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Virtanen, Marianna
Jokela, Markus
Nyberg, Solja T
Madsen, Ida E H
Lallukka, Tea
Ahola, Kirsi
Alfredsson, Lars
Batty, G David
Bjorner, Jakob B
Borritz, Marianne
Burr, Hermann
Casini, Annalisa
Clays, Els
De Bacquer, Dirk
Dragano, Nico
Erbel, Raimund
Ferrie, Jane E
Fransson, Eleonor I
Hamer, Mark
Heikkilä, Katriina
Jöckel, Karl-Heinz
Kittel, France
Knutsson, Anders
Koskenvuo, Markku
Ladwig, Karl-Heinz
Lunau, Thorsten
Nielsen, Martin L
Nordin, Maria
Oksanen, Tuula
Pejtersen, Jan H
Pentti, Jaana
Rugulies, Reiner
Salo, Paula
Schupp, Jürgen
Siegrist, Johannes
Singh-Manoux, Archana
Steptoe, Andrew
Suominen, Sakari B
Theorell, Töres
Vahtera, Jussi
Wagner, Gert G
Westerholm, Peter J M
Westerlund, Hugo
Kivimäki, Mika
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[Journal:] The BMJ [ISSN:] 1756-1833 [Volume:] 350 [Pages:] 1-14
Objective: To quantify the association between long working hours and alcohol use.Design: Systematic review and meta-analysis of published studies and unpublished individual participant data. Data sources: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. Review methods: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary: estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. Results: Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95\% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and >=55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2\%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.Conclusions Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
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