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Shift work and vascular events: systematic review and meta-analysis

Open access
Vyas, M. V., Garg, A. X., Iansavichus, A. V., Costella, J., Donner, A., Laugsand, L. E., Janszky, I., Mrkobrada, M. +2 more·2012·BMJ
DOI 10.1136/bmj.e4800PMC PMC3406223
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Abstract

OBJECTIVE: To synthesise the association of shift work with major vascular events as reported in the literature. DATA SOURCES: Systematic searches of major bibliographic databases, contact with experts in the field, and review of reference lists of primary articles, review papers, and guidelines. STUDY SELECTION: Observational studies that reported risk ratios for vascular morbidity, vascular mortality, or all cause mortality in relation to shift work were included; control groups could be non-shift ("day") workers or the general population. DATA EXTRACTION: Study quality was assessed with the Downs and Black scale for observational studies. The three primary outcomes were myocardial infarction, ischaemic stroke, and any coronary event. Heterogeneity was measured with the I(2) statistic and computed random effects models. RESULTS: 34 studies in 2,011,935 people were identified. Shift work was associated with myocardial infarction (risk ratio 1.23, 95% confidence interval 1.15 to 1.31; I(2)=0) and ischaemic stroke (1.05, 1.01 to 1.09; I(2)=0). Coronary events were also increased (risk ratio 1.24, 1.10 to 1.39), albeit with significant heterogeneity across studies (I(2)=85%). Pooled risk ratios were significant for both unadjusted analyses and analyses adjusted for risk factors. All shift work schedules with the exception of evening shifts were associated with a statistically higher risk of coronary events. Shift work was not associated with increased rates of mortality (whether vascular cause specific or overall). Presence or absence of adjustment for smoking and socioeconomic status was not a source of heterogeneity in the primary studies. 6598 myocardial infarctions, 17,359 coronary events, and 1854 ischaemic strokes occurred. On the basis of the Canadian prevalence of shift work of 32.8%, the population attributable risks related to shift work were 7.0% for myocardial infarction, 7.3% for all coronary events, and 1.6% for ischaemic stroke. CONCLUSIONS: Shift work is associated with vascular events, which may have implications for public policy and occupational medicine.

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Authors
Vyas, M. V., Garg, A. X., Iansavichus, A. V., Costella, J., Donner, A., Laugsand, L. E., Janszky, I., Mrkobrada, M., Parraga, G., & Hackam, D. G.
Affiliations
  • Western University (CA)
  • Lawson Research Institute (CA)
  • Norwegian University of Science and Technology (NO)
Corresponding author
Hackam, D. G.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2012-07-26
Volume
345
Issue
jul26 1
Pages
e4800-e4800
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.e4800
PMC
PMC3406223
OpenAlex
W2119434070
Cited by
840
References
71
Citations by year
2026: 39 · 2025: 43 · 2024: 64 · 2023: 61 · 2022: 74 · 2021: 65 · 2020: 71 · 2019: 78 · 2018: 69 · 2017: 72 · 2016: 66 · 2015: 48 · 2014: 46 · 2013: 34 · 2012: 9
FWCI
6.41
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Scholarship@Western (Western University) (publishedVersion)
  • Scholarship@Western (Western University) (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
shift work, vascular events, myocardial infarction, ischemic stroke, coronary events, vascular death, all-cause mortality, cardiovascular risk, evening shift, population attributable risk, occupational health
MeSH terms
Brain Ischemia, Coronary Disease, Humans, Myocardial Infarction, Personnel Staffing and Scheduling, Risk Factors, Work Schedule Tolerance, Odds Ratio, Risk Assessment, Stroke

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