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Cross-Sectional Findings from the C Work and health J Epidemiol Community Health: first published as 10.1136/jech-2018-210943 on 16 October 2018. Downloaded from Long working hours, anthropometry, lung function, blood pressure and blood-based biomarkers: cross- sectional findings from the CONSTANCES study Marianna Virtanen,1,2 Linda Magnusson Hansson,1 Marcel Goldberg,3,4 Marie Zins,3,4 Sari Stenholm,5 Jussi Vahtera,5 Hugo Westerlund,1,6 Mika Kivimäki7,8 ► Additional material is ABSTRact Large collaborative meta-analyses of individual published online only. To view Background Although long working hours have participant data from observational cohort studies please visit the journal online (http:// dx. doi. org/ 10. 1136/ been shown to be associated with the onset of have found long working hours to be associated jech- 2018- 210943). cardiometabolic diseases, the clinical risk factor profile with an increased risk of cardiovascular disease, associated with long working hours remains unclear. We particularly stroke, and type 2 diabetes (the For numbered affiliations see compared the clinical risk profile between people who latter among employees with low socioeconomic end of article. worked long hours and those who reported being never position (SEP)).6–8 Studies have also confirmed exposed to long hours. behavioural risk factors as potential pathways, Correspondence to Dr Marianna Virtanen, Methods A cross-sectional study in 22 health screening showing associations between long working hours 8 9 Department of Public Health centres in France was based on a random population- and smoking, risky alcohol use and physical inac- and Caring Sciences, University based sample of 75 709 participants aged 18–69 tivity.8 10 In contrast, evidence on the clinical risk of Uppsala, Uppsala 752 36, at study inception in 2012–2016 (the CONSTANCES profile of people who work long hours is scarce Sweden; marianna. virtanen@ ttl. fi study). The data included survey responses on working and inconsistent. The Whitehall II study of British hours (never, former or current exposure to long civil servants observed no consistent associations Received 25 April 2018 working hours), covariates and standardised biomedical between long working hours and cardiometa- Revised 22 September 2018 examinations including anthropometry, lung function, bolic factors such as blood pressure, lipid levels or Accepted 28 September 2018 8 Published Online First blood pressure and standard blood-based biomarkers. systemic inflammation. Some studies have found 10–12 copyright. 16 October 2018 Results Among men, long working hours were an association with self-reported hypertension associated with higher anthropometric markers (Body while others have reported no association,13 and Mass Index, waist circumference and waist:hip ratio), some further studies have found the risk of hyper- adverse lipid levels, higher glucose, creatinine, white tension to be lower among individuals who work blood cells and higher alanine transaminase (adjusted long hours than among those who work standard mean differences in the standardised scale between 40 hours work weeks.14 15 The evidence is also the exposed and unexposed 0.02–0.12). The largest mixed with regard to metabolic syndrome (an indi- differences were found for Body Mass Index and cation of multiple cardiometabolic risk factors) and waist circumference. A dose–response pattern with includes both positive and null findings.16 17 Simi- increasing years of working long hours was found for larly, studies focusing on overweight and Body Mass anthropometric markers, total cholesterol, glucose and Index (BMI) have shown positive associations,8 18–20 gamma-glutamyltransferase. Among women, long no association19–21 and a lower risk of weight gain http://jech.bmj.com/ working hours were associated with Body Mass Index among individuals who work long hours.15 One and white blood cells. limitation in many of these studies is that they rely Conclusion In this study, men who worked long hours on self-reported data or data on treated diseases, had slightly worse cardiometabolic and inflammatory and many of them have limited statistical power profile than those who did not work long hours, due to small sample sizes, which may lead to impre- especially with regard to anthropometric markers. In cise effect estimates, a high likelihood of observing women, the corresponding associations were weak or an association by chance and a reduced opportunity on September 24, 2021 by guest. Protected absent. to reliably detect small and moderate associations. To obtain more robust evidence, we examined the association between long working hours and clinically assessed risk markers for chronic diseases, INTRODUCTION using a large dataset of more than 75 000 French © Author(s) (or their Current guidelines for the prevention of chronic men and women. By carefully assessing exposure, employer(s)) 2019. Re-use diseases such as myocardial infarction, stroke and its frequency and duration, we were able to differ- permitted under CC BY-NC. No diabetes emphasise the importance of maintaining entiate those never exposed from those formerly commercial re-use. See rights and permissions. Published healthy levels of cardiometabolic risk factors such or currently exposed and examine potential dose– by BMJ. as body weight, blood pressure, cholesterol and response patterns in the association. In addition, glucose.1 2 These guidelines also acknowledge we assessed associations with several risk factors To cite: Virtanen M, Magnusson Hansson L, psychosocial factors as potential contributors to that have not been examined in relation to long 1 2 Goldberg M, et al. J cardiometabolic diseases. One of these, working working hours, such as lung function, indicators of Epidemiol Community Health long hours, is common in the USA, Europe and liver and kidney function, white and red cell count, 2019;73:130–135. Asia.3–5 and blood clotting (platelets). We also examined 130 Virtanen M, et al. J Epidemiol Community Health 2019;73:130–135. doi:10.1136/jech-2018-210943 Work and health J Epidemiol Community Health: first published as 10.1136/jech-2018-210943 on 16 October 2018. Downloaded from whether the association between long working hours and risk indicators of liver function, and blood creatinine was an indi- markers is similar among men and women and among different cator of kidney function. Other indicators were counts of white socioeconomic groups. blood cells, haemoglobin and platelets. Covariates included sociodemographic characteristics: self-re- METHODS ported sex, age and SEP. SEP was based on occupational grade, Participants and procedure which was further classified into high, intermediate and low; The French CONSTANCES is a population-based cohort study and other/not specified, according to the national socioeco- that serves as an open epidemiological research infrastruc- nomic nomenclature (‘Professions et catégories sociales’) of ture.22 The cohort is made up of French adults affiliated with the French national statistics office.25 High SEP included exec- the General Health Insurance Fund in France. This fund covers utive managers and professionals; intermediate SEP included about 85% of the French population and includes salaried intermediate professions in education, health, civil service and workers (professionally active or retired) aged 18–69 at study administration, technicians, foremen and supervisors. Low SEP inception in 2012–2016. All confidentiality, safety and secu- inlcuded employees (eg, office or commercial employee, child rity procedures were approved by the French legal authorities. minder, duty officer), farmers, craftsmen and manual workers. The study was carried out in 22 health screening centres across The following risk factors were based on survey responses: principal regions of France. Of the randomly invited population smoking (never, former, current), physical activity (regular in the selected catchment areas with stratification according to sports activity for 2 hours or more per week vs less) and alcohol unequal response probabilities, 7% agreed to participate in the consumption, which was based on the 10-item Alcohol Use survey and undergo a clinical health examination. Of the 99 Disorders Identification Test (AUDIT) survey.26 27 Alcohol use 924 participants in 2012–2016, 90 607 (91%) provided data on was further categorised into four groups: abstinence; no alcohol working hours, and of them, 88 009 (97%) also provided data abuse or dependence; alcohol abuse (AUDIT score 8–12 for on SEP. A total of 76 486 (87% of those) had data on all other men, 7–11 for women); alcohol dependence (AUDIT score >12 covariates (smoking, alcohol use, physical activity, depressive for men, >11 for women). We used the Center for Epidemio- symptoms and chronic disease), and of those, a maximum of 75 logical Studies Depression Scale to assess the presence of depres- 709 (96%) provided data on clinical measurements. sive symptoms.28 Information on chronic somatic disease (yes/ The CONSTANCES Cohort project has been approved by the no) was based on participants’ self-reported doctor-diagnosed authorisation of the National Data Protection Authority (Commis- diseases (angina pectoris, myocardial infarction, stroke, lower sion nationale de l’informatique et des libertés—CNIL). CNIL limb arteritis, other cardiovascular disease, thyroid disease, verified that before inclusion, clear information is provided to the diabetes, hypercholesterolemia, hypertriglyceridemia, other eligible subjects (presentation of
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