title: Shift work and hypertension: Prevalence and analysis of disease pathways in a German car manufacturing company.
abstract: BACKGROUND
  Hypertension and cardiovascular disease (CVD) may share a similar pathophysiology. Despite shift workers' CVD excess risk, studies on shift work and hypertension are inconclusive.
  
  
  METHODS
  Blood pressure and shift status for 25,343 autoworkers were obtained from medical check-ups and company registers. Cross-sectional associations modeling the total effect from shift work (day shifts, shift work without nights, rotating shift work with nights, and night shifts) on hypertension were assessed. By sequential adjustments, the influence of behavioral, psychosocial, and physiological factors on the total effect was examined, with subsequent mediation and moderation analyses.
  
  
  RESULTS
  Adjusted for confounders, shift work without nights (vs. day shifts) was significantly associated with hypertension (OR 1.15, 95%CI 1.02-1.30). The total effect was mediated by BMI, physical inactivity, and sleep disorders. No moderation of the total effect by behaviors was found.
  
  
  CONCLUSIONS
  The association between shift work and hypertension seems mainly attributable to behavioral mechanisms.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
authors.forename: Johan
authors.initials: J
authors.lastname: Ohlander
authors.forename: Mekail-Cem
authors.initials: MC
authors.lastname: Keskin
authors.forename: Joachim
authors.initials: J
authors.lastname: Stork
authors.forename: Katja
authors.initials: K
authors.lastname: Radon
mesh_terms: D000328:Adult; D001336:Automobiles; D001794:Blood Pressure; D015992:Body Mass Index; D002940:Circadian Rhythm / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D066192:Manufacturing Industry; D008875:Middle Aged; D009043:Motor Activity; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D020178:Sleep Disorders, Circadian Rhythm / Q000150:complications; D014940:Work Schedule Tolerance / Q000502:physiology
keywords: blood pressure; circadian rhythm; health behavior; occupational health; vascular health