The combined effect of long working hours and individual risk factors on cardiovascular disease: An interaction analysis

Association between long working hours and metabolic dysfunction-associated steatotic liver disease: a nationwide population-based study in Korea

OBJECTIVES

Long working hour is a known risk factor for metabolic diseases. We explored the association between working hours and metabolic dysfunction-associated steatotic liver disease (MASLD).

STUDY DESIGN

Data on working hours among 22,818 workers (11,999 females) from the Korea National Health and Nutrition Examination Survey (2013-2021) were used for this study.

METHODS

MASLD was defined as a combination of hepatic steatosis combined with one or more of cardiometabolic risk factors (overweight/obesity, prediabetes/diabetes, raised blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol). Hepatic steatosis was assessed using the hepatic steatosis index. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The overall prevalence of MASLD was 30.4% in men and 18.1% in women. Among male workers, 20.2% worked ≥55 h/week, whereas among female workers, 10.1% worked ≥55 h/week. Compared with working 35-40 h/week, working ≥55 h/week was positively associated with overweight/obesity (OR: 1.21; 95% CI: 1.05-1.40), pre-diabetes mellitus (pre-DM)/DM (OR: 1.20; 95% CI: 1.04-1.38), raised blood pressure (OR: 1.17; 95% CI: 1.02-1.35), and presence of any cardiometabolic risk factors (OR: 1.56; 95% CI: 1.21-2.02). The adjusted OR (95% CI) of the association between working hours and MASLD was 1.27 (1.09-1.47) for ≥55 h/week compared with working 35-40 h/week in male workers. In female workers, long working hours were not clearly associated with cardiometabolic risk factors and MASLD.

CONCLUSION

Long working hours are positively associated with MASLD among Korean male workers. Policy interventions are needed to mitigate the adverse metabolic effects of prolonged working hours.

Psychosocial Occupational Health-A Priority for Middle-Income Countries?

In response to new developments of work and employment in high-income countries (HICs), psychosocial aspects of work and health have received increased attention. In contrast, middle-income countries (MICs) are mainly concerned with severe challenges of noxious- and dangerous-material work environments, poor employment conditions, and deficient social policies, which leaves the psychosocial aspects with a marginal role, at best, in occupational health. More recently, differences between these two worlds were even aggravated by the COVID-19 pandemic. Yet, with economic globalisation and the growing worldwide interconnectivity, the world of work in MICs is being rapidly transformed, starting to share several concerns with the modern Western societies. In this process, psychosocial occupational health will become an increasingly pressing issue. This contribution explores the extent to which psychosocial aspects of work and health are already addressed in research originating from MICs. Using a narrative review approach, a selective focus on recent findings from two regions, Asia Pacific and Latin America, revealed an increasing interest in work stress-related problems, but a restricted impact of the respective research findings. It is hoped that future scientific developments in MICs will enrich the international state of the art in this field.

Shiftwork Is Associated with Higher Food Insecurity in U.S. Workers: Findings from a Cross-Sectional Study (NHANES)

The number of shift workers has increased substantially within the last decades to keep pace with the increasingly complex societal need for 24 h services. Shift work has been associated with unhealthy lifestyles and a lower overall diet quality. Little is known, however, with regard to food security and consumer behavior in shift workers. The present study sought to address this gap in the literature, exploring a sample of n = 4418 day workers and n = 1065 shift workers in the United States. Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES, 2007−2010), we found that shiftwork was associated with a lower amount of money spent on eating out and higher food insecurity issues. Compared to day workers, a higher proportion of shift workers reported receipt of food stamps (12.5% vs. 23.4%, p < 0.001) and worried about running out of food (3.95% vs. 8.05%, p < 0.001). These associations remained significant after adjustment for confounders when using multivariate logistic regression. The number of not-home-prepared meals did not differ between both groups. In light of the population health disparities and adverse health outcomes associated with food insecurity, novel strategies are urgently warranted to improve the situation of shift workers.

