Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

doi:10.1136/bmj.g7772

Review

. 2015 Jan 13:350:g7772.

doi: 10.1136/bmj.g7772.

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

Marianna Virtanen¹, Markus Jokela², Solja T Nyberg³, Ida E H Madsen⁴, Tea Lallukka⁵, Kirsi Ahola³, Lars Alfredsson⁶, G David Batty⁷, Jakob B Bjorner⁴, Marianne Borritz⁸, Hermann Burr⁹, Annalisa Casini¹⁰, Els Clays¹¹, Dirk De Bacquer¹¹, Nico Dragano¹², Raimund Erbel¹³, Jane E Ferrie¹⁴, Eleonor I Fransson¹⁵, Mark Hamer¹⁶, Katriina Heikkilä¹⁷, Karl-Heinz Jöckel¹⁸, France Kittel¹⁰, Anders Knutsson¹⁹, Markku Koskenvuo²⁰, Karl-Heinz Ladwig²¹, Thorsten Lunau¹², Martin L Nielsen²², Maria Nordin²³, Tuula Oksanen³, Jan H Pejtersen²⁴, Jaana Pentti³, Reiner Rugulies²⁵, Paula Salo²⁶, Jürgen Schupp²⁷, Johannes Siegrist¹², Archana Singh-Manoux²⁸, Andrew Steptoe¹⁶, Sakari B Suominen²⁹, Töres Theorell³⁰, Jussi Vahtera³¹, Gert G Wagner³², Peter J M Westerholm³³, Hugo Westerlund³⁰, Mika Kivimäki³⁴

Affiliations

¹ Finnish Institute of Occupational Health, 00250 Helsinki, Finland marianna.virtanen@ttl.fi.
² Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
³ Finnish Institute of Occupational Health, 00250 Helsinki, Finland.
⁴ National Research Centre for the Working Environment, Copenhagen, Denmark.
⁵ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
⁶ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden.
⁷ Department of Epidemiology and Public Health, University College London, London, UK Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
⁸ Department of Occupational Medicine, Koge Hospital, Koge, Denmark.
⁹ Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
¹⁰ School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹¹ Department of Public Health, Ghent University, Ghent, Belgium.
¹² Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
¹³ Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
¹⁴ Department of Epidemiology and Public Health, University College London, London, UK School of Social and Community Medicine, University of Bristol, Bristol, UK.
¹⁵ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Stress Research Institute, Stockholm University, Stockholm, Sweden School of Health Sciences, Jönköping University, Jönköping, Sweden.
¹⁶ Department of Epidemiology and Public Health, University College London, London, UK.
¹⁷ School of Medicine, University of Tampere, Tampere, Finland.
¹⁸ Institute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
¹⁹ Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
²⁰ Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
²¹ Helmholtz Zentrum München (German Research Center for Environmental Health (GmbH)), 85764 Oberschleißheim, Germany.
²² Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
²³ Stress Research Institute, Stockholm University, Stockholm, Sweden Department of Psychology, Umeå University, Umeå, Sweden.
²⁴ Danish National Centre for Social Research, Copenhagen, Denmark.
²⁵ National Research Centre for the Working Environment, Copenhagen, Denmark Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
²⁶ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Psychology, University of Turku, Turku, Finland.
²⁷ German Institute for Economic Research, Berlin, Germany Free University of Berlin, Berlin, Germany.
²⁸ Department of Epidemiology and Public Health, University College London, London, UK Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
²⁹ Department of Public Health, University of Turku, Turku, Finland Nordic School of Public Health, Gothenburg, Sweden Folkhälsan Research Center, Helsinki, Finland.
³⁰ Stress Research Institute, Stockholm University, Stockholm, Sweden.
³¹ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, University of Turku, Turku, Finland Turku University Hospital, Turku, Finland.
³² German Institute for Economic Research, Berlin, Germany Max Planck Institute for Human Development, Berlin, Germany Berlin University of Technology, Berlin, Germany.
³³ Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
³⁴ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Finland Department of Epidemiology and Public Health, University College London, London, UK.

PMID: 25587065
PMCID: PMC4293546
DOI: 10.1136/bmj.g7772

Review

Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

Marianna Virtanen et al. BMJ. 2015.

. 2015 Jan 13:350:g7772.

doi: 10.1136/bmj.g7772.

