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Original Article
Association between long working hours and liver enzymes: evidence from the Korea National Health and Nutrition Examination Survey, 2007–2017
Ji-Hun Song, Hyoung-Ryoul Kim, Dong-Wook Lee, Jeehee Min, Yu Min Lee, Mo-Yeol Kang
Ann Occup Environ Med 2022;34:e9.   Published online May 13, 2022
DOI: https://doi.org/10.35371/aoem.2022.34.e9
AbstractAbstract AbstractAbstract in Korean PDFSupplementary MaterialPubReaderePub
Background

Long working hours causes several health risks, but little is known about its effects on the liver. This study aimed to examine the correlation between working hours and abnormal liver enzyme levels.

Methods

We used data from the Korea National Health and Nutrition Examination Survey IV–VII. For the final 15,316 study participant, the information on working hours was obtained through questionnaires, and liver enzyme levels, consisting of serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), through blood tests. The relationship between weekly working hours and abnormal levels of liver enzymes was analyzed using multiple logistic regression, and a trend test was also conducted.

Results

In male, working ≥ 61 hours per week was significantly associated with elevated AST and ALT levels compared with working 35–52 hours per week. Even after adjusting for covariates, the odds ratios (ORs) of abnormal AST and ALT increased by 1.51 (95% confidence interval: 1.20–2.05) and 1.25 (1.03–1.52), respectively, and a dose-response relationship was observed. This association was more prominent among the high-risk group, such as those aged > 40 years, obese individuals, worker on non-standard work schedule, pink-collar workers, or temporary worker. No correlation was observed in female.

Conclusions

Long working hours are associated with abnormal liver function test results in male. Strict adherence to statutory working hours is necessary to protect workers’ liver health.

장시간 노동과 간기능 이상의 상관성: 2007-2017 국민건강영양조사 자료를 이용하여
목적
장시간 노동은 여러 가지 건강상의 위험을 초래하지만 간에 미치는 영향에 대해서는 아직까지 알려진 바가 거의 없다. 본 연구는 근로시간과 간기능 이상과의 상관관계를 알아보는 것을 목적으로 하였다.
방법
본 연구를 위해 4-7차 국민건강영양조사 자료를 사용하였다. 최종 연구참여자 15,316명을 대상으로 설문지를 통해 근무시간 정보를 얻었고 혈액검사를 통해 혈청 아스파르테이트아미노트랜스퍼라제(AST)와 알라닌아미노트랜스퍼라제(ALT)로 구성된 간효소치 정보를 얻었다. 다중 로지스틱 회귀 분석을 통해 주당 근무 시간과 간효소 이상 수치와의 관계를 분석하고 추세 검정도 함께 진행하였다.
결과
남성의 경우 주당 35-52시간 일하는 것에 비해, 법정 최대 근로시간을 초과한 주당 53-60시간을 근무하여도 AST 및 ALT 수치의 유의한 상승이 관찰되진 않았으나, 주당 60시간을 초과하여 일하는 경우 유의하게 상승하였다. 공변량을 보정한 후에도 AST와 ALT이상수치의 교차비(ORs)가 각각 1.51 (95% 신뢰 구간: 1.20-2.05) 및 1.25 (1.03-1.52) 증가하여 용량-반응 관계가 관찰되었다. 이 연관성은 40세 이상, 비만인, 비정규시간 근로자, 핑크 칼라 노동자, 임시직 노동자와 같은 고위험군에서 더 두드러졌다. 여성에서는 상관관계가 관찰되지 않았다.
결론
남성의 경우 장시간 노동은 간기능 검사 결과 이상과 관련이 있다. 근로자의 간 건강을 보호하기 위해서는 법정 근로시간을 철저히 준수하는 것이 필요하다.

