柳叶刀子刊:退休前心血管死亡风险激增52%!加班越多,得病越多!就问你还加不

2022-01-11 LILYMED MedSci原创

The Lancet Regional Health:长时间工作与50种健康状况和死亡结果的风险:一项针对四个欧洲国家的多群体研究

虽然加班已渐渐成为打工人的“必备素养”,但越来越多证据表明,这对健康有害。据世界卫生组织(WHO)研究显示,全球有4.5亿人每周工作超过55个小时,导致每年有74.5万例心脏病和中风死亡。在人群队列研究中,与每周工作35-40小时的标准相比,每周工作55小时或以上的个体中风风险增加。 长时间工作也可能与其他健康结果有关,如冠心病、抑郁症和糖尿病,但这些证据并不一致,甚至对抑郁症有保护作用的迹象。最近的系统评价和荟萃分析并不支持长时间工作与癌症之间存在关联。

目前关于工作时间和疾病风险的证据至少有三个局限性。首先,虽然有许多关于特定健康结果的研究,但很少有研究同时检查多个疾病,以全面评估健康状况不佳与长时间工作的关系。其次,研究使用了不受限制的随访,这可能会导致暴露因素错误分类,并淡化关联。例如,长时间工作可能成为高动脉粥样硬化斑块负担个体心血管事件的触发因素,而这种影响在退休后将无法观察到。第三,尽管以全因死亡率为索引的生存率是一个基本的健康终点,但很少有研究评估其与长时间工作的关系。

为了解决这些局限性,本研究将调查长时间工作与46种常见身心健康状况和4种死亡率结果的相关性。为了更准确地估计暴露时间,我们将疾病和死亡率监测限制在65岁(法定退休通用年龄)。在此过程中,还通过检查其时间顺序来探索与长时间工作相关的疾病的相互关联性。

本研究汇集了来自两项芬兰前瞻性队列研究的个体参与者数据:芬兰公共部门(FPS,N = 44 635)研究和健康与社会支持(HeSSup,N = 14 964)研究。样本选择如图1所示。选择瑞典、丹麦和英国的多个队列作为验证队列。对于工作时长,将参与者分为<35小时、35-40小时、41-48小时、49-54小时和≥55小时组。每周工作超过55小时定义为长时间工作。

在初步分析中,59599名参与者中有2747名(4·6%)被归类为长时间工作(≥55小时/周)。其中,长时间工作在男性中占比9.6%,在女性中占比2.9%,并且在相对于低社会经济群体中更为普遍。

出现疾病的平均随访时间为13.8(SD = 2·8)年,死亡时间为15.3(SD = 3·5)年。如表1所总结的那样,50种疾病中有14种(28%),较高的发病和死亡风险与长时间工作有关。因此,在对性别、年龄、社会经济地位和队列进行调整后,与标准工作时间相比,具有95%置信区间的风险比(HR)为:所有感染(1·37;1·13-1·67),包括细菌感染(1·41;1·15-1·74);内分泌疾病(1·25;1·04-1·50),包括糖尿病(1·18;1·01-1·38);神经系统疾病(1·26;1·09-1·45),包括癫痫(1·62;1·05-2·48)和睡眠障碍(1·33;1·07-1·56);肌肉骨骼疾病(1·15;1·06-1·26),包括类风湿性关节炎及相关疾病(1·54;1·20-1·98)和坐骨神经痛(1·62;1·28-2·05);循环和呼吸系统症状(1·49;1·21-1·84);损伤(1·27;1·14-1·41),包括跌倒(1·22;1·00-1·50);心血管死亡(1·68;1·08-2·61)。除内分泌疾病和心血管死亡外,在多次检查校正后,与疾病章节的所有关联仍然具有统计学意义。对生活方式因素的额外调整减弱了长时间工作与糖尿病之间的关联,但对其他健康结果几乎没有影响。

