Association between rotating night shift work and risk of coronary heart disease among women

Details

• Alternative Title:
  JAMA
• Personal Author:
  Vetter, Céline ; Devore, Elizabeth E. ; Wegrzyn, Lani R. ; Massa, Jennifer ; Speizer, Frank E. ; Kawachi, Ichiro ; Rosner, Bernard ; Stampfer, Meir J. ; Schernhammer, Eva S.
• Description:
  Importance
  
  Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up.
  
  Objective
  
  Determine whether rotating night shift work is associated with CHD risk.
  
  Design, Setting and Participants
  
  Prospective cohort study of 189,158 initially healthy women followed over 24 years in the Nurses' Health Studies (NHS (1988-2012): N=73,623, and NHS2 (1989-2013): N=115,535).
  
  Exposure
  
  Questionnaire-based lifetime history of rotating night shift work (≥3 night shifts/month, plus day and evening shifts) at baseline; also updated every 2-4yrs in NHS2.
  
  Main Outcomes and Measures
  
  Incident CHD, i.e. non-fatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass grafting (CABG), stents, and angioplasty.
  
  Results
  
  During follow-up, 7,303 incident CHD cases in NHS (mean age at baseline: 54.5yrs) and 3,519 in NHS2 (34.8yrs) occurred. In multivariable adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work were associated with a significantly higher CHD risk in both cohorts (NHS: age-standardized incidence rate (IR)<5yrs per 100,000 person-years=435.1, hazard ratio (HR)<5yrs=1.02, 95% confidence interval (CI)=0.97-1.08, IR5-9yrs=525.7, HR5-9yrs=1.12, 95%CI=1.02-1.22, IR≥10yrs=596.9, HR≥10yrs=1.18, 95%CI=1.10-1.26; Ptrend<0.001; NHS2: IR<5yrs=130.6, HR<5yrs=1.05, 95%CI=0.97-1.13; IR5-9yrs=151.6, HR5-9yrs=1.12, 95%CI=0.99-1.26; HR≥10yrs=178.0, HR≥10yrs=1.15, 95%CI=1.01-1.32; Ptrend=0.01), compared to women who never worked rotating night shifts (NHS: IRnever=425.5, NHS2: IRnever=122.6). In NHS, the association between duration of rotating night shift work and CHD was stronger in the first half of follow-up (IR<5yrs=382.4, HR<5yrs=1.10, 95%CI=1.01-1.21, IR5-9yrs=483.1, HR5-9yrs=1.19, 95%CI=1.03-1.39, IR≥10yrs=494.4, HR≥10yrs=1.27, 95%CI =1.13-1.42, Ptrend <0.001) than in the second half (IR<5yrs=424.8, HR<5yrs=0.98, 95%CI=0.92-1.05, IR5-9yrs=520.7, HR5-9yrs=1.08, 95%CI=0.96-1.21, IR≥10yrs=556.2, HR≥10yrs=1.13, 95%CI =1.04-1.24, Ptrend=0.004, PInteraction=0.02), suggestive of waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in NHS2 (Ptrend<0.001).
  
  Conclusions and Relevance
  
  Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant, but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics.
  
  
• Subjects:
  Adult Article Coronary Artery Disease Female Follow-Up Studies Humans Incidence Middle Aged Nurses Personnel Staffing And Scheduling Proportional Hazards Models Prospective Studies Risk Assessment Surveys And Questionnaires Time Factors Work Schedule Tolerance

  More +
• Source:
  JAMA. 315(16):1726-1734.
• Pubmed ID:
  27115377
• Pubmed Central ID:
  PMC5102147
• Document Type:
  Journal Article
• Funding:
  R01 OH009803/OH/NIOSH CDC HHS/United States ; UM1 CA176726/CA/NCI NIH HHS/United States ; R01HL034594/HL/NHLBI NIH HHS/United States ; R01 HL034594/HL/NHLBI NIH HHS/United States ; UM1 CA186107/CA/NCI NIH HHS/United States ; UM1CA186107/CA/NCI NIH HHS/United States ; UM1CA176726/CA/NCI NIH HHS/United States ; 5R01OH009803/OH/NIOSH CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  315
• Issue:
  16
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a9a934a0746c1d6c4a7d9ae6dc0d89fc2bf3ccacd6c80f748757e47c1b0c2111
• Download URL:
  https://stacks.cdc.gov/view/cdc/42727/cdc_42727_DS1.pdf
• File Type:
  [PDF - 378.47 KB ]