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. 2021 Sep:154:106595.
doi: 10.1016/j.envint.2021.106595. Epub 2021 May 17.

Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Frank Pega  1 , Bálint Náfrádi  2 , Natalie C Momen  3 , Yuka Ujita  2 , Kai N Streicher  3 , Annette M Prüss-Üstün  3 ; Technical Advisory Group; Alexis Descatha  4 , Tim Driscoll  5 , Frida M Fischer  6 , Lode Godderis  7 , Hannah M Kiiver  8 , Jian Li  9 , Linda L Magnusson Hanson  10 , Reiner Rugulies  11 , Kathrine Sørensen  12 , Tracey J Woodruff  13
Affiliations

Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Frank Pega et al. Environ Int. 2021 Sep.

Abstract

Background: World Health Organization (WHO) and International Labour Organization (ILO) systematic reviews reported sufficient evidence for higher risks of ischemic heart disease and stroke amongst people working long hours (≥55 hours/week), compared with people working standard hours (35-40 hours/week). This article presents WHO/ILO Joint Estimates of global, regional, and national exposure to long working hours, for 194 countries, and the attributable burdens of ischemic heart disease and stroke, for 183 countries, by sex and age, for 2000, 2010, and 2016.

Methods and findings: We calculated population-attributable fractions from estimates of the population exposed to long working hours and relative risks of exposure on the diseases from the systematic reviews. The exposed population was modelled using data from 2324 cross-sectional surveys and 1742 quarterly survey datasets. Attributable disease burdens were estimated by applying the population-attributable fractions to WHO's Global Health Estimates of total disease burdens.

Results: In 2016, 488 million people (95% uncertainty range: 472-503 million), or 8.9% (8.6-9.1) of the global population, were exposed to working long hours (≥55 hours/week). An estimated 745,194 deaths (705,786-784,601) and 23.3 million disability-adjusted life years (22.2-24.4) from ischemic heart disease and stroke combined were attributable to this exposure. The population-attributable fractions for deaths were 3.7% (3.4-4.0) for ischemic heart disease and 6.9% for stroke (6.4-7.5); for disability-adjusted life years they were 5.3% (4.9-5.6) for ischemic heart disease and 9.3% (8.7-9.9) for stroke.

Conclusions: WHO and ILO estimate exposure to long working hours (≥55 hours/week) is common and causes large attributable burdens of ischemic heart disease and stroke. Protecting and promoting occupational and workers' safety and health requires interventions to reduce hazardous long working hours.

Keywords: Burden of disease; Ischemic heart disease; Stroke; Working hours.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Professor Alexis Descatha reports personal fees from University of Angers, personal fees from the Angers University Hospital Center, personal fees from Elsevier, and grants from Regional found (Pays de la Loire/Angers Loire Metropole), outside the submitted work.

Figures

Fig. 1
Fig. 1
Conceptual model of the possible causal relationship between exposure to long working hours and ischemic heart disease and stroke. Footnote: Adapted from Li et al. (2020a) and Descatha et al. (2020). Some variables in this conceptual model, such as smoking and physical inactivity, could be confounders, mediators or both at the same time.
Fig. 2
Fig. 2
Number of exposed population and proportion of population exposed to long working hours (≥55 hours/week), by sex and age group, 2016, 194 countries.
Fig. 3
Fig. 3
Proportion (%) of population exposed to long working hours (≥55 hours/week), 2016, 194 countries.
Fig. 4
Fig. 4
Rate of deaths (per 100,000 of population) and DALYs (per 100,000 of population) from ischemic health disease attributable to exposure to long working hours (≥55 hours/week), 2016, 183 countries. Footnote: No estimates were produced for Andorra, Cook Islands, Dominica, Marshall Islands, Monaco, Nauru, Niue, Palau, Saint Kitts and Nevis, San Marino, and Tuvalu, because the envelopes for the burdens of ischemic heart disease were unavailable for these countries (World Health Organization, 2018b).
Fig. 5
Fig. 5
Rate of deaths (per 100,000 of population) and DALYs (per 100,000 of population) from stroke attributable to exposure to long working hours (≥55 hours/week), 2016, 183 countries. Footnote: No estimates were produced for Andorra, Cook Islands, Dominica, Marshall Islands, Monaco, Nauru, Niue, Palau, Saint Kitts and Nevis, San Marino, and Tuvalu, because the envelopes for the burdens of stroke were unavailable for these countries (World Health Organization, 2018b).
Fig. 6
Fig. 6
Number of deaths and rate of death (per 100,000 of population) for ischemic heart disease and stroke attributable to exposure to long working hours (≥55 hours/week), by age group, 2016, 183 countries.
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