An initial analysis: working hours and delay in seeking care during acute coronary events

Association between work style and presenteeism in the Japanese service sector

OBJECTIVES

To address ongoing problems concerning population aging and labor shortages in Japan, employers have sought to improve work efficiency and labor productivity. However, it is unclear how presenteeism is affected by working styles in line with current corporate initiatives, such as reduced working hours, varied employment status, and flexible work arrangements. The purpose of this article was to investigate the association between work style and presenteeism.

METHODS

This cross-sectional study extracted data from employee profiles, employee attendance records, and a questionnaire in a large service sector company. Multiple linear regression was conducted to estimate the contributions of work style variables to the Work Limitations Questionnaire (WLQ) index score.

RESULTS

In total, 21 500 participants were eligible for analysis. The WLQ index was lower for those working < 35 h/week (adjusted regression coefficient [ARC]:-0.35%; 95% CI: -0.48 to - 0.21) and higher for those working 40-44 h/week or ≥ 45 h/week, compared with those working 35-39 h/week. The position of team manager was positively associated with the WLQ index, whereas senior manager (ARC: -1.44%; 95% CI: -1.71 to - 1.17) and part-time staff (ARC: -1.75%; 95% CI: -1.98 to - 1.52) positions were negatively associated with the WLQ index, compared with non-managers. Those who worked remotely had significantly lower WLQ index scores (ARC: -0.61%; 95% CI: -0.95 to - 0.27).

CONCLUSIONS

Reduced working hours and flexible work arrangements were associated with lower work limitations, which imply presenteeism, although additional research is necessary to verify these results.

Long Working Hours and Risk of Cardiovascular Disease

Purpose of Review

To summarize the evidence on the relationship between long working hours and cardiovascular disease, such as coronary heart disease and stroke.

Recent Findings

Large-scale meta-analyses with published and individual participant observational data on more than 740,000 men and women free of cardiovascular disease report a link between long working hours (≥ 55 h a week) and the onset of cardiovascular events. Our meta-analytic update of summary evidence suggests a 1.12-fold (95% CI 1.03–1.21) increased risk associated with coronary heart disease and a 1.21-fold (95% CI 1.01–1.45) increased risk of stroke, although the evidence is somewhat inconsistent and the possibility of residual confounding and bias cannot be ruled out. Few studies have examined the mechanisms which may be stress-related, behavioral, or biological. The recent pooled analyses suggest that increased cardiac electric instability and hypercoagulability might play a role.

Summary

The evidence that long working hours are a risk factor for cardiovascular disease is accumulating and suggests a small risk. Studies on the effects of long working hours in high-risk populations and those with pre-existing cardiovascular disease, mechanistic research, and intervention studies are needed to advance this research field.

Working hours and self-rated health over 7 years: gender differences in a Korean longitudinal study

Background

To investigate the association between long working hours and self-rated health (SRH), examining the roles of potential confounding and mediating factors, such as job characteristics.

Methods

Data were pooled from seven waves (2005–2011) of the Korean Labour and Income Panel Study. A total of 1578 workers who consecutively participated in all seven study years were available for analysis. A generalized estimating equation for repeated measures with binary outcome was used to examine the association between working hours (five categories; 20–35, 36–40, 41–52, 53–68 and ≥69 h) and SRH (two categories; poor and good health), considering possible confounders and serial correlation.

Results

Associations between working hours and SRH were observed among women, but only for the category of the shortest working hours among men. The associations with the category of shortest working hours among men and women disappeared after adjustment for socioeconomic factors. Among women, though not men, working longer than standard hours (36–40 h) showed a linear association with poor health; OR = 1.41 (95 % CI = 1.08–1.84) for 52–68 working hours and OR = 2.11 (95 % CI = 1.42–3.12) for ≥69 working hours. This association persisted after serial adjustments. However, it was substantially attenuated with the addition of socioeconomic factors (e.g., OR = 1.66 (95 % CI = 1.07–2.57)) but only slightly attenuated with further adjustment for behavioural factors (e.g., OR = 1.63 (95 % CI = 1.05–2.53)). The associations with job satisfaction were significant for men and women.

Conclusions

The worsening of SRH with increasing working hours only among women suggests that female workers are more vulnerable to long working hours because of family responsibilities in addition to their workload.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2641-1) contains supplementary material, which is available to authorized users.

Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals

BACKGROUND

Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

METHODS

We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

FINDINGS

We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

INTERPRETATION

Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

FUNDING

Medical Research Council, Economic and Social 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), US National Institutes of Health, British Heart Foundation.

Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature

BACKGROUND

Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research.

