title: Total mortality and cause-specific mortality of Swedish shift- and dayworkers in the pulp and paper industry in 1952-2001.
abstract: OBJECTIVE
  The study investigated the relationship between shiftwork and mortality, both total mortality and cause-specific mortality from coronary heart disease (CHD), stroke, and diabetes. Methods The cohort consisted of 2354 shiftworkers and 3088 dayworkers in two pulp and paper manufacturing plants. The mortality of the cohort was monitored from 1 January 1952 to 31 December 2001 by linkage to the national Cause of Death Register. Groups of workers defined by different durations of shiftwork exposure were compared with dayworkers by calculating standardized relative rates (SRR).
  
  
  RESULTS
  Death due to any cause (total mortality) was not higher among the shiftworkers than among the dayworkers [SRR 1.02, 95% confidence interval (95% CI) 0.93-1.11]. A longer duration of shiftwork was associated with an increased risk of CHD, and shiftworkers with >30 years of shiftwork had the highest risk of CHD (SRR 1.24, 95% CI 1.04-1.49) Diabetes was more common as the number of shift years of exposure increased [b(linear coefficient) = 4.14 x 10(-5), 95% CI 2.46 x 10(-5) -5.81 x 10(-5)]. Compared with dayworkers, shiftworkers had a greater risk of death due to stroke (SRR 1.56, 95% CI 0.98-2.51).
  
  
  CONCLUSIONS
  In the present study, no general increase in mortality was observed among shiftworkers when they were compared with dayworkers. However, the results demonstrate an increased mortality from CHD among shiftworkers with a long duration of shiftwork exposure. Mortality due to diabetes also increased as the number of shift years and mortality due to ischemic stroke in shiftworkers increased.
authors.affiliation: Department of Public Health and Clinical Medicine, Occupational Medicine, University of Umeå, Umeå, Sweden. bernt.karlsson@vll.se
authors.forename: Berndt
authors.initials: B
authors.lastname: Karlsson
authors.forename: Lars
authors.initials: L
authors.lastname: Alfredsson
authors.forename: Anders
authors.initials: A
authors.lastname: Knutsson
authors.forename: Eva
authors.initials: E
authors.lastname: Andersson
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D010209:Paper; D020521:Stroke / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D014940:Work Schedule Tolerance