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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals.

Overview of attention for article published in The Lancet, August 2015
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  • In the top 5% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#21 of 24,961)
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (99th percentile)

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256 Mendeley
4 CiteULike
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working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals.
Published in
The Lancet, August 2015
DOI 10.1016/s0140-6736(15)60295-1
Pubmed ID

Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Raimund Erbel, Goedele A Geuskens, Mark Hamer, Wendela E Hooftman, Irene L Houtman, Karl-Heinz Jöckel, France Kittel, Anders Knutsson, Markku Koskenvuo, Thorsten Lunau, Ida E H Madsen, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Martin J Shipley, Johannes Siegrist, Andrew Steptoe, Sakari B Suominen, Töres Theorell, Jussi Vahtera, Peter J M Westerholm, Hugo Westerlund, Dermot O'Reilly, Meena Kumari, G David Batty, Jane E Ferrie, Marianna Virtanen, Kivimäki, Mika, Jokela, Markus, Nyberg, Solja T, Singh-Manoux, Archana, Fransson, Eleonor I, Alfredsson, Lars, Bjorner, Jakob B, Borritz, Marianne, Burr, Hermann, Casini, Annalisa, Clays, Els, De Bacquer, Dirk, Dragano, Nico, Erbel, Raimund, Geuskens, Goedele A, Hamer, Mark, Hooftman, Wendela E, Houtman, Irene L, Jöckel, Karl-Heinz, Kittel, France, Knutsson, Anders, Koskenvuo, Markku, Lunau, Thorsten, Madsen, Ida E H, Nielsen, Martin L, Nordin, Maria, Oksanen, Tuula, Pejtersen, Jan H, Pentti, Jaana, Rugulies, Reiner, Salo, Paula, Shipley, Martin J, Siegrist, Johannes, Steptoe, Andrew, Suominen, Sakari B, Theorell, Töres, Vahtera, Jussi, Westerholm, Peter J M, Westerlund, Hugo, O'Reilly, Dermot, Kumari, Meena, Batty, G David, Ferrie, Jane E, Virtanen, Marianna, , , Kivimäki, M, Jokela, M, Nyberg, ST, Singh-Manoux, A, Fransson, EI, Alfredsson, L, Bjorner, JB, Borritz, M, Burr, H, Casini, A, Clays, E, De Bacquer, D, Dragano, N, Erbel, R, Geuskens, GA, Hamer, M, Hooftman, WE, Houtman, IL, Jöckel, K-H, Kittel, F, Knutsson, A, Koskenvuo, M, Lunau, T, Madsen, IEH, Nielsen, ML, Nordin, M, Oksanen, T, Pejtersen, JH, Pentti, J, Rugulies, R, Salo, P, Shipley, MJ, Siegrist, J, Steptoe, A, Suominen, SB, Theorell, T, Vahtera, J, Westerholm, PJM, Westerlund, H, O'Reilly, D, Kumari, M, Batty, GD, Ferrie, JE, Virtanen, M


Long 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. We 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. We 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). Employees 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. Medical 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.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 256 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 6 2%
United States 6 2%
Brazil 3 1%
Spain 3 1%
Germany 2 <1%
Denmark 2 <1%
Finland 2 <1%
Portugal 2 <1%
Switzerland 2 <1%
Other 11 4%
Unknown 217 85%

Demographic breakdown

Readers by professional status Count As %
Researcher 49 19%
Student > Bachelor 37 14%
Student > Master 37 14%
Student > Ph. D. Student 36 14%
Other 33 13%
Other 64 25%
Readers by discipline Count As %
Medicine and Dentistry 116 45%
Psychology 33 13%
Social Sciences 24 9%
Agricultural and Biological Sciences 16 6%
Economics, Econometrics and Finance 11 4%
Other 56 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 1900. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 November 2017.
All research outputs
of 8,665,431 outputs
Outputs from The Lancet
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Outputs of similar age
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Outputs of similar age from The Lancet
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Altmetric has tracked 8,665,431 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 24,961 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 28.9. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 231,324 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 442 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 99% of its contemporaries.