Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK.
Instituto de Salud Pública de Chile, Av. Marathon 1000, Santiago, Chile.
Ann Work Expo Health. 2022 Jul 2;66(6):698-713. doi: 10.1093/annweh/wxac004.
Cardiovascular diseases (CVDs) are the number one cause of death, and there is evidence that work exposures could be associated with their development. This study aimed to systematically review observational studies of adults exposed to job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise, and assess the association of those work exposures with CVDs.
The Navigation Guide framework was applied. The population were adults of working age (18-65), and cohort and case-control studies were included. The work exposures were job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise. The outcomes were cerebrovascular diseases, ischaemic heart disease, and hypertensive diseases. The selection, data extraction, risk of bias assessment, and quality assessment were carried out by two reviewers independently and disagreements were solved by a third reviewer or by consensus. The synthesis of the results was done by applying the 'vote counting based on direction' method, and the results were summarized in an effect direction plot. The strength of the evidence for every risk factor and CVD was defined by consensus.
A total of 17 643 papers were initially identified in the literature search, but after applying the filters by title and abstract, and full text, 86 studies were finally included. From the included studies, sufficient evidence was found of the harmfulness of job strain for cerebrovascular disease and ischemic heart disease. Furthermore, there was sufficient evidence of the harmfulness of shift work for ischemic heart disease. Evidence of no relationship was found between long working hours and shift work with ischaemic heart disease and hypertensive disease, respectively. The other associations of work exposures and CVDs had limited or inadequate evidence of harmfulness.
In this comprehensive review, there was sufficient evidence of a harmful relationship between job strain, shift work, and CVDs. For the other work exposures, more high-quality studies are needed. In order to improve current prevention strategies for CVDs, the findings of this review imply that job strain and shift work are work exposures that constitute additional risk factors that could be approached as targets for worksite interventions.
PROSPERO CRD42020179972.
心血管疾病（CVD）是头号死因，有证据表明工作暴露可能与它们的发展有关。本研究旨在系统综述成年人暴露于工作压力、工作投入与回报失衡、工作时间长、工作不安全感、轮班工作和职业性噪声，并评估这些工作暴露与 CVD 的关系。
应用导航指南框架。研究人群为 18-65 岁的成年工作者，纳入队列和病例对照研究。工作暴露包括工作压力、工作投入与回报失衡、工作时间长、工作不安全感、轮班工作和职业性噪声。结果为脑血管疾病、缺血性心脏病和高血压疾病。选择、数据提取、偏倚风险评估和质量评估由两名审查员独立进行，如果意见不一致，则由第三名审查员或通过协商解决。结果的综合采用了“基于方向的票数计数”方法，并在效应方向图中进行了总结。根据共识定义了每个危险因素和 CVD 的证据强度。
在文献检索中最初确定了 17643 篇论文，但在通过标题和摘要以及全文应用过滤器后，最终纳入了 86 项研究。从纳入的研究中，有足够的证据表明工作压力对脑血管病和缺血性心脏病有害。此外，有足够的证据表明轮班工作对缺血性心脏病有害。没有发现工作时间长和轮班工作与缺血性心脏病和高血压疾病之间存在相关性。其他工作暴露与 CVD 之间的关联的危害性证据有限或不足。
在这项全面综述中，有足够的证据表明工作压力、轮班工作与 CVD 之间存在有害关系。对于其他工作暴露，需要更多高质量的研究。为了改善当前 CVD 的预防策略，本综述的结果表明，工作压力和轮班工作是构成额外风险因素的工作暴露，可以作为工作场所干预的目标。
PROSPERO CRD42020179972。