Citations

Citations to this article as recorded by  
  • Association between long working hours and metabolic dysfunction–associated steatotic liver disease: a nationwide population-based study in Korea
    S.-U. Baek, J.-U. Won, Y.-M. Lee, J.-H. Yoon
    Public Health.2024; 232: 188.     CrossRef
  • Long working hours and increased risks of lean non-alcoholic fatty liver disease among Korean men and women
    Ga-Young Lim, Yoosoo Chang, Inah Kim, Seungho Ryu, Ria Kwon, Jaechul Song
    Scientific Reports.2023;[Epub]     CrossRef
  • The associations of health behaviors and working hours with high-sensitivity C-reactive protein levels in Korean wage workers: a cross-sectional study
    Choong-Won Seo, Eun-A Park, Tae-Hyung Yoon
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Research Articles
Relationship between working hours and probability to take alopecia medicine among Korean male workers: a 4-year follow-up study
Kyung-Hun Son, Byung-Seong Suh, Han-Seur Jeong, Min-Woo Nam, Hyunil Kim, Hyeong-Cheol Kim
Ann Occup Environ Med 2019;31:e12.   Published online July 11, 2019
DOI: https://doi.org/10.35371/aoem.2019.31.e12
AbstractAbstract PDFPubReaderePub
Background

Many studies have reported the negative effects of long working hours on various health problems. However, whether hair loss is associated with working hours has been rarely investigated so far. The main purpose of this study is to explore the relationship between long working hours and the development of alopecia among Korean male workers.

Methods

A total of 13,391 male workers not to take alopecia medicine in 2013 were followed up to see if they have alopecia medicine after 4 years, and that was used to confirm the alopecia development. Weekly working hours were categorized into three groups: reference working hours (RWH; < 40 hours/week), long working hours (LWH, 40–52 hours/week), and much longer working hours (MLWH; > 52 hours/week). Multiple logistic regression analyses were conducted to investigate the relationship between long working hours and the development of alopecia after adjusting age, marital status, education, monthly household income, smoking, and work schedule within strata of the covariates.

Results

Long working hours was significantly related to the development of alopecia. The adjusted odds ratios (ORs) for the development of alopecia were 1.57 (95% confidence interval [CI]: 1.21–2.05) for LWH group and 1.74 (95% CI: 1.23–2.47) for MLWH group relative to RWH group.

Conclusions

Our findings suggest that unintentional development of alopecia is another potential health consequence of long working hours among Korean male workers. Preventive interventions to promote appropriate and reasonable working hours are required in our society.


Citations

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  • Clinical Patterns of Hair Loss in Men
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The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study)
Jae-Gwang Lee, Guang Hwi Kim, Sung Won Jung, Sang Woo Kim, June-Hee Lee, Kyung-Jae Lee
Ann Occup Environ Med 2018;30:67.   Published online December 3, 2018
DOI: https://doi.org/10.1186/s40557-018-0278-0
AbstractAbstract PDFPubReaderePub
Background

It has been reported that long working hours are hazardous to the workers’ health. Especially, work-related musculoskeletal disorders (WMSDs) have been considered as one of the significant health issues in workplace. The objective of this study was to identify the association between long working hours and work-related musculoskeletal symptoms.

Methods

The analysis was conducted using data from the Fourth Korean Working Conditions Survey (KWCS). Subjects of this study were 24,783 wage workers and divided into three groups according to the weekly working hours, which were ≤ 40, 41–52 and > 52 h. The relationship between long working hours and work-related musculoskeletal symptoms was analyzed by multivariate logistic regression method after adjusting for general, occupational characteristics including specific working motions or postures and psychosocial factors.

Results

Approximately 18.4% of subjects worked more than 52 h per week and 26.4 and 16.4% of male subjects and 33.0 and 23.4% of female subjects experienced work-related upper and lower limb pains, respectively, over the last 12 months. Moreover, the prevalence of upper and lower limb pain was increased in both genders as the weekly working hours increased. The odds ratios (ORs) of upper limb pain for those working 41–52 h and more than 52 h per week when adjusted for general, occupational characteristics including specific motions or postures and psychosocial factors were 1.36 and 1.40 for male workers and 1.26 and 1.66 for female workers compared to the reference group, respectively. Furthermore, ORs of lower limb pain for the same weekly working hour groups were 1.26 and 1.47 for male workers and 1.20 and 1.47 for female workers, respectively.

Conclusions

Long working hours were significantly related to work-related musculoskeletal symptoms in Korean wage workers and appropriate interventions should be implemented to reduce long working hours that can negatively affect workers’ health.


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The effect of long working hours on 10-year risk of coronary heart disease and stroke in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES), 2007 to 2013
Dong-Wook Lee, Yun-Chul Hong, Kyoung-Bok Min, Tae-Shik Kim, Min-Seok Kim, Mo-Yeol Kang
Ann Occup Environ Med 2016;28:64.   Published online November 15, 2016
DOI: https://doi.org/10.1186/s40557-016-0149-5
AbstractAbstract PDFPubReaderePub
Background

Recently, the emergence of long working hours and the associated conditions such as coronary heart disease (CHD) and stroke have gained attention. The aim of this study was to investigate the association between long working hours and the 10-year-risk of CHD and stroke, estimated by Jee’s health risk-appraisal model for ischemic heart disease.

