Abstract
Studies on the association between shift-work and cardiovascular disease (CVD), in particular coronary heart disease (CHD), have given conflicting results. In this prospective population-based study we assessed the association of shift-work with three endpoints: CHD mortality, disability retirement due to CVD, and incident hypertension. A cohort of 20,142 adults (the Finnish Twin Cohort) was followed from 1982 to 2003. Type of working time (daytime/nighttime/shift-work) was assessed by questionnaires in 1975 (response rate 89%) and in 1981 (84%). Causes of death, information on disability retirement and hypertension medication were obtained from nationwide official registers. Cox proportional hazard models were used to obtain hazard ratios (HR) for each endpoint by type of working time. Adjustments were made for 14 socio-demographic and lifestyle covariates. 76.9% were daytime workers and 9.5% shift-workers both in 1975 and in 1981. During the follow-up, 857 deaths due to CHD, 721 disability retirements due to CVD, and 2,642 new cases of medicated hypertension were observed. However, HRs for shift-work were not significant (mortality HR men 1.09 and women 1.22; retirement 1.15 and 0.96; hypertension 1.15 and 0.98, respectively). The results were essentially similar after full adjustments for all covariates. Within twin pairs, no association between shift work and outcome was observed. Our results do not support an association between shift-work and cardiovascular morbidity.
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Knutsson A. Health disorders of shift workers. Occup Med. 2003;53:103–8.
Bøggild H, Knutsson A. Shift work, risk factors and cardiovascular disease. Scand J Work Environ Health. 1999;25:85–99.
Bøggild H, Knutsson A. Shift work and heart disease: meta analysis of the epidemiological literature. In: Hornberger S, Knauth P, Costa G, Folkard S, editors. Shift work in the 21st century: challenges for research and practice. Frankfurt am Main: Peter Lang; 2000. p. 189–94.
Frost P, Kolstad HA, Bonde JP. Shift work and the risk of ischemic heart disease—a systematic review of the epidemiologic evidence. Scand J Work Environ Health. 2009;35:163–79.
Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Speizer FE, et al. Prospective study of shift work and risk of coronary heart disease in women. Circulation. 1995;92:3178–82.
Knutsson A, Hallquist J, Reuterwall C, Theorell T, Akerstedt T. Shiftwork and myocardial infarction: a case-control study. Occup Environ Med. 1999;56:46–50.
Tüchsen F, Christensen KB, Lund T, Feveile H. A 15-year prospective study of shift work and disability pension. Occup Environ Med. 2008;65:283–5.
Suwazono Y, Dochi M, Sakata K, Okubo Y, Oishi M, Tanaka K, et al. Shift work is a risk factor for increased blood pressure in Japanese men: a 14-year historical cohort study. Hypertension. 2008;52:581–6.
Morikawa Y, Nakagawa H, Miura K, Ishizaki M, Tabata M, Nishijo M, et al. Relationship between shift work and onset of hypertension in a cohort of manual workers. Scand J Work Environ Health. 1999;25:100–4.
Sakata K, Suwazono Y, Harada H, Okubo Y, Kobayashi E, Nogawa K. The relationship between shift work and the onset of hypertension in male Japanese workers. J Occup Environ Med. 2003;45:1002–6.
Oishi M, Suwazono Y, Sakata K, Okubo Y, Harada H, Kobayashi E, et al. A longitudinal study on the relationship between shift work and the progression of hypertension in male Japanese workers. J Hypertens. 2005;23:2173–8.
Kaprio J, Koskenvuo M. Genetic and environmental factors in complex diseases: the Older Finnish Twin Cohort. Twin Research. 2002;5:358–65.
Kaprio J, Koskenvuo M, Langinvainio H, Romanov K, Sarna S, Rose RJ. Genetic influences on use and abuse of alcohol: a study of 5638 adult Finnish twin brothers. Alcohol Clin Exp Res. 1987;11:349–56.
Järvenpää T, Rinne JO, Koskenvuo M, Räihä I, Kaprio J. Binge drinking in midlife and dementia risk. Epidemiology. 2005;16:766–71.
