Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals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Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals

Lancet Diabetes Endocrinol. 2015 Jan;3(1):27-34. doi: 10.1016/S2213-8587(14)70178-0. Epub 2014 Sep 25.

Authors

Mika Kivimäki¹, Marianna Virtanen², Ichiro Kawachi³, Solja T Nyberg², Lars Alfredsson⁴, G David Batty⁵, Jakob B Bjorner⁶, Marianne Borritz⁷, Eric J Brunner⁸, Hermann Burr⁹, Nico Dragano¹⁰, Jane E Ferrie¹¹, Eleonor I Fransson¹², Mark Hamer⁸, Katriina Heikkilä¹³, Anders Knutsson¹⁴, Markku Koskenvuo¹⁵, Ida E H Madsen⁶, Martin L Nielsen⁷, Maria Nordin¹⁶, Tuula Oksanen², Jan H Pejtersen¹⁷, Jaana Pentti², Reiner Rugulies¹⁸, Paula Salo¹⁹, Johannes Siegrist¹⁰, Andrew Steptoe⁸, Sakari Suominen²⁰, Töres Theorell²¹, Jussi Vahtera²², Peter J M Westerholm²³, Hugo Westerlund²¹, Archana Singh-Manoux²⁴, Markus Jokela²⁵

Affiliations

¹ Department of Epidemiology and Public Health, University College London, London, UK; Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland. Electronic address: m.kivimaki@ucl.ac.uk.
² Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland.
³ Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA, USA.
⁴ Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Epidemiology and Public Health, University College London, London, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
⁶ National Research Centre for the Working Environment, Copenhagen, Denmark.
⁷ Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
⁸ Department of Epidemiology and Public Health, University College London, London, UK.
⁹ Federal Institute for Occupational Safety and Health, Berlin, Germany.
¹⁰ Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
¹¹ Department of Epidemiology and Public Health, University College London, London, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK.
¹² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
¹³ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland; School of Medicine, University of Tampere, Tampere, Finland.
¹⁴ Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
¹⁵ Department of Public Health, University of Helsinki, Helsinki, Finland.
¹⁶ Department of Psychology, Umeå University, Umeå, Sweden.
¹⁷ Danish National Centre for Social Research, Copenhagen, Denmark.
¹⁸ National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
¹⁹ Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland; Department of Psychology, University of Turku, Turku, Finland.
²⁰ Folkhälsan Research Center, Helsinki, Finland; Nordic School of Public Health, Göteborg, Sweden; Department of Public Health, University of Turku, Turku, Finland.
²¹ Stress Research Institute, Stockholm University, Stockholm, Sweden.
²² Finnish Institute of Occupational Health, Helsinki, Tampere, and Turku, Finland; Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
²³ Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
²⁴ Department of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
²⁵ Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.

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.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diabetes Mellitus, Type 2 / epidemiology
Diabetes Mellitus, Type 2 / etiology*
Female
Humans
Incidence
Male
Middle Aged
Risk Factors
Social Class
Work Schedule Tolerance*

Abstract

Publication types

MeSH terms

Grants and funding