Frost Poul, Kolstad Henrik A, Bonde Jens Peter
Danish Ramazzini Center, Department of Occupational Medicine, Arhus University Hospital, Arhus Sygehus, Noerrebrogade 44, Building 2C, 8000 Arhus C, Denmark.
Scand J Work Environ Health. 2009 May;35(3):163-79. doi: 10.5271/sjweh.1319. Epub 2009 Apr 22.
The objective of this review was to evaluate the epidemiologic evidence for a causal relation -between shift work and ischemic heart disease.
We conducted a systematic search until the end of March 2008 for studies providing information on the relative risk of ischemic heart disease in relation to shift work. The quality of included papers was evaluated with respect to design, exposure and outcome information, bias, and exposure response assessment.
Relevant information was retrieved from 14 studies. Seven of these analyzed fatal events, six -combined fatal and non-fatal events, while one study reported separately on both types of events. Relative risks ranged from 0.6-1.4 in 12 papers while two papers reported relative risks around 2.0. Most studies based on fatal events showed no or weak associations while studies that combined fatal and non-fatal events showed modest positive associations. In a majority of studies, we could not reasonably rule out negative or positive bias due to the quality of outcome or exposure information, or confounder control. Five studies used years in shift work for exposure response analysis and no consistent pattern were seen.
There is limited epidemiological evidence for a causal relation between shift work and ischemic heart disease.
本综述的目的是评估轮班工作与缺血性心脏病之间因果关系的流行病学证据。
我们进行了系统检索，直至2008年3月底，以查找提供轮班工作与缺血性心脏病相对风险相关信息的研究。根据设计、暴露和结局信息、偏倚以及暴露反应评估对纳入论文的质量进行了评估。
从14项研究中检索到相关信息。其中7项分析了致命事件，6项综合分析了致命和非致命事件，而1项研究分别报告了这两类事件。12篇论文的相对风险在0.6至1.4之间，而两篇论文报告的相对风险约为2.0。大多数基于致命事件的研究显示无关联或关联较弱，而综合分析致命和非致命事件的研究显示出适度的正相关。在大多数研究中，由于结局或暴露信息的质量或混杂因素控制问题，我们无法合理排除阴性或阳性偏倚。5项研究使用轮班工作年限进行暴露反应分析，未发现一致的模式。
轮班工作与缺血性心脏病之间存在因果关系的流行病学证据有限。
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