Long-term prognosis of cardiometabolic diseases among U.S. workers - The contribution of shift work to mortality

Sep 30, 2026

Shift work is a recognized risk factor for cardiometabolic diseases (CMD), yet evidence remains limited on long-term prognosis for individuals already diagnosed with CMD, especially for mortality after ongoing shift exposure. Using linked National Health Interview Survey (NHIS) data (2010 and 2015) and National Death Index follow-up through 2019, Cox models assessed all-cause, CMD, and CVD mortality. Among 9,622 workers, shift work predicted higher risks of all-cause, CMD, and CVD mortality. Results underscore occupational exposures for secondary prevention.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Methods

Results

Conclusions

American Journal of Preventive Cardiology 25 (2026) 101379 Contents lists available at ScienceDirect American Journal of Preventive Cardiology journal [homepage:](homepage: www.journals.elsevier.com/american-journal-of-preventive-cardiology)[ www.journals.elsevier.com/american-journal-of-preventive-cardiology](homepage: www.journals.elsevier.com/american-journal-of-preventive-cardiology) | Long-term prognosis of cardiometabolic diseases among U.S. workers: The contribution of shift work to mortality
Xiang Li a, Tong Xiab,c, Paul Landsbergis d, Imelda Wong e,f, Jian Li a,g,h,*
a Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA b Channing Division of Network Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, USAc Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
d Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, USA e Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, Canada
f Centers for Health, Work & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA g Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA h Joe C. Wen School of Nursing, University of California Los Angeles, Los Angeles, USA | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords: Cardiometabolic Diseases Mortality
Prognosis
Workers, Shift work | | Background: Shift work is a known risk factor for cardiometabolic diseases (CMD), including cardiovascular diseases (CVD) and diabetes. However, limited evidence exists on the long-term prognosis of individuals already diagnosed with CMD, particularly regarding mortality outcomes following continued exposure to shift work. This study aimed to investigate the prospective association between shift work and mortality outcomes, including allcause, CMD, and CVD mortality, among U.S. workers with CMD.
Methods: The data of 2010 and 2015 National Health Interview Survey (NHIS) were linked to mortality records from the National Death Index through December 31, 2019. A total of 9,622 workers with CMD were included. Shift work exposure was self-reported usual work schedules and categorized as shift versus regular daytime work. Cox proportional hazards models were performed, with adjustment for baseline demographic information, socioeconomic status, and occupational characteristics.
Results: At baseline, 25.7 %(2,470) reported shift work. During follow-up period, 308 deaths in the non-shift work group (100 CMD deaths and 90 CVD deaths) and 129 deaths in the shift work group (50 CMD deaths and 43 CVD deaths) were documented. Shift work was associated with a higher risk of all-cause mortality (HR= 1.28, 95 % CI= 1.02, 1.62), CMD mortality (HR= 1.57, 95 % CI= 1.01, 2.42), and CVD mortality (HR= 1.61, 95 % CI= 1.02, 2.53), adjusting for baseline covariates.
Conclusions: Among U.S. workers with CMD, shift work was associated with substantially higher risks of all-cause and cause-specific mortality, highlighting the need to consider occupational exposures in clinical care and workplace policies to support secondary prevention for workers with CMD. | 1. Introduction Cardiometabolic diseases (CMD) are a group of interconnected conditions that involve both the cardiovascular system and metabolic processes. These conditions often share common risk factors and can lead to serious health problems like cardiovascular diseases (CVD, primarily heart disease and stroke) and type 2 diabetes, which are the leading causes of death worldwide [1]. In the United States (U.S.), the prevalence ofCVD (excluding hypertension), hypertension, and diabetes among adults (≥18y) was estimated

FAQs

What was the study’s main question about shift work and CMD?

The study examined whether ongoing shift work is prospectively associated with mortality outcomes among U.S. workers who already have cardiometabolic diseases.

How were shift work exposure and mortality outcomes measured?

Shift work exposure was self-reported usual work schedules and categorized as shift versus regular daytime work. Mortality outcomes were obtained by linking NHIS data to National Death Index records through December 31, 2019.

What did the results show about mortality risk?

Shift work was associated with higher risk of all-cause mortality, CMD mortality, and CVD mortality after adjusting for baseline demographic information, socioeconomic status, and occupational characteristics.

Sep 30, 2026

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