Evidence map›Paper›PMID 26298822›Full record

SynthesisLancet (London, England)2015

Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals.

Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini and 35 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Lancet (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 316 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
316citing papers in PubMed, 9 pooled it
112.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

316 citing papers in PubMed, 9 syntheses or guidelines pooled it, 698 citations in OpenAlex.

  1. The consequences of a compressed workweek: a systematic literature review.International archives of occupational and environmental health · 2025
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  17. Coronary heart disease risk factors in taxi drivers in Medellín.Occupational medicine (Oxford, England) · 2026
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256 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

45 authors at 20 institutions in 7 countries.

Mika KivimäkiDepartment of Epidemiology and Public Health, University College London, London, UK; Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: m.kivimaki@ucl.ac.uk.
Markus JokelaInstitute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
Solja T NybergFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
Archana Singh-ManouxDepartment of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
Eleonor I FranssonInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
Lars AlfredssonInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
Jakob B BjornerNational Research Centre for the Working Environment, Copenhagen, Denmark.
Marianne BorritzDepartment of Occupational Medicine, Koege Hospital, Copenhagen, Denmark.
Hermann BurrFederal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
Annalisa CasiniSchool of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
Els ClaysDepartment of Public Health, Ghent University, Ghent, Belgium.
Dirk De BacquerDepartment of Public Health, Ghent University, Ghent, Belgium.
Nico DraganoInstitute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Raimund ErbelDepartment of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
Goedele A GeuskensTNO, Hoofddorp, Netherlands.
Mark HamerDepartment of Epidemiology and Public Health, University College London, London, UK.
Wendela E HooftmanTNO, Hoofddorp, Netherlands.
Irene L HoutmanTNO, Hoofddorp, Netherlands.
Karl-Heinz JöckelInstitute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
France KittelSchool of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
Anders KnutssonDepartment of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
Markku KoskenvuoDepartment of Public Health, University of Helsinki, Helsinki, Finland.
Thorsten LunauInstitute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Ida E H MadsenNational Research Centre for the Working Environment, Copenhagen, Denmark.
Martin L NielsenUnit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
Maria NordinStress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden.
Tuula OksanenFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
Jan H PejtersenThe Danish National Centre for Social Research, Copenhagen, Denmark.
Jaana PenttiFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
Reiner RuguliesNational Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Paula SaloFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland; Department of Psychology, University of Turku, Turku, Finland.
Martin J ShipleyDepartment of Epidemiology and Public Health, University College London, London, UK.
Johannes SiegristInstitute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
Andrew SteptoeDepartment of Epidemiology and Public Health, University College London, London, UK.
Sakari B SuominenDepartment of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; University of Skövde, Skövde, Sweden.
Töres TheorellStress Research Institute, Stockholm University, Stockholm, Sweden.
Jussi VahteraFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland; Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
Peter J M WesterholmOccupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
Hugo WesterlundStress Research Institute, Stockholm University, Stockholm, Sweden.
Dermot O'ReillyCentre for Public Health, Queen's University Belfast, Belfast, UK.
Meena KumariDepartment of Epidemiology and Public Health, University College London, London, UK; Institute for Social and Economic Research, University of Essex, Colchester, UK.
G David BattyDepartment of Epidemiology and Public Health, University College London, London, UK; Centre for Cognitive Ageing and Cognitive Epidemiology and Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
Jane E FerrieDepartment of Epidemiology and Public Health, University College London, London, UK; School of Community and Social Medicine, University of Bristol, Bristol, UK.
Marianna VirtanenFinnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
IPD-Work Consortium
University College London · GBFinnish Institute of Occupational Health · FIHeinrich Heine University Düsseldorf · DENational Research Centre for the Working Environment · DKUniversity of Helsinki · FIGhent University · BEStockholm University · SEUniversité Libre de Bruxelles · BECentre de recherche en Epidémiologie et Santé des Populations · FRDanish National Centre for Social Research · DKFederal Institute for Occupational Safety and Health · DEFrederiksberg Hospital · DKKarolinska Institutet · SEMid Sweden University · SEQueen's University Belfast · GBStockholm County Council · SETurku University Hospital · FIUmeå University · SEUniversity of Duisburg-Essen · DEUniversity of Essex · GB

Funding

Socioeconomic gradient in CHD in early old ageR01HL036310 · NHLBI · UNIVERSITY OF LONDON · PI KIVIMAKI, MIKA J, MARMOT, MICHAEL G · 1986 to 2012
$3.1M
Health behaviors over the adult lifecourse and cognitive agingR01AG034454 · NIA · UNIVERSITY COLLEGE LONDON · PI KIVIMAKI, MIKA J, SINGH-MANOUX, ARCHANA · 2009 to 2013
$1.5M
British Heart Foundation RG/13/2/30098Medical Research Council G0100222Medical Research Council K013351Medical Research Council MR/K013351/1NHLBI NIH HHS R01HL036310NIA NIH HHS R01AG034454
6 · The paper itself

Abstract

backgroundLong working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

methodsWe identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

findingsWe included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

interpretationEmployees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

fundingMedical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

Indexed as

Work Schedule ToleranceAge FactorsCoronary DiseaseFemaleHumansMaleMiddle AgedRiskRisk FactorsSex FactorsSocioeconomic FactorsStroke

Identifiers

PMID26298822
OpenAlexW2109705034

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.