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Shift-work and cardiovascular disease: a population-based 22-year follow-up study
Open accessAbstract
Studies on the association between shift-work and cardiovascular disease (CVD), in particular coronary heart disease (CHD), have given conflicting results. In this prospective population-based study we assessed the association of shift-work with three endpoints: CHD mortality, disability retirement due to CVD, and incident hypertension. A cohort of 20,142 adults (the Finnish Twin Cohort) was followed from 1982 to 2003. Type of working time (daytime/nighttime/shift-work) was assessed by questionnaires in 1975 (response rate 89%) and in 1981 (84%). Causes of death, information on disability retirement and hypertension medication were obtained from nationwide official registers. Cox proportional hazard models were used to obtain hazard ratios (HR) for each endpoint by type of working time. Adjustments were made for 14 socio-demographic and lifestyle covariates. 76.9% were daytime workers and 9.5% shift-workers both in 1975 and in 1981. During the follow-up, 857 deaths due to CHD, 721 disability retirements due to CVD, and 2,642 new cases of medicated hypertension were observed. However, HRs for shift-work were not significant (mortality HR men 1.09 and women 1.22; retirement 1.15 and 0.96; hypertension 1.15 and 0.98, respectively). The results were essentially similar after full adjustments for all covariates. Within twin pairs, no association between shift work and outcome was observed. Our results do not support an association between shift-work and cardiovascular morbidity.
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“Follow-up rates for this cohort remain at approximately 90%, and the overall death follow-up is >98% complete.49”
From Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts (2015) · cites this paper as [49]
In the citing paper
“the National Death Index, which is highly sensitive and specific in this cohort.49”
From Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts (2015) · cites this paper as [49]
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BackgroundThe Relationship Between Shift Work and Metabolic Risk Factors
Proper, K. I., van de Langenberg, D., Rodenburg, W., Vermeulen, R. C. H., van der Beek, A. J., STEEG, H. V., & van Kerkhof, L. W. M. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.11.013 · Cited by 210
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Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts
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Sleep in the United States Military
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“Unfortunately, shift work has been reported to have a negative impact on the health of workers and is accompanied by greater incidence of non-communicable diseases such as cancer (5) , CVD (6) , metabolic (7) , gastrointestinal (8) and sleep disorders (9) .”
MethodResultInfluentialAssociations of rotational shift work and night shift status with hypertension
Manohar, S., Thongprayoon, C., Cheungpasitporn, W., Mao, M. A., & Herrmann, S. M. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001442 · Cited by 155
The impact of shiftwork on health: a literature review
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Sleep Duration Affects Risk for Ulcerative Colitis: A Prospective Cohort Study
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“Shift work is recognized as a risk factor of many health outcomes by interrupting human circadian rhythm [4,5].”
BackgroundResultRotating night shift work and disparate hypertension risk in African–Americans
Lieu, S. J., Curhan, G. C., Schernhammer, E. S., & Forman, J. P. (2011) · Journal of Hypertension · doi:10.1097/hjh.0b013e32834e1ea3 · Cited by 84
The Relationship Between Shift Work and Men’s Health
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“Multiple epidemiological studies, of which many have been published in the European Journal of Epidemiology, identified various risk factors in childhood and adulthood for these diseases [5–35].”
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Attarchi, M., Dehghan, F., Farnaz, S., Nojomi, M., & Mohammadi, S. (2012) · Industrial Health · doi:10.2486/indhealth.ms1321 · Cited by 69
Palliative care services for those with chronic lung disease
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“That disturbed sleep in shift-workers is linked to stress and to cardiovascular disease has been shown previously [7,13,21] and could also explain our fi nding here.”
Shift Work Is Not Associated with High Blood Pressure or Prevalence of Hypertension
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Inflammatory Long Pentraxin 3 is Associated with Leukocyte Telomere Length in Night-Shift Workers
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“These data confirm results from studies on hypertension prevalence (Biggi et al., 2008) and incidence (Hublin et al., 2010).”