Methods

We analyzed data from Koreans who randomly enrolled in Korean National Health and Nutrition Examination Survey 2008–2012 and finally included 13,799 participants. The participants were classified as per their working hours: 0–30 h/week, 31–39 h/week, 40 h/week, 41–50 h/week, 51–60 h/week, 61–70 h/week, 71–80 h/week, and >80 h/week. The risks for CHD and stroke were determined using Jee’s health risk-appraisal model. Multiple logistic regression was used to analyze the association between working hours and 10-year risk for CHD.

Results

The 10-year risks for CHD and stroke were significantly and positively associated with working hours in both men and women. Furthermore, higher risks for CHD and stroke were associated with longer working hours in women.

Conclusion

Long working hours are significantly associated with the risks of CHD and stroke, estimated by Jee’s health risk-appraisal model. This study suggests the need for proper management of working hours to reduce CHD risk and stroke risk in the Korean population.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-016-0149-5) contains supplementary material, which is available to authorized users.


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    Mi-Jung Eum, Hye-Sun Jung
    International Journal of Environmental Research and Public Health.2020; 17(5): 1585.     CrossRef
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    Harald Hannerz, Karen Albertsen, Hermann Burr, Martin Lindhardt Nielsen, Anne Helene Garde, Ann Dyreborg Larsen, Jan Hyld Pejtersen
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    Jia Ryu, Yeogyeong Yoon, Hyunjoo Kim, Chung won Kang, Kyunghee Jung-Choi
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    Harald Hannerz, Ann Dyreborg Larsen, Anne Helene Garde
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The association between long working hours and hearing impairment in noise unexposed workers: data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES 2010–2012)
Jung-Woo Park, Jin-Soo Park, Seyoung Kim, Minkyu Park, Hyunrim Choi, Sinye Lim
Ann Occup Environ Med 2016;28:55.   Published online October 6, 2016
DOI: https://doi.org/10.1186/s40557-016-0140-1
AbstractAbstract PDFPubReaderePub
Background

This study is aimed at finding out the relationship between long working hours, one of major job stress elements, and hearing impairment in unexposed workers to occupational and environmental noise.

Methods

This study was performed on 1628 regular, full-time wage workers between the age of 25-64 who indicated in the survey of having no experience of exposure to noise, normal otoscopic findings, and not suffering from diabetes based on the data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES 2010–2012). The average working hours per week was categorized into 40 h and lower group, more than 40 to 48 h group, more than 48 to 60 h group, and more than 60 h group. The groups were defined as suffering from low or high frequencies hearing impairment if the average hearing threshold for 0.5, 1, 2 kHz or 3, 4, 6 kHz in both ears exceeds 25 dB based on the pure tone audiometry. The association between average weekly working hours and hearing impairment was analyzed using logistic regression after gender stratification.

Results

The prevalences of low and high frequencies hearing impairment in male workers were 4.3 and 28.6 %, respectively, which were much higher than female’s prevalence of 2.7 and 11.1 %. For male workers, no significant association was found between average weekly working hours and low and high frequencies hearing impairment. For female workers, odds ratios (OR) of low and high frequencies hearing impairment were 4.22 (95 % confidence interval (CI) 1.09–16.27) and 4.49 (95 % CI 1.73–11.67), respectively, after controlling for several related factors, such as, age, Body Mass Index (BMI), socio-economic status, health-related behavioral, and occupational characteristics variables, in the final model in the group working more than 60 h compared to the group working 40 h and lower. In addition, a dose-response relationship was observed that ORs of low and high frequencies hearing impairment were increased according to increasing average weekly working hours.

Conclusions

The association between long working hours and hearing impairment in both low and high frequencies was significant in Korean female workers with a dose-response relationship. Therefore, the law to change the culture of long working hours should be enacted in order to protect the workers’ health and improve the quality of life in Korean workers.


