Global Epidemic of Cardiovascular Morbidity and Mortality: Share of work-relatedness

Introduction: Recently, work-relatedness of cardiovascular disorders has been generously recognized in the determination of workers’ compensation, in administrative or civil suits. We conducted systematic literature reviews on the etiological and prognostic associations between several work-related factors and cardiovascular disorders to examine the evidence from epidemiological perspective.

Methods: The studies published up to 2010 were searched from the retrieval databases of PubMed, using the relevant keywords: cardiovascular diseases and cerebrovascular disorders in MeSH for outcome and respective work-related factors--overtime work (long working hours), shift work, frequent business travel (incl. jet lag), noise and psychosocial factors (stress). Strict inclusion criteria were employed; the studies included had a prospective cohort design with a large sample size. We selected case-control studies only in the cases of obtaining very few prospective studies. Instruments for psychosocial exposure (stress) measurements were used in two or more studies. If any study was reported in duplicate, only one of the reports was reviewed. The overall effect size regarding the study hypothesis was assessed, and each study finding was verified by taking into consideration confounding and interaction. Results: The current reviews indicate that long working hours, shift work and psychosocial factors (stress) are associated with increased risk for cardiovascular disorders. However, evidence is lacking for definite conclusion on noise and frequent business travel (incl. jet lag; circadian disruption). The reason of negative appraisals is attributable to the difficulties of exposure measurement and the inappropriate study populations. Lifestyle-related diseases, also recognized as work-related diseases, such as hypertension and dyslipidemia appear to mediate the work-related factors and cardiovascular disorders. Several studies showed interaction between socioeconomic status and psychosocial factors (stress). Discussion: Evidence on work-relatedness of cardiovascular disorders has been accumulating. Sophistication for methodological procedures may produce further evidence on the work-relatedness of cardiovascular disorders.