Epidemiology and Health

Original Articles

Long working hours and the risk of hypothyroidism in healthy Korean workers: a cohort study: Yesung Lee, Woncheol Lee, Hyoung-Ryoul Kim; Epidemiol Health. 2022;44:e2022104. Published online November 8, 2022; DOI: https://doi.org/10.4178/epih.e2022104

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Long working hours have been reported to cause various health problems, but are currently practiced in many countries. Building upon a previous cross-sectional study, the authors aimed to elucidate the causal relationship between long working hours and hypothyroidism through a longitudinal study.

METHODS

Data were collected at baseline from 45,259 participants without thyroid disease and with consistent weekly working hours (36-40, 41-52, 53-60, and >60 hours) during the follow-up period. Hypothyroidism was defined using the reference limits of serum thyroid-stimulating hormone and free thyroxine levels. By estimating hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analysis, the risk of incident hypothyroidism was evaluated with 36-40 hours of work per week as the reference.

RESULTS

During 138,261.7 person-years of follow-up, 2,914 participants developed hypothyroidism (incidence density, 2.11/102 person-years). The multivariable-adjusted HRs of incident hypothyroidism for 41-52 hours, 53-60 hours, and >60 hours of work per week were 1.13 (95% CI, 1.03 to 1.24), 2.53 (95% CI, 2.17 to 2.95), and 2.57 (95% CI, 2.09 to 3.15), respectively. In dose-response analyses, long working hours had an approximately linear relationship with hypothyroidism incidence. The risk of incident hypothyroidism in those who worked 53-60 hours and >60 hours per week compared with the reference group was significantly higher among the older age group (≥36 years, stratified by median age), men, and daytime workers.

CONCLUSIONS

This large-scale cohort study demonstrated the association between long working hours and an increased risk of incident hypothyroidism with a dose-response relationship.

Summary

Korean summary
대규모 코호트연구를 통해 장시간노동을 수행한 노동자들에서 갑상선기능저하증의 위험이 높아지는 것을 확인할 수 있었다. 특히 연령, 성, 교대근무 유무에 따라 층화하여 분석한 결과에서 고연령, 남성, 교대근무를 하지 않는 노동자에서 관련성의 크기가 증가하였다.

Key Message
This large-scale cohort study (The Kangbuk Samsung Health Study), which used 45,259 participants without thyroid disease at baseline and estimated hazard ratios (HRs) using Cox proportional hazards regression analysis, demonstrated the association between long working hours and an increased risk of incident hypothyroidism with a dose-response relationship especially in older age group, men, and daytime workers.

Citations

Citations to this article as recorded by

Association between shift work and the risk of hypothyroidism in adult male workers in Korea: a cohort study
Seonghyeon Kwon, Yesung Lee, Eunhye Seo, Daehoon Kim, Jaehong Lee, Youshik Jeong, Jihoon Kim, Jinsook Jeong, Woncheol Lee
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef

Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: a nationwide study: Ju Hwan Kim, Yeon-Hee Baek, Hyesung Lee, Young June Choe, Hyun Joon Shin, Ju-Young Shin; Epidemiol Health. 2021;43:e2021004. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021004

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450 Download
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Abstract Summary PDF

Abstract

OBJECTIVES
Recent evidence has shown no harm associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). We sought to further clarify the possible association between ACEI/ARB use and the risk of poor clinical outcomes of COVID-19.

METHODS

From the completely enumerated COVID-19 cohort in Korea, we identified 1,290 patients with hypertension, of whom 682 had and 603 did not have records of ACEI/ARB use during the 30-day period before their COVID-19 diagnosis. Our primary endpoint comprised clinical outcomes, including all-cause mortality, use of mechanical ventilation, intensive care unit admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and a Poisson regression model to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for comparing outcomes between ACEI/ARB users and non-users.