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  • Evaluation of the effect of Nigella sativa oil on the outcome of missed abortion in women: A randomized double‐blind clinical trial
    Belgheis Mohammadi, Leila Nazari Robati, Zeinab Tavakol, Mina Movahhed
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    Yesung Lee, Eunchan Mun, Soyoung Park, Woncheol Lee, Jee-Fu Huang
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Long working hours and overweight and obesity in working adults
Byung-Mi Kim, Bo-Eun Lee, Hye-Sook Park, Young-Ju Kim, Young-Ju Suh, Jeong-youn Kim, Ji-Young Shin, Eun-Hee Ha
Ann Occup Environ Med 2016;28:36.   Published online August 22, 2016
DOI: https://doi.org/10.1186/s40557-016-0110-7
AbstractAbstract PDFPubReaderePub
Background

Previous studies have identified a link between gender and the various risk factors associated with obesity. We examined obesity risk factors in working adults to identify the effects of differences in body mass index (BMI) and percentage body fat (PBF) between women and men.

Methods

A total of 1,120 adults agreed to participate in the study. Data from 711 participants, including 411 women and 300 men, were analyzed. Multiple logistic regression analysis was used to estimate the effects of risk factors on obesity and being overweight. In addition, the least-squares (LS) means of both BMI and PBF were estimated by analysis of covariance (ANCOVA) in a generalized linear model. 

Results

Increases in BMI and PBF were significantly related to an age > 50 years and long working hours in women after compensating for confounding factors. Using the PBF criterion, the odds ratio (OR) of being overweight or obese in women > 50 years of age who worked for > 9 h a day was 3.9 (95% confidence interval [CI], 1.05–11.00). For BMI, women who were > 50 years of age and worked for > 9 h a day were 3.82 times (95% CI, 1.31–11.14) more likely to be overweight or obese than those who were < 50 years of age and worked for < 9 h a day.

Conclusion

Obesity in working adults was associated with > 50 years of age and long working hours in women. Further studies are needed to investigate the underlying mechanisms of this relationship and its potential implications for the prevention and management of excess weight and obesity.


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    Fong Fong Liew, Theysshana Visuvanathan, Shalini Vellasamy
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    Yesung Lee, Eunchan Mun, Soyoung Park, Woncheol Lee, Jee-Fu Huang
    PLOS ONE.2021; 16(7): e0255118.     CrossRef
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    Eyun Song, Jung A. Kim, Eun Roh, Ji Hee Yu, Nam Hoon Kim, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi
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    C. Di Tecco, L. Fontana, G. Adamo, M. Petyx, S. Iavicoli
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    Marianna Virtanen, Linda Magnusson Hansson, Marcel Goldberg, Marie Zins, Sari Stenholm, Jussi Vahtera, Hugo Westerlund, Mika Kivimäki
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The association between long working hours and the metabolic syndrome: evidences from the 5th Korean National Health and Nutrition Examination Survey of 2010 and 2012
Jae Uk Jeong, Man Joong Jeon, Joon Sakong
Ann Occup Environ Med 2014;26:53.   Published online December 21, 2014
DOI: https://doi.org/10.1186/s40557-014-0053-9
AbstractAbstract PDFPubReaderePub
Objectives

This study was conducted in order to evaluate the association between the working hours of Korean employees and the metabolic syndrome and the effects of long working hours on metabolic syndrome based on the 5th Korean National Health and Nutrition Examination Survey (2010-2012).

Methods

Based on the 5th Korean National Health and Nutrition Examination Survey (2010-2012), 4,456 Korean employees without shift work, aged over 15, who work 30 hours or more per week were targeted in this study. The association between the general characteristics, including age, smoking, alcohol drinking, exercise, and the metabolic syndrome criteria defined by International Diabetes Federation (IDF) and weekly working hours were analyzed. In addition, the association between weekly working hours and the metabolic syndrome of the subjects stratified by gender was analyzed through multiple logistic regression analyses and generalized linear mixed model after adjusting the general characteristics.

Results

In the results of stratified analysis by gender, in male subjects, in comparison with the 30-39 weekly working hours group, there were no significant adjusted odds ratios to the other working hours groups. In female subjects, in comparison with the 30-39 weekly working hours group, there were no significant adjusted odds ratios to the other working hours groups. In addition, no trend associations were observed among weekly working hour groups in both stratified genders.

Conclusion

No significant differences in prevalence of metabolic syndrome of the subjects stratified by gender were found according to weekly increasing working hours. However, due to some limitations of this study, further prospective studies may be necessary for verification.