ResultNight and rotational work exposure within the last 12 months and risk of incident hypertension
Ferguson, J. M., Costello, S., Neophytou, A. M., Balmes, J. R., Bradshaw, P. T., Cullen, M. R., & Eisen, E. A. (2018) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3788 · Cited by 43
Bernardes‐Souza, B., Monteze, N. M., de Oliveira, F. L. P., de Oliveira, J. M., de Freitas, S. N., Neto, R. M. D. N., Sales, M. L., & Souza, G. G. L. (2014) · Occupational and Environmental Medicine · doi:10.1136/oemed-2014-102429 · Cited by 38
Circadian regulation of renal function and potential role in hypertension
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“However, the results of Finnish Twin Cohort and one nursing cohort in Brazil population did not show the association of shift work with the increase in blood pressure level and the incidence of hypertension [19,20].”
ResultShift work and the risk of knee osteoarthritis among Chinese workers: a retrospective cohort study
Zhou, M., Yang, S., Guo, Y., Wang, D., Qiu, W., Wang, B., Mu, G., Cao, L., Zhang, Z., & Chen, W. (2019) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3861 · Cited by 33
Shift-work and cardiovascular disease
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“In this issue of EJE two papers, both issued from large cohorts, bring interesting contributions to this complex question [1, 2].”
BackgroundNight Shift Work, Genetic Risk, and Hypertension
Xiao, Z., Xu, C. Y., Liu, Q., Yan, Q., Liang, J., Weng, Z., Zhang, X., Xu, J., Hang, D., & Gu, A. (2022) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2022.04.007 · Cited by 33
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The Adverse Health Effects of Shift Work in Relation to Risk of Illness/Disease: A Review
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“A freshly available summing up of the literature focusing on ischemic heart illness and based on 16 studies (1972-2008) did not bring to a close with confi dence that shift work has crashed [10].”
BackgroundWork schedules and 11‐year progression of carotid atherosclerosis in middle‐aged Finnish men
Wang, A., Arah, O. A., Kauhanen, J., & Krause, N. (2014) · American Journal of Industrial Medicine · doi:10.1002/ajim.22388 · Cited by 25
“…of any shift work, or night shift, or rotating shift among our sample is relatively low compared to studies among Copenhagen men [Boggild et al., 1999] or a general population in Germany [Haupt et al., 2008] but similar to the prevalence found in the Finnish twin study [Hublin et al., 2010].”
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Historical cohort study of shift work and blood pressure
Fesharaki, M. G., Kazemnejad, A., Zayeri, F., Rowzati, M., & Akbari, H. (2014) · Occupational Medicine · doi:10.1093/occmed/kqt156 · Cited by 24
“On the other hand, other studies [9–15] have found no significant association between BP and SW and even reported a reverse association [16,17].”
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“Previous studies have suggested that shift work increased the risk of chronic metabolic-related diseases, such as cardiovascular disease and type 2 diabetes (Hublin et al., 2010; Shan et al., 2018), and one common risk factor shared by these pathologies is inflammation (Castanon-Cervantes et al.”
BackgroundKantermann, T., Duboutay, F., Haubruge, D., Hampton, S. M., Darling, A. L., Berry, J., Kerkhofs, M., Boudjeltia, K. Z., & Skene, D. J. (2014) · Chronobiology International · doi:10.3109/07420528.2014.957295 · Cited by 24
“wise (CC) direction, is the healthier solution (Frost et al., 2009; Hublin et al., 2010; Kantermann et al., 2010).”
BackgroundNoisy and individual, but doable
Kantermann, T., Wehrens, S. M. T., Ulhôa, M. A., Moreno, C. R. D. C., & Skene, D. J. (2012) · Progress in brain research · doi:10.1016/b978-0-444-59427-3.00022-8 · Cited by 24
“, 2011), (iii) cardiovascular system disturbances (Boggild and Knutsson, 1999; Hublin et al., 2010; Puttonen et al., 2010), and (iv) cancer (Erren et al.”
BackgroundShift-work: a review of the health consequences
Silva, A., Silva, A. M. N., Duarte, J., & Costa, J. T. (2020) · International Journal of Occupational and Environmental Safety · doi:10.24840/2184-0954_004.002_0005 · Cited by 27
“However, more recent studies have been questioning the absolute causal relationship, since they consider that the evidence is limited, and there are still some studies that conclude that there is no relation between shift work and cardiovascular diseases (Frost et al., 2009; Hublin et al., 2010).”