RESULTS

Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW-adjusted RR, 0.60; 95% CI, 0.42 to 0.85; p=0.005). For individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW-adjusted RR, 0.62; 95% CI, 0.35 to 1.09; p=0.097) or respiratory events (IPTW-adjusted RR, 0.99; 95% CI, 0.84 to 1.17; p=0.904). Subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against overall outcomes in men (IPTW-adjusted RR, 0.84; 95% CI, 0.69 to 1.03; p<sub>interaction</sub>=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; p<sub>interaction</sub>=0.002).

CONCLUSIONS

We present clinical evidence to support continuing ACE/ARB use in COVID-19 patients with hypertension based on the completely enumerated Korean cohort.

Summary

Korean summary
– 코로나-19 검사를 받은 69,793명 중에 코로나-19 양성이며 고혈압이 있는 1,290명을 연구대상자로 선정했으며, 이중 코로나-19 진단일로부터 30일이내에 ACEI 또는 ARB를 사용한 환자는 682명이었음. – ACEI 또는 ARB 사용은 비사용 대비 사망 또는 폐 관련 질환의 위험과의 관련성이 없었음. – 하위그룹 분석에서 남성 또는 기저 폐질환 보유 환자에서 ACEI 또는 ARB 사용이 코로나-19 예후 악화를 예방하는 트렌드를 보였음.

Key Message
– Among 69,793 individuals screened for COVID-19, we identified 1,290 patients with hypertension who tested positive, of whom 682 had records of using ACEIs or ARBs in the 30 days before their COVID-19 diagnosis. – ACEI/ARB use (compared with non-use) was not associated with all-cause mortality or respiratory events. – A subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against the overall composite endpoint of poor outcomes in men and those with pre-existing respiratory disease.

Citations

Citations to this article as recorded by

Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19
Nancy Xurui Huang, Qi Yuan, Fang Fang, Bryan P. Yan, John E. Sanderson, Masaki Mogi
PLOS ONE.2023; 18(1): e0280280. CrossRef
Mortality and Severity in COVID-19 Patients on ACEIs and ARBs—A Systematic Review, Meta-Analysis, and Meta-Regression Analysis
Romil Singh, Sawai Singh Rathore, Hira Khan, Abhishek Bhurwal, Mack Sheraton, Prithwish Ghosh, Sohini Anand, Janaki Makadia, Fnu Ayesha, Kiran S. Mahapure, Ishita Mehra, Aysun Tekin, Rahul Kashyap, Vikas Bansal
Frontiers in Medicine.2022;[Epub] CrossRef
Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research
Jordan Loader, Frances C. Taylor, Erik Lampa, Johan Sundström
Journal of the American Heart Association.2022;[Epub] CrossRef
Drugs acting on the renin–angiotensin–aldosterone system (RAAS) and deaths of COVID-19 patients: a systematic review and meta-analysis of observational studies
Ruchika Sharma, Anoop Kumar, Jaseela Majeed, Ajit K. Thakur, Geeta Aggarwal
The Egyptian Heart Journal.2022;[Epub] CrossRef
Acute motor-sensory axonal polyneuropathy variant of Guillain–Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report
Ahmed Maseh Haidary, Sarah Noor, Esmatullah Hamed, Tawab Baryali, Soma Rahmani, Maryam Ahmad, Farahnaz Erfani, Hashmatullah Azimi, Habib Ul Rahman Habib, Gul Ahmad Tahiri, Ramin Saadaat, Abdul Sami Ibrahimkhil, Esmatullah Esmat, Haider Ali Malakzai
Journal of Medical Case Reports.2021;[Epub] CrossRef
Renin‐Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID‐19
Jordan Loader, Erik Lampa, Stefan Gustafsson, Thomas Cars, Johan Sundström
Journal of the American Heart Association.2021;[Epub] CrossRef
Role of Hypertension on the Severity of COVID-19: A Review
Mei Peng, Jia He, Ying Xue, Xue Yang, Shao Liu, Zhicheng Gong
Journal of Cardiovascular Pharmacology.2021; 78(5): e648. CrossRef
COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases
Yuanyuan Zhang, Mingjie Wang, Xian Zhang, Tianxiao Liu, Peter Libby, Guo-Ping Shi
Cardiology Discovery.2021; 1(4): 233. CrossRef

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