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    Hye-Eun Lee, Ichiro Kawachi
    Safety and Health at Work.2023; 14(1): 59.     CrossRef
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    Yoona Kim, Hyeon Hee Kim, Dong Hoon Lim
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Association between long working hours and serum gamma-glutamyltransferase levels in female workers: data from the fifth Korean National Health and Nutrition Examination Survey (2010-2011)
Seung-Gwon Park, Yong-Jin Lee, Jung-Oh Ham, Eun-Chul Jang, Seong-Woo Kim, Hyun Park
Ann Occup Environ Med 2014;26:40.   Published online December 1, 2014
DOI: https://doi.org/10.1186/s40557-014-0040-1
AbstractAbstract PDFPubReaderePub
Objectives

The present study investigated the association between long working hours and serum gamma-glutamyltransferase (GGT) levels, a factor influencing the incidence of cardiovascular disease.

Methods

Data from the fifth Korean National Health and Nutrition Examination Survey (2010–2011) were used to analyze 1,809 women. Subjects were divided into three groups based on the number of weekly working hours: ≤29, 30–51, and ≥52 hours per week. Complex samples logistic regression was performed after adjusting for general and occupational factors to determine the association between long working hours and high serum GGT levels.

Results

The prevalence of high serum GGT levels in groups with ≤29, 30–51, and ≥52 working hours per week was 22.0%, 16.9%, and 26.6%, respectively. Even after adjusting for general and occupational factors, those working 30–51 hours per week had the lowest prevalence of high serum GGT levels. Compared to those working 30–51 hours per week, the odds ratios (OR) of having high serum GGT levels in the groups with ≥52 and ≤29 working hours per week were 1.56 (95% confidence interval [CI], 1.10–2.23) and 1.53 (95% CI, 1.05–2.24), respectively.

Conclusions

Long working hours were significantly associated with high serum GGT levels in Korean women.


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  • Multi-ancestry sleep-by-SNP interaction analysis in 126,926 individuals reveals lipid loci stratified by sleep duration
    Raymond Noordam, Maxime M. Bos, Heming Wang, Thomas W. Winkler, Amy R. Bentley, Tuomas O. Kilpeläinen, Paul S. de Vries, Yun Ju Sung, Karen Schwander, Brian E. Cade, Alisa Manning, Hugues Aschard, Michael R. Brown, Han Chen, Nora Franceschini, Solomon K.
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    Hyunil Kim, Byung-Seong Suh, Won-Cheol Lee, Han-Seur Jeong, Kyung-Hun Son, Min-Woo Nam, Hyeong-Cheol Kim
    Annals of Occupational and Environmental Medicine.2019;[Epub]     CrossRef
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Effect of Long Working Hours on Self-reported Hypertension among Middle-aged and Older Wage Workers
Dong Hyun Yoo, Mo-yeol Kang, Domyung Paek, Bokki Min, Sung-il Cho
Ann Occup Environ Med 2014;26:25-25.   Published online September 3, 2014
DOI: https://doi.org/10.1186/s40557-014-0025-0
AbstractAbstract PDFPubReaderePub
Objectives

Many studies have reported an association between overwork and hypertension. However, research on the health effects of long working hours has yielded inconclusive results. The objective of this study was to identify an association between overtime work and hypertension in wage workers 45 years and over of age using prospective data.

Methods

Wage workers in Korea aged 45 years and over were selected for inclusion in this study from among 10,254 subjects from the Korean Longitudinal Study of Ageing. Workers with baseline hypertension and those with other major diseases were excluded. In the end, a total of 1,079 subjects were included. A Cox proportional hazards model was used to calculate hazard ratios and adjust for baseline characteristics such as sex, age, education, income, occupation, form of employment, body mass index, alcohol habit, smoking habit, regular exercise, and number of working days per week. Additional models were used to calculate hazard ratios after gender stratification.

Results

Among the 1,079 subjects, 85 workers were diagnosed with hypertension during 3974.2 person-months. The average number of working hours per week for all subjects was 47.68. The proportion of overtime workers was 61.0% (cutoff, 40 h per week). Compared with those working 40 h and less per week, the hazard ratio of subjects in the final model, which adjusted for all selected variables, working 41-50 h per week was 2.20 (95% confidence interval [CI], 1.19–4.06), that of subjects working 51-60 h per week was 2.40 (95% CI, 1.07–5.39), and that of subjects working 61 h and over per week was 2.87 (95% CI, 1.33–6.20). In gender stratification models, the hazard ratio of the females tended to be higher than that of the males.