BackgroundShift work and risk of non-cancer mortality in a cohort of German male chemical workers
Yong, M., Nasterlack, M., Germann, C., Lang, S., & Oberlinner, C. (2013) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-013-0922-5 · Cited by 22
“The most recent study in a Finnish population-based cohort with 22-year follow-up did not support an association between shift work and CHD mortality, neither in women nor in men (Hublin et al. 2010).”
Ferguson, J. M., Bradshaw, P. T., Eisen, E. A., Rehkopf, D. H., Cullen, M. R., & Costello, S. (2023) · Chronobiology International · doi:10.1080/07420528.2023.2168200 · Cited by 21
“Shift work has been associated with increased risk of cardiovascular disease (Akerstedt et al. 1984; Hublin et al. 2010; Lunde et al. 2020; Mosendane et al. 2008; Skogstad et al. 2019), injury (Mustard et al. 2013; Nielsen et al. 2011), hypertension (Manohar et al. 2017; Ferguson et al. 2019),…”
BackgroundWang, A., Arah, O. A., Kauhanen, J., & Krause, N. (2016) · Occupational and Environmental Medicine · doi:10.1136/oemed-2015-103245 · Cited by 21
Long working hours, sedentary work, noise, night shifts and risk of ischaemic heart disease
Eng, A., Denison, H. J., Corbin, M., Barnes, L., Mannetje, A. ’., McLean, D., Jackson, R., Laird, I., & Douwes, J. E. (2022) · Heart · doi:10.1136/heartjnl-2022-320999 · Cited by 20
Xi, J., Ma, W., Tao, Y., Zhang, X., Liu, L., & Wang, H. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1668848 · Cited by 20
Influence of Shift Work on Arterial Stiffness and Systemic Inflammation
Skogstad, M., Aass, H. C. D., Sirnes, P. A., Mamen, A., Skare, Ø., Matre, D., Hammer, S. E., Goffeng, E. M., & Lunde, L.-K. (2022) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002779 · Cited by 19
“When it comes to cardiovascular disease (CVD), the results have been conflicting.(4,5) However, recent systematic reviews with meta-analyses show an association between shift work and CVD, with increased risk”
ResultQT and Tpeak-Tend intervals in shift workers
Mozos, I. M., & Filimon, L. (2013) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2012.10.014 · Cited by 18
Dark-light cycle disrupts bone metabolism and suppresses joint deterioration in osteoarthritic rats
Song, X., Zhao, M., Tang, J., Ma, T., Bai, H., Wang, X., Liu, L., Li, T., Xu, X., Sheng, X., et al. (2022) · Arthritis Research & Therapy · doi:10.1186/s13075-022-02832-8 · Cited by 15
Tucker, P., Härmä, M., Ojajärvi, A., Mika Kivimaki, B., Leineweber, C., Oksanen, T., Salo, P., & Vahtera, J. (2019) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3813 · Cited by 15
“While the current study used rather more specific definitions of shift work, it is plausible that the discrepancy between the significant findings in the 10-town cohort, and the non-significant findings in both the hospital cohort and the previous study by Hublin et al (11), may be due to unmeasured differences in the…”
BackgroundResultSachdeva, A., & Goldstein, C. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-43803-6_11 · Cited by 14
Meta-Analysis of Cardiac Mortality in Three Cohorts of Carbon Black Production Workers
Morfeld, P., Mundt, K. A., Dell, L. D., Sorahan, T., & McCunney, R. J. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13030302 · Cited by 14
“[79] summarized many of these, including smoking, LDL cholesterol, hypertension, BMI, diabetes, alcohol intake [80–82], genetics [83], social factors [84], diet [85–88], noise [89–92], perceived stress, job strain, low decision latitude [93–96], carbon monoxide [97], styrene [98], ambient temperature [99], and shift-w…”
BackgroundSolymanzadeh, F., Rokhafroz, D., Asadizaker, M., & Dastoorpoor, M. (2022) · International Journal of Occupational Safety and Ergonomics · doi:10.1080/10803548.2021.2024403 · Cited by 13
“Previous reports have shown that shift workers have a higher prevalence of CAD risk factors including increased blood pressure (BP), cholesterol, smoking [10] and poor diet [11].”