在感染,睡眠障碍,类风湿性关节炎,坐骨神经痛,循环和呼吸系统症状,损伤和跌倒方面,观察到跨工作时间类别的剂量 - 反应关联的证据图2)。当我们检查相互作用时,根据性别或社会经济地位,这些关系没有差异,但有一个例外:与高社会经济地位(1.12; 0·86-1·46;相互p<0.03)相比,低社会经济地位(2.09; 1.49-2·93)的参与者中,长时间工作与细菌感染的相关性更为明显长工作时间对14种健康结果的PAF在肌肉骨骼疾病的0.7%和心血管死亡的3.3%之间(表2)。

如图3所示,长时间工作与全因死亡率(随访至65岁:1.04,0·84-1·29;最大随访:1·01,0·84-1·20),癌症相关死亡(0·78;0·54-1·14和0·85;0·64-1·13)或心血管疾病或所有癌症以外的原因造成的死亡(1·05;0·75-1·47和0·99;0·74-1·32)无关。从绝对值来看,长时间工作和标准时间参与者之间死亡结局的所有差异都很小。随访至65岁,长时间工作的参与者的早期心血管死亡率为每10,000人年2.5,正常工作时间参与者为每10,000人年1.7。这些组的全因死亡率相似。在最大程度随访分析中,未观察到长时间工作和正常工作时间的人之间在特定病因或总体死亡率方面的差异。按年龄、性别和工作时间分列的死亡累积危害证实,长时间工作和标准时间的参与者之间在死亡率方面没有区别

在验证队列中,44262名参与者出现疾病的时间为8.1年,出现死亡的为9.4年。并且验证了细菌感染、心血管死亡、糖尿病、受伤和肌肉骨骼系统疾病风险的增加仍然与长时间工作有关(图4)。验证队列中的数字不足以分析癫痫,睡眠障碍,坐骨神经痛和类风湿性关节炎。

接下来分析疾病发生的顺序,包括细菌感染、糖尿病、受伤、肌肉骨骼疾病和心血管死亡(图5)。糖尿病与心血管死亡(2·87;1·05-7·84)和细菌感染(3·68;2·19-6·17)有关。细菌感染与糖尿病有关(2·22;1·20-4·09)。

此外,糖尿病与肌肉骨骼疾病之间、细菌感染、肌肉骨骼疾病和糖尿病之间以及损伤与肌肉骨骼疾病之间的关联较弱(所有风险比<2.0)。尽管有这些关联,但与这些工作标准时间相比,长时间工作的员工患多病(至少以下两种疾病:细菌感染,糖尿病,肌肉骨骼系统疾病,损伤,早期心血管死亡)的风险(1.27;1·11-1.47)仅略高。

综上,在这项全结果范围多组研究中,长时间工作始终与一系列健康事件相关。总体而言,在所研究的50个疾病终点中,有6个(12%)被证实存在强大的关联。每周工作时间超过55小时的人,在65岁之前死于心血管疾病的风险增加52%,并且增加细菌感染、糖尿病、心血管死亡风险。没有发现这些关联中存在性别差异的证据,但长时间工作与传染病之间的关联仅在社会经济地位较低的员工中观察到。

 

原文来源:

J. Ervasti et al. Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries. The Lancet Regional Health - Europe 11 (2021) 100212

https://doi.org/10.1016/j.lanepe.2021.100212

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    2022-01-19 ms5000000354910400

    不加班有点儿难啊

    0

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time=2022-01-11, status=1, ipAttribution=)]
    2022-01-18 zybear

