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  • 1.
    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.

  • 2.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kawachi, Ichiro
    Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA.
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Björner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg Hosp, Dept Occupat & Environm Med, Copenhagen, Denmark.
    Brunner, Eric J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth, Berlin, Germany.
    Dragano, Nico
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Heikkila, Katriina
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    Bispebjerg Hosp, Dept Occupat & Environm Med, Copenhagen, Denmark.
    Nordin, Maria
    Umea Univ, Dept Psychol, S-90187 Umea, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Siegrist, Johannes
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Suominen, Sakari
    Folkhalsan Res Ctr, Helsinki, Finland.
    Theorell, Tres
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Westerholm, Peter J. M.
    Uppsala Univ, Occupat & Environm Med, Uppsala, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals2015In: LANCET DIABETES & ENDOCRINOLOGY, ISSN 2213-8587, Vol. 3, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    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 diff erence 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. Copyright (C) Kivimaki et al. Open Access article distributed under the terms of CC BY.

  • 3.
    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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