Background

Previous reviews have demonstrated that shift work and long work hours are associated with increased risk for chronic conditions. However, these reviews did not comprehensively assessed the body of evidence, and some were not conducted in a systematic manner. A better understanding of the health consequences of shift work and long work hours will aid in creating policy and practice recommendations. This review revisits the epidemiologic evidence on the association of shift work and long work hours with chronic conditions with particular emphasis on assessing the quality of the evidence.

Methods and findings

We conducted a systematic review of systematic reviews with meta-analyses (SR-MA) that assessed the link between shift work or long work hours and chronic conditions (PROSPERO CRD42019122084). We evaluated the risk of bias of each SR-MA using AMSTAR v2 and assessed the overall evidence for each condition using the GRADE approach. We included 48 reviews covering cancers, cardiovascular diseases, metabolic syndrome and related conditions, pregnancy complications, depression, hypertension, and injuries. On average, only 7 of 16 AMSTAR items were fulfilled. Few SR-MAs had a registered protocol and nearly all failed to conduct a comprehensive search. We found moderate grade evidence linking shift work to breast cancer and long work hours to stroke. We found low grade evidence linking both shift work and long work hours with low to moderate increase in risk for some pregnancy complications and cardiovascular diseases. Low grade evidence also link long work hours and depression.

Conclusions

Moderate grade evidence suggest that shift work and long work hours increase the risk of breast cancer and stroke, but the evidence is unclear on other chronic conditions. There is a need for high-quality studies to address this gap. Stakeholders should be made aware of these increased risks, and additional screening and prevention should be considered, particularly for workers susceptible to breast cancer and stroke.

中文翻译：

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轮班和漫长的工作时间及其与慢性病的关系：系统评价的系统评价和荟萃分析。

背景

先前的评论表明，轮班工作和长时间工作与慢性病风险增加有关。但是，这些审查并未全面评估证据，有些审查没有系统地进行。更好地了解轮班工作和长时间工作对健康的影响，将有助于制定政策和实践建议。这篇评论回顾了轮班工作和长时间工作与慢性病之间的关系的流行病学证据，尤其着重于评估证据的质量。

方法和发现

我们使用荟萃分析（SR-MA）对系统评价进行了系统评价，该评价评估了轮班工作或长时间工作与慢性病之间的联系（PROSPERO CRD42019122084）。我们使用AMSTAR v2评估了每种SR-MA的偏倚风险，并使用GRADE方法评估了每种情况的总体证据。我们纳入了48条评论，涵盖了癌症，心血管疾病，代谢综合征和相关疾病，妊娠并发症，抑郁症，高血压和伤害。平均而言，AMSTAR 16件商品中只有7件可以满足。很少有SR-MA具有已注册的协议，几乎所有SR-MA都无法进行全面搜索。我们发现中等等级的证据将轮班工作与乳腺癌以及长时间的工作时间与中风联系起来。我们发现低级证据将轮班工作和长时间工作与某些妊娠并发症和心血管疾病的风险低至中度增加联系起来。低年级的证据还表明工作时间长和沮丧。

结论

中等等级的证据表明，轮班工作和长时间的工作会增加患乳腺癌和中风的风险，但在其他慢性病中尚不清楚。需要进行高质量的研究来弥补这一差距。应当使利益相关者意识到这些增加的风险，并应考虑进行额外的筛查和预防，尤其是对于易患乳腺癌和中风的工人。