• Mika Kivimäki, Marianna Virtanen, Ichiro Kawachi, Solja T Nyberg, Lars Alfredsson, G David Batty, Jakob B Bjorner, Marianne Borritz, Eric J Brunner, Hermann Burr, Nico Dragano, Jane E Ferrie, Eleonor I Fransson, Mark Hamer, Katriina Heikkilä, Anders Knutsson, Markku Koskenvuo, Madsen Ida E H IEH National Research Centre for the Working Environment, Copenhagen, Denmark., Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Johannes Siegrist, Andrew Steptoe, Sakari Suominen, Töres Theorell, Jussi Vahtera, Westerholm Peter J M PJM Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden., Hugo Westerlund, Archana Singh-Manoux, and Markus Jokela.
• Department of Epidemiology and Public Health, University College London, London, UK; Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland. Electronic address: m.kivimaki@ucl.ac.uk.
• Lancet Diabetes Endocrinol. 2015 Jan 1; 3 (1): 27-34.

BackgroundWorking long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.MethodsWe identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.FindingsDuring 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35-40 h) was 1·07 (95% CI 0·89-1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I(2)=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06-1·57, difference in incidence 13 per 10 000 person-years, I(2)=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80-1·25, incidence difference zero per 10 000 person-years, I(2)=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.InterpretationIn this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.FundingMedical 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), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.Copyright © 2015 Kivimäki et al. Open Access article distributed under the terms of CC BY. Published by .. All rights reserved.

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