Conclusion

As the number of working hours per week increased, the hazard ratio for diagnosis of hypertension significantly increased. This result suggests a positive association between overtime work and the risk of hypertension.


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The Association between Long Working Hours and Self-Rated Health
Jun-Taek Song, Goeun Lee, Jongho Kwon, Jung-Woo Park, Hyunrim Choi, Sinye Lim
Ann Occup Environ Med 2014;26:2-2.   Published online January 20, 2014
DOI: https://doi.org/10.1186/2052-4374-26-2
AbstractAbstract PDFPubReaderePub
Objectives

This study was conducted to determine the number of hours worked per week by full-time wage workers by using the data of the Korean Labor and Income Panel Study (KLIPS), which represents the domestic urban area household, and to determine the association between weekly working hours and the level of self-rated health.

Methods

We used data from the 11th KLIPS conducted in 2008. The subjects of this study were 3,699 full-time wage workers between the ages of 25 and 64 years. The association between weekly working hours and self-rated health was analyzed considering socio-demographic characteristics, work environment, and health-related behaviors.

Results

Among the workers, 29.7% worked less than 40 hours per week; 39.7%, more than 40 to 52 hours; 19.7%, more than 52 to 60 hours; and 10.9%, more than 60 hours per week. After controlling for socio-demographic variables, work environment-related variables, and health-related behavior variables, the odds ratio (OR) for poor self-rated health for the group working more than 40 hours and up to 52 hours was calculated to be 1.06 (95% confidence interval (CI), 0.89-1.27) when the group working less than 40 hours per week was considered the reference. The OR for the group working more than 60 hours was 1.42 (95% CI, 1.10-1.83) and that for the group working more than 52 hours and up to 60 hours was 1.07 (95% CI, 0.86-1.33). After stratification by gender and tenure, the OR of the female workers group and that of the group with a tenure of more than 1 year were found to be significantly higher than those of the other groups.

Conclusions

This study showed that workers working more than 60 hours per week have a significantly higher risk of poor self-rated health than workers working less than 40 hours per week. This effect was more obvious for the female workers group and the group with a tenure of more than 1 year. In the future, longitudinal studies may be needed to determine the association between long working hours and various health effects in Korean workers.


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Original Article
The relationship of working hours and work intensity with sleep disturbance among continuous 12 hours day and night shift workers in the automobile factory in Korea
Mia Son
Korean Journal of Occupational and Environmental Medicine 2004;16(1):13-24.   Published online March 31, 2004
DOI: https://doi.org/10.35371/kjoem.2004.16.1.13
AbstractAbstract PDF
BACKGROUND
S: The objective of this study is to explore the relationships of working hours and work intensity with sleep disturbance among 12-hour shift workers in the automobile factory in Korea.
METHODS
A questionnaire and a sleep diary were distributed among 2200 (25% of total workers) and 300 workers who were randomly selected in the 8700 workers in one car factory. Among the 300 randomely selected workers, who were randomly selected, 262 workers filled out a sleep diary. For a questionnaire, 2200 (25%) among 8700 workers were randomly selected, 1200 (54% response rate) of whom filled out the questionnaire. The cross-sectional questionnaire and the sleep diary during 14 consecutive days were distributed and collected by workers' representatives, who were trained for the participatory action research in this study. One hundred and sixty workers' sleep diaries and questionnaires were merged by the same worker and used for the analysis in this study. Logistic regression analysis for repeated measurements was modeled using the prevalence of severe sleepiness at work (i.e. Karonlinska Sleepiness Scale 7 or higher) as dependent variable and working hours, sleep pattern, work intensity and health behaviours as independent variables.
RESULTS
The prevalence of severe sleepiness at the end of work was more than 60% after finishing night shift in the automobile factory. The main risk factors related to the severe sleepiness at the end of work were the night shift, long working hours more than 10 hours, the higher frequency of night shift per month, less free time between shifts, poor quality of sleep, deficit of sleeping hours and intensified work (reducing tendency of rest time per day and increasing tendency of additional working time) such as increasing tendency of absolute surplus value.
DISCUSSION
We suggest that the 12-hour shift system, long working hours, intensified work and poor quantity as well as quality of sleep were the main risk factors for the severe sleepiness among the shift workers in the automobile factory in Korea.

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