METHODS AND RESULTS

We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing.

CONCLUSION

We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.

Excessive work and risk of haemorrhagic stroke: a nationwide case-control study

BACKGROUND

Adverse effect of excessive work on health has been suggested previously, but it was not documented in cerebrovascular diseases.

AIM

The authors investigated whether excessive working conditions would associate with increased risk of haemorrhagic stroke.

METHODS

A nationwide matched case-control study database, which contains 940 cases of incident haemorrhagic stroke (498 intracerebral haemorrhages and 442 sub-arachnoid haemorrhages) with 1880 gender- and age- (± 5-year) matched controls, was analysed. Work-related information based on the regular job situation, including type of occupation, regular working time, duration of strenuous activity during regular work and shift work, was gathered through face-to-face interviews. Conditional logistic regression analyses were used for the multivariable analyses.

RESULTS

Compared with white-collar workers, blue-collar workers had a higher risk for haemorrhagic stroke (odds ratio, 1.33 [95% confidence interval, 1.06-1.66]). Longer regular working time was associated with increased risk of haemorrhagic stroke [odds ratio, 1.38 (95% confidence interval, 1.05-1.81) for 8-12 h/day; odds ratio, 1.95 (95% confidence interval, 1.33-2.86) for ≥ 13 h/day; compared with ≤ 4 h/day]. Exposure to ≥ 8 h/week of strenuous activity also associated haemorrhagic stroke risk [odds ratio, 1.61 (95% confidence interval, 1.26-2.05); compared with no strenuous activity]. Shift work was not associated with haemorrhagic stroke (P = 0.98). Positive associations between working condition indices and haemorrhagic stroke risk were consistent regardless of haemorrhagic stroke sub-types and current employment status.

CONCLUSIONS

Blue-collar occupation, longer regular working time and extended duration of strenuous activity during work may relate to an increased risk of haemorrhagic stroke.

Long working hours and coronary heart disease: a systematic review and meta-analysis

The authors aggregated the results of observational studies examining the association between long working hours and coronary heart disease (CHD). Data sources used were MEDLINE (through January 19, 2011) and Web of Science (through March 14, 2011). Two investigators independently extracted results from eligible studies. Heterogeneity between the studies was assessed using the I² statistic, and the possibility of publication bias was assessed using the funnel plot and Egger's test for small-study effects. Twelve studies were identified (7 case-control, 4 prospective, and 1 cross-sectional). For a total of 22,518 participants (2,313 CHD cases), the minimally adjusted relative risk of CHD for long working hours was 1.80 (95% confidence interval (CI): 1.42, 2.29), and in the maximally (multivariate-) adjusted analysis the relative risk was 1.59 (95% CI: 1.23, 2.07). The 4 prospective studies produced a relative risk of 1.39 (95% CI: 1.12, 1.72), while the corresponding relative risk in the 7 case-control studies was 2.43 (95% CI: 1.81, 3.26). Little evidence of publication bias but relatively large heterogeneity was observed. Studies varied in size, design, measurement of exposure and outcome, and adjustments. In conclusion, results from prospective observational studies suggest an approximately 40% excess risk of CHD in employees working long hours.

A multicentre analysis of troponin use in clinical practice

BACKGROUND

The role of troponin quantification in evaluation of patients with suspected acute coronary syndrome is established, but with cost implications. Emerging high-sensitivity troponin and novel multi-marker assays herald further resource implications.

AIMS

The objective of this study was to quantify recent trends in troponin usage and costs in a cross-section of hospitals.

METHODS

A cross-sectional survey seeking data on troponin usage and costs from six tertiary referral, public access teaching hospitals for consecutive years between 2003 and 2009 was carried out.

RESULTS

A median annual increase in the volume of troponin assays requested was identified in all six hospitals, with an average median annual increase of 6.9 % across hospitals (interquartile range 3.4, 10.1 %). This annual increase was not accompanied by a corresponding increase in volume of patients presenting to the Emergency Department (ED) with chest pain. The majority (44-67 %) of troponin requests originated in the ED of hospitals. The median annual spend on troponins per hospital was <euro>115,612 (interquartile range <euro>80,452, <euro>140,918). An analysis of results of assays performed in one centre found that the majority (91 %) of troponin assays performed were in the normal range.

CONCLUSIONS

An annual increase in troponin requests without a corresponding increase in patient activity raises the possibility of increasingly indiscriminate troponin testing. The cumulative direct and indirect costs of inappropriate testing are significant. Corrective strategies are necessary to improve patient selection and testing protocols, particularly in the advent of the high-sensitivity troponin assays and novel multi-marker strategies.