title: The impact of the introduction of new recognition criteria for overwork-related cardiovascular and cerebrovascular diseases: a cross-country comparison.
abstract: Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. We defined the baseline period as the 5 years before launch of the new criteria, then collected data to 5 years after the new criteria. We applied a Poisson regression model to analyze the longitudinal change in rates of overwork-related CVDs before and after, adjusting for indicators of working conditions. Implementation of the new criteria was associated with a 2.58-fold increase in the rate of overwork-related CVDs (p-value < 0.05). However, the examined policy framework in Taiwan still appears to miss a substantial number of cases compared to that are captured by a similar policy framework used to capture overwork-related CVD rates in Japan by a factor of 0.42 (p-value < 0.05). Accordingly, we make a case for enhancements of Taiwan's system for reporting and recognizing overwork-related diseases and deaths.
authors.affiliation: Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1210A, Boston, Massachusetts, 02115, USA. roting@ntu.edu.tw.|National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan. roting@ntu.edu.tw.|Department of Occupational Safety and Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. roting@ntu.edu.tw.
authors.forename: Ro-Ting
authors.identifier: http://orcid.org/0000-0002-2687-203X
authors.initials: RT
authors.lastname: Lin
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1401, Boston, Massachusetts, 02115, USA.
authors.forename: Cheng-Kuan
authors.initials: CK
authors.lastname: Lin
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1401, Boston, Massachusetts, 02115, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1401, Boston, Massachusetts, 02115, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, Massachusetts, 02115, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 617, No. 17, Xuzhou Road, Taipei, 10055, Taiwan.
authors.forename: Yawen
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1206D, Boston, Massachusetts, 02115, USA.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1215, Boston, Massachusetts, 02115, USA.|Science Based Business, Leiden University, Snellius Building, Niels Bohrweg 1, 2333, CA, Leiden, Netherlands.
authors.forename: Simcha
authors.identifier: http://orcid.org/0000-0002-3281-5381
authors.initials: S
authors.lastname: Jong