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Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women

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Vetter, Céline, Devore, Elizabeth E., Wegrzyn, Lani R., Massa, Jennifer, Speizer, Frank E., Kawachi, Ichiro, Rosner, Bernard, Stampfer, Meir J., Schernhammer, Eva S.·2016·JAMA
DOI 10.1001/jama.2016.4454PMC PMC5102147
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Abstract

Importance Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. Objective To determine whether rotating night shift work is associated with CHD risk. Design, Setting, and Participants Prospective cohort study of 189 158 initially healthy women followed up over 24 years in the Nurses’ Health Studies (NHS [1988-2012]: N = 73 623 and NHS2 [1989-2013]: N = 115 535). Exposures Lifetime history of rotating night shift work (≥3 night shifts per month in addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2). Main Outcomes and Measures Incident CHD; ie, nonfatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents, and angioplasty. Results During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at baseline, 54.5 years) and 3519 cases in the NHS2 (mean age, 34.8 years). In multivariable-adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work were associated with a significantly higher CHD risk in both cohorts. In the NHS, the age-standardized incidence rate (IR) for less than 5 years of rotating night shift work per 100 000 person-years was 435.1 (hazard ratio [HR], 1.02; 95% CI, 0.97-1.08); the IR for 5 to 9 years of rotating night shift work was 525.7 (HR, 1.12; 95% CI, 1.02-1.22); and the IR for 10 years or more of rotating night shift work was 596.9 (HR, 1.18; 95% CI, 1.10-1.26;P<.001 for trend) vs an IR of 425.5 in women who never worked rotating night shifts. In the NHS2, the IR for less than 5 years was 130.6 (HR, 1.05; 95% CI, 0.97-1.13); the IR for 5 to 9 years was 151.6 (HR,1.12; 95% CI, 0.99-1.26); and the IR for 10 years or more was 178.0 (HR, 1.15; 95% CI, 1.01-1.32;P = .01 for trend) vs an IR of 122.6 in women who never worked rotating night shifts. In the NHS, the association between duration of rotating night shift work and CHD was stronger in the first half of follow-up (IR for <5 years, 382.4; HR, 1.10 [95% CI, 1.01-1.21]; IR for 5-9 years, 483.1; HR, 1.19 [95% CI, 1.03-1.39]; and IR for ≥10 years, 494.4; HR, 1.27 [95% CI, 1.13-1.42];P<.001 for trend) than in the second half (IR for <5 years, 424.8; HR, 0.98 [95% CI, 0.92-1.05]; IR for 5-9 years, 520.7; HR, 1.08 [95% CI, 0.96-1.21]; IR for ≥10 years, 556.2; HR, 1.13 [95% CI, 1.04-1.24];P = .004 for trend;P = .02 for interaction), suggestive of waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in the NHS2 (P<.001 for trend). Conclusions and Relevance Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics.

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Authors
Vetter, C., Devore, E. E., Wegrzyn, L. R., Massa, J., Speizer, F. E., Kawachi, I., Rosner, B., Stampfer, M. J., & Schernhammer, E. S.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
Corresponding author
Vetter, Céline
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2016-04-26
Volume
315
Issue
16
Pages
1726
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2016.4454
PMC
PMC5102147
OpenAlex
W2342969444
Cited by
517
References
39
Citations by year
2026: 42 · 2025: 61 · 2024: 59 · 2023: 51 · 2022: 64 · 2021: 53 · 2020: 57 · 2019: 44 · 2018: 44 · 2017: 27 · 2016: 13
FWCI
60.73
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Deutsche Forschungsgemeinschaft
  • National Heart, Lung, and Blood Institute (R01HL034594)
  • National Cancer Institute (UM1CA176726, UM1CA186107)
  • National Institute for Occupational Safety and Health (5R01OH009803, R01OH009803)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
rotating night shift work, shift work, coronary artery disease, women, myocardial infarction, angina pectoris, coronary artery bypass grafting, Nurses' Health Study, cardiovascular risk, occupational exposure, coronary CT angiography, coronary artery calcification, coronary microvascular dysfunction
MeSH terms
Adult, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Middle Aged, Nurses, Personnel Staffing and Scheduling, Prospective Studies, Surveys and Questionnaires, Time Factors, United States, Work Schedule Tolerance, Incidence, Proportional Hazards Models, Risk Assessment

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