To make matters worse, working too much has been shown to be deleterious to workers’ health. This long suspected correlation between heavy work schedules and poor health has never been definitively proven (though suspected by many). Yet a recent study appears to have provided the strongest evidence to date.² This study, published online in August 2015 in The Lancet, one of England’s (and the world’s) preeminent peer-reviewed medical journals, was disheartening to me the first time I read it. Let’s spend a moment to review this article.

The authors performed a systematic review and meta-analysis looking at high quality prospective cohort studies that assessed the risk of cardiovascular complications associated with long work hours. They additionally looked at unpublished data from a European research consortium and open-access data archives. After winnowing down the systemic review using the validated PRISMA guidelines for meta-analyses, the authors ended up with 25 studies that looked at coronary heart disease and 17 studies that analyzed stroke. They then performed a high quality meta-analysis (you’ll have to take my word that this is one of the best meta-analyses I’ve read – feel free to read the article). The majority of published studies defined “long working hours” as 45 – 55 hours or more per week.

Personally, I found the definition of long working hours to be funny since my average work week runs around 60-70 hours.

When combining all of the data the authors obtained a homogeneous cohort of 603,838 men and women who had been free of coronary heart disease at baseline and 528,908 men and women free from stroke at baseline. After meta-analysis the authors found a relative risk of coronary heart disease of 1.13 with a 95% confidence interval and p value 0.02. This was considered a modest overall increase in heart disease as a result of long work hours.

More importantly, the authors found a 1.33 relative risk of stroke with a 95% confidence interval and p value 0.002. They also found a “dose response” relationship. In essence the more a person works per week the greater the risk of having a stroke as follows:

• 41-48 working hours - relative risk 1.10 (10% increased risk of stroke)
• 49-54 working hours - relative risk 1.27 (27% increased risk of stroke)
• 55 working hours - relative risk 1.33 (33% increased risk of stroke)

Let’s put that last number (relative risk 1.33) in perspective. Let’s say three of you are about to leave for work on a nice sunny Monday morning. As you are walking out the door you receive a phone call from me (Shapiro). I have magically gained the power to tell the future (go me!), and I have just told you that of the three of you leaving today one of you will be killed in a car accident. You have a 1 in 3 chance (or 33% chance) of dying if you leave. Will you call in sick that day or go to work? I’ll bet I won’t be seeing three of you at work that day. This might be a bit hyperbolic, and the comparison might not be totally accurate, but I think you get the point.

The study’s authors discussed a few “biologically plausible” (their words) causes including triggering the stress response, the effects of physical inactivity, and potentially avoiding the warning signs of disease.²

I’ll admit to you that this study has me somewhat disturbed. With my work hours I’m clearly in their higher risk group for stroke, and I’m sure many of you are as well. This study looked at heavy work hours but did not consider the contribution of a busy home life into this risk. For example, I usually leave the house at about 6:00 AM, work until about 5:30- 6:00 PM (a bit later when on call), drive home for 45 minutes, and then attend to my home duties for a couple of hours before resting. At least a few times per week, I’ll work 2 to 3 more hours after the family has gone to sleep. In some sense, the time at home is additional work. If I combined all of that time together, I’m working somewhere between 12 and 16 hours per day 5 days a week (sometimes 6 days per week).

The only saving grace for us in the health professions is that the risk was also found to be greater for those with lower socioeconomic status (relative risk up to 2.18 in the lowest group – that’s a 118% increased risk in this group).²

It seems clear that the best evidence we have to date examining the risk of working long hours tells those of us who work too much that we are risking our health. I don’t have a pithy answer to rationalize this situation or a bulleted list of recommendations like I have done in prior issues. The only suggestion I can make without sounding incredibly hypocritical is for each of us to consider where we place our health on the continuum of what’s most important. If your health is most important then I suggest decreasing your work hours. How practical is that? I don’t know. That’s for you to figure out.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References

1. https://www.bestmedicaldegrees.com/salary-of-doctors Last accessed Sept 19/2015.
2. Kivimaki M, Jokela M, Nyberg S, et al. Long working hours and risk of coronary heart disease and stroke: a systemic review and meta-analysis of published and unpublished data for 603 838 individuals. The Lancet. Published online August 20, 2015.

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