BackgroundResultFesharaki, M. G., Kazemnejad, A., Zayeri, F., Sanati, J., & Akbari, H. (2013) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.10930 · Cited by 13
Sleep and Cardiovascular Health
Pinilla, L., Pumarega, I. C., & Sánchez‐de‐la‐Torre, M. (2025) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/a-2591-5462 · Cited by 13
Shift Work, Genetic Factors, and the Risk of Heart Failure
Xu, C. Y., Weng, Z., Liang, J., Liu, Q., Zhang, X., Xu, J., Li, Q., Zhou, Y., & Gu, A. (2022) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.12.003 · Cited by 12
Kang, E. (2021) · Workplace Health & Safety · doi:10.1177/2165079920986160 · Cited by 14
Association of night shift work and biological ageing: the mediating role of body mass index
Shen, W., Cai, L., Li, J., Sun, Y., Wang, B., Wang, N., & Lu, Y. (2024) · Age and Ageing · doi:10.1093/ageing/afae242 · Cited by 12
Multicenter historical cohort study of the relationship between shift work and blood pressure.
Fesharaki, M. G., Kazemnejad, A., Zayeri, F., Rowzati, M., Sanati, J., & Akbari, H. (2014) · Europe PMC (PubMed Central) · Cited by 11
Struck, O., Dütsch, M., Liebig, V., & Springer, A. (2013) · Journal for Labour Market Research · doi:10.1007/s12651-013-0132-3 · Cited by 12
Dong, H., Cao, Y., Ding, X., Yan, T., Zhou, C., Bi, M., Wang, H., Wang, X., & Li, J. (2024) · BMC Public Health · doi:10.1186/s12889-024-18849-4 · Cited by 9
Seibt, R., Hunger, B., Stieler, L., Stoll, R., & Kreuzfeld, S. (2018) · BioMed Research International · doi:10.1155/2018/6820160 · Cited by 9
“In the years following, some studies provided indications of the influence of working conditions on the development of hypertension such as, for example, physical work and incontrollable stress [31], constant demand for attention [32], long working hours [5], job strain [8], and shift work [33].”
BackgroundSolymanzadeh, F., Rokhafroz, D., Asadizaker, M., & Dastoorpoor, M. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1936542 · Cited by 7
“While some studies have reported increased rates of hypertension in rotating shift workers (De Bacquer et al. 2009; Ranawat and Srivastava 2017), others have failed to replicate the association (Gholami-Fesharaki et al. 2014; Hublin et al. 2010).”
Emergency Physician Shift Work
(2017) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2017.08.028 · Cited by 7
A nationally representative study of law enforcement shiftwork and health outcomes
Mumford, E. A., Maitra, P., Liu, W., & Taylor, B. G. (2021) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459624.2021.1876876 · Cited by 8
“However, while a Finnish twin cohort study examining shiftwork assignments longitudinally found a significant risk for cardiovascular disability for female but not male workers, there was no difference in coronary heart disease or hypertension outcomes by gender (Hublin et al. 2010).”
BackgroundCai, Y., Gao, J., Xie, Y., Wu, M., Liao, G., Zeng, C.-R., Cai, J., Chen, Z., Liu, P., Chen, Y., et al. (2025) · QJM · doi:10.1093/qjmed/hcaf091 · Cited by 6
Wang, L., Wang, S., Wang, Y., Jiang, Y., He, J., & Li, X. (2024) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2024.0075 · Cited by 5
“17,18 However, contrasting evidence exists in the literature.”
Hypertension in Black Patients: An Update
Kountz, D. S. (2013) · Postgraduate Medicine · doi:10.3810/pgm.2013.05.2671 · Cited by 5
Inflammatory Status and Cardio-metabolic Risk Stratification of Rotational Shift Work
Collins, B. E. G., Hartmann, T. E., Marino, F. E., & Skein, M. (2021) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxab043 · Cited by 4
Promoting Older Workers’ Job Retention and Health by Working Hour Patterns
Härmä, M. (2015) · Aligning perspectives on health, safety and well-being · doi:10.1007/978-94-017-9798-6_14 · Cited by 5
Physiological and Physical Effects of Sleep Disorder among Shift Work Nurses
Rahimpoor, R. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.110417 · Cited by 4
The relationship between shift work and Framingham risk score: A five-year prospective cohort study.
