title: The triad of shift work, occupational noise, and physical workload and risk of coronary heart disease.
abstract: BACKGROUND
  Shift work, noise, and physical workload are very common occupational exposures and they tend to cluster in the same groups of workers.
  
  
  OBJECTIVE
  To study the short and long term effects of these exposures on risk of coronary heart disease (CHD) and to estimate the joint effects of these factors.
  
  
  METHODS
  The study population in this prospective 13 year follow up study of 1804 middle aged industrially employed men was collected at the first screening for the Helsinki Heart Study. The CHD end points (ICD-9 codes 410-414 and ICD-10 codes I20-I25) were obtained from official Finnish registers. The Finnish job-exposure matrix FINJEM provided information on occupational exposures. Relative risks (RR) of CHD for the exposures were estimated using Cox's proportional hazard models adjusting for classical risk factors of CHD.
  
  
  RESULTS
  The RR in the five year follow up for continuous noise combined with impulse noise was 1.28; for shift work it was 1.59, and for physical workload 1.18, while in the 13 year follow up the RRs were 1.58, 1.34, and 1.31, respectively. When adjusted for white-collar/blue-collar status the RRs decreased markedly. The RR in the 13 year follow up for those exposed to two risk factors was close to 1.7 and for those exposed to all three, 1.87.
  
  
  CONCLUSIONS
  Shift work and continuous noise entailed an excess risk for CHD in the shortest follow up with only a few retired workers but a decreasing risk during the longer follow up. For physical workload and impulse noise the trend was opposite: the CHD risk was increasing with increasing follow up time despite increasing numbers of retired workers.
authors.affiliation: Tampere School of Public Health, University of Tampere, Finland. hanna.virkkunen@uta.fi
authors.forename: H
authors.initials: H
authors.lastname: Virkkunen
authors.forename: M
authors.initials: M
authors.lastname: Härmä
authors.forename: T
authors.initials: T
authors.lastname: Kauppinen
authors.forename: L
authors.initials: L
authors.lastname: Tenkanen
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D004812:Epidemiologic Methods; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009623:Noise, Occupational / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects; D012307:Risk Factors; D012923:Social Class; D014940:Work Schedule Tolerance / Q000502:physiology*; D016526:Workload / Q000706:statistics & numerical data*
chemical_list: D008055:Lipids