    不加班可能吗

    0

  4. 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time=2022-01-11, status=1, ipAttribution=)]
  5. 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time=2022-01-11, status=1, ipAttribution=)]
  6. 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time=2022-01-11, status=1, ipAttribution=)]
    2022-01-13 zgwhgch
  7. 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13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1554231, encodeId=d6d7155423192, content=<a href='/topic/show?id=ab025182080' target=_blank style='color:#2F92EE;'>#心血管死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51820, encryptionId=ab025182080, topicName=心血管死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0fb814514579, createdName=huperzia, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591721, encodeId=4b481591e219f, content=<a href='/topic/show?id=c315330300a' target=_blank style='color:#2F92EE;'>#加班#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33030, encryptionId=c315330300a, topicName=加班)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d5217990608, createdName=zgwhgch, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629881, encodeId=a41416298813b, content=<a href='/topic/show?id=a913518225e' target=_blank style='color:#2F92EE;'>#心血管死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51822, encryptionId=a913518225e, topicName=心血管死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76421361831, createdName=baoya, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183522, encodeId=5f09118352212, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, 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time=2022-01-11, status=1, ipAttribution=)]
  8. 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d5217990608, createdName=zgwhgch, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629881, encodeId=a41416298813b, content=<a href='/topic/show?id=a913518225e' target=_blank style='color:#2F92EE;'>#心血管死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51822, encryptionId=a913518225e, topicName=心血管死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76421361831, createdName=baoya, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183522, encodeId=5f09118352212, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=57de6415950, createdName=ms5000000254917531, createdTime=Wed Jan 12 14:37:18 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183361, encodeId=7b161183361ae, content=珍爱生命,拒绝加班, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=01e36454182, createdName=ms6000000789885196, createdTime=Tue Jan 11 21:00:24 CST 2022, time=2022-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183343, encodeId=01b3118334387, content=好好学习,天天向上, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3e495565045, createdName=王江军, createdTime=Tue Jan 11 20:14:10 CST 2022, time=2022-01-11, status=1, ipAttribution=)]
    2022-01-12 ms5000000254917531

    涨知识

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1764289, encodeId=d7a61e642897b, content=<a href='/topic/show?id=967b66e9727' target=_blank style='color:#2F92EE;'>#激增#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66797, encryptionId=967b66e9727, topicName=激增)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=faa237702659, createdName=ms1756883563247400, createdTime=Sun May 22 14:55:43 CST 2022, time=2022-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1186022, encodeId=1d4711860227e, content=不加班有点儿难啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfec6473972, createdName=ms5000000354910400, createdTime=Wed Jan 19 14:39:12 CST 2022, time=2022-01-19, status=1, ipAttribution=), 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d5217990608, createdName=zgwhgch, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629881, encodeId=a41416298813b, content=<a href='/topic/show?id=a913518225e' target=_blank style='color:#2F92EE;'>#心血管死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51822, encryptionId=a913518225e, topicName=心血管死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76421361831, createdName=baoya, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183522, encodeId=5f09118352212, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=57de6415950, createdName=ms5000000254917531, createdTime=Wed Jan 12 14:37:18 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183361, encodeId=7b161183361ae, content=珍爱生命,拒绝加班, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=01e36454182, createdName=ms6000000789885196, createdTime=Tue Jan 11 21:00:24 CST 2022, time=2022-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183343, encodeId=01b3118334387, content=好好学习,天天向上, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3e495565045, createdName=王江军, createdTime=Tue Jan 11 20:14:10 CST 2022, time=2022-01-11, status=1, ipAttribution=)]
    2022-01-11 ms6000000789885196

    珍爱生命,拒绝加班

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d5217990608, createdName=zgwhgch, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629881, encodeId=a41416298813b, content=<a href='/topic/show?id=a913518225e' target=_blank style='color:#2F92EE;'>#心血管死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51822, encryptionId=a913518225e, topicName=心血管死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76421361831, createdName=baoya, createdTime=Thu Jan 13 07:55:43 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183522, encodeId=5f09118352212, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=57de6415950, createdName=ms5000000254917531, createdTime=Wed Jan 12 14:37:18 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183361, encodeId=7b161183361ae, content=珍爱生命,拒绝加班, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=01e36454182, createdName=ms6000000789885196, createdTime=Tue Jan 11 21:00:24 CST 2022, time=2022-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183343, encodeId=01b3118334387, content=好好学习,天天向上, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3e495565045, createdName=王江军, createdTime=Tue Jan 11 20:14:10 CST 2022, time=2022-01-11, status=1, ipAttribution=)]
    2022-01-11 王江军

    好好学习,天天向上

    0

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