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Respiratory epidemiology
Original research
Night shift work is associated with an increased risk of asthma
  1. Robert J Maidstone1,2,
  2. James Turner3,
  3. Celine Vetter4,5,
  4. Hassan S Dashti5,6,7,
  5. Richa Saxena5,6,7,
  6. Frank A J L Scheer8,9,10,
  7. Steven A Shea11,
  8. Simon D Kyle12,
  9. Deborah A Lawlor13,14,
  10. Andrew S I Loudon15,
  11. John F Blaikley16,17,
  12. Martin K Rutter15,18,
  13. David W Ray2,15,19,
  14. Hannah Jane Durrington16,17
  1. 1Division of Informatics, Imaging & Data Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  2. 2Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
  3. 3Medical School, University of Manchester, Manchester, UK
  4. 4Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado, USA
  5. 5Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
  6. 6Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  8. 8Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
  9. 9Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  10. 10Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
  11. 11Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA
  12. 12Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  13. 13MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  14. 14Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  15. 15Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  16. 16Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  17. 17Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
  18. 18Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  19. 19NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK, University of Oxford, Oxford, UK
  1. Correspondence to Dr Hannah Jane Durrington, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK; hannah.durrington{at}manchester.ac.uk

Abstract

Introduction Shift work causes misalignment between internal circadian time and the external light/dark cycle and is associated with metabolic disorders and cancer. Approximately 20% of the working population in industrialised countries work permanent or rotating night shifts, exposing this large population to the risk of circadian misalignment-driven disease. Analysis of the impact of shift work on chronic inflammatory diseases is lacking. We investigated the association between shift work and asthma.

Methods We describe the cross-sectional relationship between shift work and prevalent asthma in >280000 UK Biobank participants, making adjustments for major confounding factors (smoking history, ethnicity, socioeconomic status, physical activity, body mass index). We also investigated chronotype.

Results Compared with day workers, ‘permanent’ night shift workers had a higher likelihood of moderate-severe asthma (OR 1.23 (95% CI 1.03 to 1.46)). Individuals doing any type of shift work had higher adjusted odds of wheeze/whistling in the chest. Shift workers who never or rarely worked on nights and people working permanent nights had a higher adjusted likelihood of having reduced lung function (FEV1 <80% predicted). We found an increase in the risk of moderate-severe asthma in individuals with extreme chronotypes (morning, OR 1.55 (95% CI 1.06 to 2.27) or evening, OR 1.31 (95%CI 1.22 to 1.40)).

Conclusions The public health implications of these findings are far-reaching due to the high prevalence and co-occurrence of both asthma and shift work. Future longitudinal follow-up studies are needed to determine if modifying shift work schedules to take into account chronotype might present a public health measure to reduce the risk of developing inflammatory diseases such as asthma.

  • asthma epidemiology
  • asthma

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data is available on request from the first or corresponding author and the codes used to analyse the data.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/thoraxjnl-2020-215218

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All data is available on request from the first or corresponding author and the codes used to analyse the data.

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    Footnotes

    • Twitter @robertmaidstone, @h_durrington

    • Correction notice This article has been corrected since it was published Online First. Some author names were misspelt and missing middle initials.

    • Contributors HJD, RM, DR and MR conceived the study and planned and conducted it. RM, HJD, JT, MR and DR acquired the data. RM, HJD, JT, MR, DR, HD and RS performed the data analysis. HJD, RM, DR, ASL, JB, RS, CV, FS, SS, SK, DL, HD and MR interpreted the data and wrote the manuscript.

    • Funding RM is funded by a Wellcome Trust Grant (107849/Z/15/Z) and a Medical Research Council grant MR/P023576/1). CV was supported in part by the National Institutes of Health grant R01 DK105072. HD is supported by NIDDK R01DK107859. RS is supported by NIDDK R01DK102696 and R01DK107859 and MGH Research Scholar Fund. FS was supported in part by National Institutes of Health grants R01 DK102696 and R01 DK105072. SS was supported by National Institutes of Health grants R01-HL-125893, R01-HL-142064 and R01-HL-140577 and by the Oregon Institute of Occupational Health Sciences via funds from the State of Oregon (ORS 656.630). SK is supported by a NIHR Oxford Senior Fellowship and the NIHR Oxford Biomedical Research Centre. DL works in a unit that is supported by the University of Bristol ((MC_UU_00011/6); she is a National Institute of Health Research Senior Investigator (NF-0616-10102). ASL is a Wellcome Investigator Wellcome Trust (107849/Z/15/Z). JB is funded by a Medical Research Council Grant (MR/L006499/1). DR is a Wellcome Investigator Wellcome Trust (107849/Z/15/Z) and holds a Medical Research Council Programme grant (MR/P023576/1). HJD is supported by the NIHR Manchester Biomedical Research Centre.

    • Competing interests FS has received lecture fees from Bayer HealthCare (2016), Sentara HealthCare (2017), Philips (2017), Vanda Pharmaceuticals (2017) and Pfizer Pharmaceuticals (2018). DL has received research support from Medtronic Ltd and Roche Diagnostics for research unrelated to that presented here. MR has received speaker fees and research support from Novo Nordisk and Roche Diabetes Care for research unrelated to that presented here.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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