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American Journal of Epidemiology Advance Access published online on October 27, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj355
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received March 31, 2005
Accepted May 31, 2006

ORIGINAL CONTRIBUTIONS

Work Characteristics and Incidence of Type 2 Diabetes in Women

Candyce H. Kroenke 1 *, Donna Spiegelman 2, JoAnn Manson 3, Eva S. Schernhammer 4, Graham A. Colditz 5, and Ichiro Kawachi 6

1 Robert Wood Johnson Health and Society Scholars Program, University of California, San Francisco and Berkeley, CA
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA
3 Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
4 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
5 Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
6 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA

* To whom correspondence should be addressed.
Candyce H. Kroenke, E-mail: ckroenke{at}berkeley.edu


  Abstract

The authors prospectively investigated associations between potentially stressful work characteristics and type 2 diabetes incidence in 62,574 young and middle-aged women, aged 29-46 years at baseline in 1993, from the Nurses' Health Study II; 365 cases of type 2 diabetes accrued over 6 years of follow-up. Cox proportional hazards regression was used to simultaneously evaluate associations of hours per week in paid employment, years of rotating night-shift work, and job strain with incidence of type 2 diabetes. In multivariate-adjusted analyses, women working less than 20 hours per week had a lower risk of diabetes (relative risk = 0.80, 95% confidence interval: 0.50, 1.30), and those working overtime (≥41 hours/week) had an elevated risk of diabetes (relative risk = 1.23, 95% confidence interval: 0.98, 1.55) compared with women working 21-40 hours/week (referent) in paid employment (ptrend = 0.03). In subsequent analysis, the elevated association appeared stronger in unmarried women (pinteraction = 0.02). A positive association between years in rotating night-shift work and diabetes was mediated entirely by body weight. Job strain was unrelated to risk of type 2 diabetes. In conclusion, working overtime predicted a slightly elevated risk of type 2 diabetes in young and middle-aged female nurses.

Keywords: diabetes mellitus, type 2; nursing staff; stress, psychological; women; work schedule tolerance.
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