Health and Economic Impact of Atrial Fibrillation of Workers in Italy: Social Security Benefits

Background: The aim of this research was to analyze trends in social security applications in Italy as a result of the onset of atrial fibrillation, analyzing data pertaining to the classification of professions and assessing the economic impact on the social security system. Methods: We analyzed all applications for invalidity allowances and invalidity pensions throughout Italy over a 10-year period from 01.01.2009 to 31.12.2019, giving specific attention to all reports indicating atrial fibrillation as the principal diagnosis (Cod. ICD-9-CM 427.31). We then extracted the relative expenditure data for said benefits. The results of all analyses have been collated in tables. Results: Over the period in question, a total of 3468 applications for assistance were filed throughout Italy indicating a diagnosis of atrial fibrillation, of which 58% were rejected, 41% qualified for an invalidity allowance, and only 1.1% qualified for a pension. On average, every year, 1100 workers received social security benefits as a result of a diagnosis of atrial fibrillation, which equates to an average annual expenditure of EUR 10 million. A comparison of the data from the first observation year (2009) with data from the last (2019) shows a rising trend in the number of beneficiaries and consequently in expenses. Conclusions: The social security assistance provided by the Italian government by means of the National Institute of Social Security is fundamental to social cohesion and to those who are either permanently disabled from working or those with a significantly diminished earning capacity. This assistance is associated with a significant financial cost, which requires careful monitoring.

The combined effect of long working hours and individual risk factors on cardiovascular disease: An interaction analysis

Objectives

We examined whether the effect of long working hours on the risk of developing cardiovascular disease (CVD) differs depending on individual risk factors.

Methods

Seven‐year follow‐up data were extracted from the 2009 to 2016 waves of the Korea Health Panel Survey. Physician's diagnosis or medication for hypertension, diabetes, dyslipidemia, and obesity were included as chronic disease status. Smoking, drinking alcohol, and exercise levels were considered as lifestyle behavior. Hazard ratios were calculated using the Cox regression models to evaluate the risk of CVD related to chronic diseases and unhealthy behavior, based on working hour groups, after adjusting for other covariates. The interactive effects of long working hours with or without chronic diseases and unhealthy behavior on CVD were assessed using the relative excess risk due to interaction and attributable proportion measures.

Results

There was a statistically significant interaction between long working hours and chronic diseases within the population, especially among male participants (P‐value for interaction <.01 and .03, respectively). There were no significant interactions between unhealthy behavior and long working hours.

Conclusions

Long working hours and chronic disease have a synergistic negative effect on the risk of CVD.

Work-related factors among people with diabetes and the risk of cardiovascular diseases: A systematic review

BACKGROUND

Diabetes is a major risk factor for cardiovascular diseases (CVD). This systematic review aims to explore the work-related factors among people with diabetes in developing CVD.

METHODS

Four electronic databases were searched on 1 February 2021 using a comprehensive search strategy without any time restriction. Two independent researchers screened the articles and extracted data. The risk of bias was assessed independently using the risk of bias assessment tool for non-randomized studies (RoBANS). A narrative synthesis was conducted considering the heterogeneity of the included articles.

RESULTS

A total of five articles incorporating 4 409 810 participants from three geographic regions were included that highlights the research gap. As per the included studies, Occupational drivers with diabetes were at a higher risk of CVD in comparison to the nondrivers, workers with diabetes having a long working hour were at a higher risk of CVD mortality, workers with a lower occupational status were at a higher risk of 10-years stroke risk, and occupational physical activity and occupational commuting lowered the risk of CVD deaths.

CONCLUSIONS

This systematic review summarized the available evidence on work-related factors influencing the risk of CVD in people with diabetes. The findings should be interpreted cautiously pondering the limited evidence and imprecision. We identified only five articles related to the topic, and there were no studies from Japan. The scarcity of studies on work-related factors on the prognosis of diabetic patients implies the need for more research in this field. We recommend further exploration of the topic designing primary studies.