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Cited by 275Sleep and related disordersCircadian rhythm and melatoninSleep and Work-Related Fatigue

Associations between chronotype, morbidity and mortality in the UK Biobank cohort

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Knutson, Kristen L., von Schantz, Malcolm·2018·Chronobiology International
DOI 10.1080/07420528.2018.1454458PMC PMC6119081
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Abstract

Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease (CVD). However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433 268 adults aged 38-73 at the time of enrolment and an average 6.5-year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question-defining participants as definite morning types, moderate morning types, moderate evening types or definite evening types. The primary outcomes were all-cause mortality and mortality due to CVD. Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86-2.02, p = < 0.001), followed by diabetes (OR 1.30, 95% CI 1.24-1.36, p = < 0.001), neurological disorders (OR 1.25, 95% CI 1.20-1.30, p = < 0.001), gastrointestinal/abdominal disorders (OR 1.23, 95% CI 1.19-1.27, p = < 0.001) and respiratory disorders (OR 1.22, 95% CI 1.18-1.26, p = < 0.001). The total number of deaths was 10 534, out of which 2127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004-1.05, p = 0.017) and CVD mortality (HR 1.04, 95% CI 1.00-1.09, p = 0.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02-1.18, p = 0.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.

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  • Many human health effects are linked to misalignment of chronotype, including cancer, obesity, and diabetes.

    “Many human health effects are linked to the misalignment of chronotype (Knutson and von Schantz 2018), including cancer, obesity (Gyarmati et al. 2016; Papantoniou et al. 2016, 2017; Gan et al. 2018; Shi et al. 2020; Yousef et al. 2020), and diabetes (Gan et al. 2015; Larcher et al. 2015, 2016).”

    From Archaic Introgression Shaped Human Circadian Traits (2023) · cites this paper as Knutson and von Schantz 2018

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  1. Horne JA Ostberg O 1976 The Owl and Lark Questionnaire Int J Chronobiol 4 97 110 1027738

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Authors
Knutson, K. L., & von Schantz, M.
Affiliations
  • Northwestern University (US)
  • Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
Corresponding author
Knutson, Kristen L.
ORCID
Venue
Chronobiology International
Publisher
Informa UK Limited
Published
2018-04-11
Volume
35
Issue
8
Pages
1-9
ISSN
  • 0742-0528 (ISSN-L)
  • 1525-6073
DOI
10.1080/07420528.2018.1454458
PMC
PMC6119081
OpenAlex
W2789630154
Cited by
275
References
49
Citations by year
2026: 21 · 2025: 36 · 2024: 40 · 2023: 38 · 2022: 32 · 2021: 39 · 2020: 32 · 2019: 26 · 2018: 11
FWCI
35.37
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Chronobiology International (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Northumbria Research Link (Northumbria University) (acceptedVersion, other-oa)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Figshare (cc-by)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095207)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
chronotype, eveningness, all-cause mortality, cardiovascular mortality, sleep timing, comorbidities, mental illness, diabetes mellitus, sleep duration, UK Biobank, circadian rhythm
MeSH terms
Noncommunicable Diseases, Activity Cycles, Adult, Aged, Cause of Death, Circadian Rhythm, Female, United Kingdom, Health Status, Humans, Life Expectancy, Male, Middle Aged, Personnel Staffing and Scheduling, Prognosis, Risk Factors, Social Behavior, Time Factors, Work Schedule Tolerance, Comorbidity, Prevalence, Risk Assessment

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