Romanov K, Rose RJ, Kaprio J, Koskenvuo M, Langinvainio H, Sarna S. Self-reported alcohol use: a longitudinal study of 12, 994 adults. Alcohol Alcohol. 1987;S1:619–23.
Hernelahti M, Kujala U, Kaprio J. Stability and change of volume and intensity of physical activity as predictors of hypertension. Scand J Public Health. 2004;32:303–9.
Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality. JAMA. 1998;279:440–4.
Koivumaa-Honkanen H, Honkanen R, Antikainen R, et al. Self-reported life satisfaction and recovery from depression in a 1-year prospective study. Acta Psychiatr Scand. 2001;103:38–44.
Koskenvuo M, Hublin C, Partinen M, Kaprio J. Heritability of diurnal types: a nationwide study of 9212 adult twin pairs. J Sleep Res. 2007;16:156–62.
Hublin C, Kaprio J, Partinen M, Koskenvuo M. Insufficient sleep: a population based study in adults. Sleep. 2001;24:392–400.
Hublin C, Partinen M, Koskenvuo M, Kaprio J. Sleep and mortality: a population-based 22-year follow-up study. Sleep. 2007;30:1245–53.
Koivumaa-Honkanen H, Kaprio J, Honkanen R, Viinamäki H, Koskenvuo M. Life satisfaction and depression in a 15-year follow-up of healthy adults. Soc Psychiatr Psychiatr Epidemiol. 2004;39:994–9.
Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000;56:645–6.
Kujala UM, Kaprio J, Koskenvuo M. Modifiable risk factors as predictors of all-cause mortality: the roles of genetics and childhood environment. Am J Epidemiol. 2002;156:985–93.
Sørensen TI, Rissanen A, Korkeila M, Kaprio J. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med. 2005;2:e171.
Christensen K, Wienke A, Skytthe A, Holm NV, Vaupel JW, Yashin AI. Cardiovascular mortality in twins and the fetal origins hypothesis. Twin Res. 2001;4:344–9.
de Geus EJ, Posthuma D, Ijzerman RG, Boomsma DI. Comparing blood pressure of twins and their singleton siblings: being a twin does not affect adult blood pressure. Twin Res. 2001;4:385–91.
Fujino Y, Iso H, Tamakoshi A, Inaba Y, Koizumi A, Kubo T, et al. Japanese Collaborative Cohort Study Group. A prospective cohort study of shift work and risk of ischemic heart disease in Japanese male workers. Am J Epidemiol. 2006;164:128–35.
Virtanen SV, Notkola V. Socioeconomic inequalities in cardiovascular mortality and the role of work: a register study of Finnish men. Int J Epidemiol. 2002;31:614–21.
Ueshima H. Explanation for the Japanese paradox: prevention of increase in coronary heart disease and reduction in stroke. J Atheroscler Thromb. 2007;14:278–86.
Tüchsen F, Hannerz H, Burr H. A 12 year prospective study of circulatory disease among Danish shift workers. Occup Environ Med. 2006;63:451–5.
Knutsson A. Shift work and ischaemic heart disease. Occup Environ Med. 2008;65:152.
van Amelsvoort LG, Jansen NW, Kant I. Smoking among shift workers: more than a confounding factor. Chronobiol Int. 2006;23:1105–13.
Knutsson A. Methodological aspects of shift-work research. Chronobiol Int. 2004;21:1037–47.
Lehto AM, Sutela H. Threats and Opportunities. Findings of Finnish Quality of Work life Surveys 1977–2003. Helsinki: Statistics Finland; 2005.
Kivimäki M, Virtanen M, Elovainio M, Väänänen A, Keltikangas-Järvinen L, Vahtera J. Prevalent cardiovascular disease, risk factors and selection out of shift work. Scand J Work Environ Health. 2006;32:204–8.
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Supported by the Academy of Finland Center of Excellence in Complex Disease Genetics and the Social Insurance Institution of Finland.
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Hublin, C., Partinen, M., Koskenvuo, K. et al. Shift-work and cardiovascular disease: a population-based 22-year follow-up study. Eur J Epidemiol 25, 315–323 (2010). https://doi.org/10.1007/s10654-010-9439-3
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DOI: https://doi.org/10.1007/s10654-010-9439-3