Bazyar, F., Fesharaki, M. G., & Rowzati, M. (2017) · Europe PMC (PubMed Central) · Cited by 3
Emergency Physician Shift Work
(2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.08.009 · Cited by 3
Maternal Lifestyle and Pregnancy Complications: The Generation R Study
Bakker, R. (2011) · RePub (Erasmus University Rotterdam) · Cited by 3
Seibt, R., Kreuzfeld, S., & Hunger, B. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1616810 · Cited by 3
“However, other reviews and studies have not provided convincing evidence of a link between shift work and cardiovascular disease (24–26) or type II diabetes (21).”
Association of Work-related Characteristics and Hypertension among White Collar Workers
Kim, C.-B., & Kim, K. (2015) · Journal of Korean Society of Occupational and Environmental Hygiene · doi:10.15269/jksoeh.2015.25.3.418 · Cited by 2
“또한 우리나라의 경우, 2010년 야 간근무로 인해 업무상 재해로 인정된 사례가 보고된 바 있고 야간근무가 심혈관계 질환의 위험을 증가시 킬 뿐만 아니라(Lee & Kim, 2008; Hublin et al., 2010; Puttonen et al., 2010) 인간의 생리적 리듬을 방 해하는 것으로 알려져 있다.”
(2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.08.008 · Cited by 2
Uzdil, Z., Kaya, S., Kayacan, A. G., Özyıldırım, C., Kaya, P., & Ulus, C. A. (2020) · Progress in Health Sciences · doi:10.5604/01.3001.0014.6579 · Cited by 2
Fatigue Risk Management in the Workplace ACOEM Presidential Task Force on Fatigue Risk Management
Lerman, S. E., Eskin, E., Flower, D., George, E. C., Gerson, B., Hartenbaum, N. P., Hursh, S. R., & Moore‐Ede, M. C. (2012) · Cited by 1
Vazirinejad, R., Esmaeili, A., Hassanshahi, G., & Razi, L. (2012) · Journal of Occupational Health and Epidemiology · doi:10.18869/acadpub.johe.1.1.9 · Cited by 1
Witteman, S. J. C. M., Leening, M. J. G., Deckers, J. W., Mattace-Raso, F. U. S., & Ziere, G. J. (2012) · Cited by 1
Blood Pressure Modifications during Shift Work among Workers in Isfahan City, Iran
Ghazanfari, E., Kazemnejad, A., Fesharaki, M. G., Rowzati, M., & Zayeri, F. (2016) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.30092 · Cited by 1
Exploration of the adverse effects of shift work in a multicultural environment
Bures, M., Cadkova, V., & Altunpinar, A. (2019) · Work · doi:10.3233/wor-182934 · Cited by 1
Shift work and cardiovascular events: systematic review and meta-analysis
Vyas, M. V. (2012) · Scholarship@Western (Western University) · Cited by 1
Exploration of the adverse effects of shift work in a multicultural environment
Bures, M., Cadkova, V., & Altunpinar, A. (2019) · Work · doi:10.3233/wor-192934 · Cited by 1
“This extensive research programme [4, 5] has come to no definitive conclusions, and neither has the research performed by [6].”
Bures, M., Machova, A., & Altunpinar, A. (2018) · Advances in intelligent systems and computing · doi:10.1007/978-3-319-96080-7_20 · Cited by 1
Metadata
- Authors
- Hublin, C., Partinen, M., Koskenvuo, K., Silventoinen, K., Koskenvuo, M., & Kaprio, J.
- Affiliations
- Finnish Institute of Occupational Health (FI)
- University of Helsinki (FI)
- Corresponding author
- Hublin, Christer
- Venue
- European Journal of Epidemiology
- Published
- 2010-03-14
- Volume
- 25
- Issue
- 5
- Pages
- 315-323
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- OpenAlex
- W2098774138
- Cited by
- 117
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 9 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 8 · 2016: 7 · 2015: 11 · 2014: 11 · 2013: 10 · 2012: 11
- FWCI
- 13.32
- Type
- journal article
- Language
- en
- Open access
- green
- hal.science
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- 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
- shift work, cardiovascular disease, coronary heart disease mortality, disability retirement, hypertension, working hours, night work, twin cohort, occupational health
- MeSH terms
- Adult, Cardiovascular Diseases, Female, Finland, Follow-Up Studies, Humans, Male, Middle Aged, Surveys and Questionnaires, Work Schedule Tolerance, Proportional Hazards Models, Twin Studies as Topic, Young Adult
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