and 8.5 (7.1 to 9.8) for class II-III obese. The corresponding estimates for women were 0.0 (-1.4 to 1.4) for underweight, 1.1 (0.6 to 1.5) for overweight, 2.7 (1.5 to 3.9) for class I obese, and 7.3 (6.1 to 8.6) for class II-III obese. The loss of disease-free years associated with class II-III obesity varied between 7.1 and 10.0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. Interpretation Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy.

  • 6.
    Virtanen, Marianna
    et al.
    Finnish Inst Occupat Hlth, Helsinki, Finland; Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Hanson, Linda L. Magnusson
    Stockholm Univ, Stress Res Inst, Stockholm.
    Lallukka, Tea
    Finnish Inst Occupat Hlth, Helsinki, Finland; Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Koge Hosp, Dept Occupat Med, Koge, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Dragano, Nico
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Erbel, Raimund
    Univ Duisburg Essen, Dept Cardiol, West German Heart Ctr Essen, Essen, Germany.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
    Heikkila, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv & Policy, London, England.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Lahelma, Eero
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, Copenhagen, Denmark.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Rahkonen, Ossi
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Rugulies, Reiner
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark; Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland; Univ Turku, Dept Psychol, Turku, Finland.
    Schupp, Jurgen
    German Inst Econ Res, Berlin, Germany; Free Univ Berlin, Berlin, Germany.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Siegrist, Johannes
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England; INSERM, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland; Univ Skövde, Skövde; Folkhälsan Res Ctr, Helsinki, Finland.
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Stockholm.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland; Turku Univ Hosp, Turku, Finland.
    Wagner, Gert G.
    German Inst Econ Res, Berlin, Germany; Max Planck Inst Human Dev, Berlin, Germany; Berlin Univ Technol, Berlin, Germany.
    Wang, Jian Li
    Univ Ottawa, Sch Epidemiol Publ Hlth & Prevent Med, Inst Mental Hlth Res, Ottawa, ON, Canada.
    Yiengprugsawan, Vasoontara
    Australian Natl Univ, Ctr Res Ageing Hlth & Wellbeing, Canberra, ACT, Australia; Australian Natl Univ, ARC Ctr Excellence Populat Ageing Res, Canberra, ACT, Australia.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm.
    Kivimaki, Mika
    Finnish Inst Occupat Hlth, Helsinki, Finland; Univ Helsinki, Dept Publ Hlth, Helsinki, Finland; UCL, Dept Epidemiol & Publ Hlth, London, England.
    Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 3, p. 239-250Article, review/survey (Refereed)
    Abstract [en]

    Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms.

    Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies.

    Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working >= 55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I-2 = 45.1%, P=0.004). A strong association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small.

    Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

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