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Balance of evidence reviews suggest that shift workers are at higher risk of ischaemic heart disease. However, results from individual studies have not been wholly consistent, a variation that could be explained by bias or confounding. Investigation is hampered by potential healthy hire and survivor effects. Yadegarfar and McNamee have conducted a case-referent study nested within a male industrial cohort from the nuclear fuel industry.1 Over 600 cases who died from ischaemic heart disease were matched on age and year of hire with surviving controls, with focus on events 10 years after hire. Adjustment was made for several risk factors such as blood pressure and smoking, social class, duration of employment and time since leaving employment. Shift workers more often belonged to social class IV or V and some evidence was found for confounding by social class. In the fully adjusted model, however, the odds ratio for shift versus day
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