Authors

Affiliations

¹ Finnish Institute of Occupational Health, 00250 Helsinki, Finland marianna.virtanen@ttl.fi.
² Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
³ Finnish Institute of Occupational Health, 00250 Helsinki, Finland.
⁴ National Research Centre for the Working Environment, Copenhagen, Denmark.
⁵ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
⁶ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden.
⁷ Department of Epidemiology and Public Health, University College London, London, UK Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
⁸ Department of Occupational Medicine, Koge Hospital, Koge, Denmark.
⁹ Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
¹⁰ School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹¹ Department of Public Health, Ghent University, Ghent, Belgium.
¹² Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
¹³ Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
¹⁴ Department of Epidemiology and Public Health, University College London, London, UK School of Social and Community Medicine, University of Bristol, Bristol, UK.
¹⁵ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Stress Research Institute, Stockholm University, Stockholm, Sweden School of Health Sciences, Jönköping University, Jönköping, Sweden.
¹⁶ Department of Epidemiology and Public Health, University College London, London, UK.
¹⁷ School of Medicine, University of Tampere, Tampere, Finland.
¹⁸ Institute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
¹⁹ Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
²⁰ Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
²¹ Helmholtz Zentrum München (German Research Center for Environmental Health (GmbH)), 85764 Oberschleißheim, Germany.
²² Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
²³ Stress Research Institute, Stockholm University, Stockholm, Sweden Department of Psychology, Umeå University, Umeå, Sweden.
²⁴ Danish National Centre for Social Research, Copenhagen, Denmark.
²⁵ National Research Centre for the Working Environment, Copenhagen, Denmark Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
²⁶ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Psychology, University of Turku, Turku, Finland.
²⁷ German Institute for Economic Research, Berlin, Germany Free University of Berlin, Berlin, Germany.
²⁸ Department of Epidemiology and Public Health, University College London, London, UK Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
²⁹ Department of Public Health, University of Turku, Turku, Finland Nordic School of Public Health, Gothenburg, Sweden Folkhälsan Research Center, Helsinki, Finland.
³⁰ Stress Research Institute, Stockholm University, Stockholm, Sweden.
³¹ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, University of Turku, Turku, Finland Turku University Hospital, Turku, Finland.
³² German Institute for Economic Research, Berlin, Germany Max Planck Institute for Human Development, Berlin, Germany Berlin University of Technology, Berlin, Germany.
³³ Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
³⁴ Finnish Institute of Occupational Health, 00250 Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Finland Department of Epidemiology and Public Health, University College London, London, UK.

PMID: 25587065
PMCID: PMC4293546
DOI: 10.1136/bmj.g7772

Abstract

Objective: To quantify the association between long working hours and alcohol use.

Design: Systematic review and meta-analysis of published studies and unpublished individual participant data.

Data sources: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.

Review methods: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.

Results: Cross sectional analysis was based on 61 studies representing 333,693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100,602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥ 55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.

Conclusions: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work other than those mentioned above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None — **Fig 1** Search strategy and selection of studies for meta-analysis of effect of long working hours on alcohol use

See this image and copyright information in PMC

Comment in

Long working hours are linked to risky alcohol consumption.
Okechukwu CA. Okechukwu CA. BMJ. 2015 Jan 13;350:g7800. doi: 10.1136/bmj.g7800. BMJ. 2015. PMID: 25587066 No abstract available.

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References

1. World Health Organization. Global status report on alcohol and health 2014. WHO, 2014.
1. Friedmann PD. Clinical practice. Alcohol use in adults. N Engl J Med 2013;368:365-73. - PubMed
1. Alcohol in the workplace. Institute of Alcohol Studies (IAS), 2014.
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1. International Centre for Alcohol Policies. International drinking guidelines, 2010.

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[1] World Health Organization. Global status report on alcohol and health 2014. WHO, 2014.

[2] World Health Organization. Global status report on alcohol and health 2014. WHO, 2014.

[3] Friedmann PD. Clinical practice. Alcohol use in adults. N Engl J Med 2013;368:365-73. - PubMed

[4] Friedmann PD. Clinical practice. Alcohol use in adults. N Engl J Med 2013;368:365-73. - PubMed

[5] Alcohol in the workplace. Institute of Alcohol Studies (IAS), 2014.

[6] Alcohol in the workplace. Institute of Alcohol Studies (IAS), 2014.

[7] Nicholson P, Mayho G, Sharp C. Alcohol, drugs and the workplace. The role of medical professionals. A briefing from the BMA Occupational Medicine Committee. BMA, 2014.

[8] Nicholson P, Mayho G, Sharp C. Alcohol, drugs and the workplace. The role of medical professionals. A briefing from the BMA Occupational Medicine Committee. BMA, 2014.

[9] International Centre for Alcohol Policies. International drinking guidelines, 2010.

[10] International Centre for Alcohol Policies. International drinking guidelines, 2010.

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Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

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Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data

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