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Original Article
- Association between shift work patterns and the incidence of prediabetes and diabetes among night shift workers: a retrospective cohort study
- Hyundong Lee, Changil Shin, Minsun Kang, Jae Bum Park, Inchul Jeong, Jaehyuk Jung
- Ann Occup Environ Med 2026;38:e26. Published online July 9, 2026
- DOI: https://doi.org/10.35371/aoem.2026.38.e26
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Abstract
Abstract in Korean
PDF
Supplementary Material - Background
Prediabetes and diabetes represent major public health challenges, and shift work has been identified as a significant occupational risk factor. While two-shift systems are gaining preference over conventional three-shift systems, evidence comparing their risks for diabetes and prediabetes remains limited. We aimed to evaluate the risk of developing prediabetes and diabetes according to shift work patterns among night shift workers.
Methods
This retrospective cohort study analyzed 14,879 night shift workers at a tertiary hospital in Korea (2016–2022). Participants were classified into two- and three-shift patterns. Incident diabetes and prediabetes were identified based on fasting blood glucose and hemoglobin A1c levels, diagnosis, or medication use. Data were censored at shift change, diagnosis, loss to follow-up, or the end of the study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographics, lifestyle, body mass index, and occupational characteristics including working hours, consecutive night shifts, quick returns, and shift duration.
Results
The two-shift group showed significantly higher incidence rates of diabetes and prediabetes than the three-shift group. After adjusting for covariates, two-shift work remained an independent risk factor for diabetes (adjusted HR: 1.43; 95% CI: 1.10–1.87) and prediabetes (adjusted HR: 1.34; 95% CI: 1.20–1.48). Stratified analyses indicated that the increased risk of diabetes associated with two-shift work was prominent in participants working 40 hours and 41–51 hours per week, whereas the association was not significant in those working ≥52 hours.
Conclusions
Two-shift work was associated with a significantly higher risk of diabetes and prediabetes compared with three-shift work. Our findings highlight the need to consider specific shift schedules and their potential health effects when designing or selecting workforce systems, rather than focusing solely on productivity or preference. - 야간 교대 근로자에서 교대 근무 형태와 당뇨병 전단계 및 당뇨병 발생의 연관성: 후향적 코호트 연구
목적
당뇨병 전단계 및 당뇨병은 주요 공중 보건 과제이며, 교대 근무는 이를 유발하는 중요한 직업적 위험 요인으로 확인되었다. 기존의 3교대 근무제보다 2교대 근무제가 더 선호되고 있는 추세이나, 이 두 교대 근무 형태에 따른 당뇨 및 당뇨병 전단계 발생 위험을 비교한 근거는 여전히 부족하다. 이에 본 연구는 야간 교대 근무자를 대상으로 교대 근무 형태에 따른 당뇨병 전단계 및 당뇨병 발생 위험을 평가하고자 하였다.
방법
본 후향적 코호트 연구는 2016년부터 2022년까지 국내 한 3차 병원의 야간 교대 근무자 14,879명을 대상으로 분석을 수행하였다. 연구 대상자는 2교대 및 3교대 근무 형태로 분류되었다. 당뇨 및 당뇨병 전단계의 발생은 공복 혈당, 당화혈색소 수치, 진단 이력 또는 약물 복용 여부를 기준으로 확인하였다. 추적 관찰은 교대 근무 형태의 변경, 질환의 진단, 추적 관찰 소실, 또는 연구 종료 시점에서 중단되었다. 콕스 비례위험 모형을 사용하여 위험비와 95% 신뢰구간을 추정하였다. 인구학적 특성, 생활습관, 체질량지수 및 직업적 요인을 보정하여 분석하였다.
결과
2교대 군은 3교대 군에 비해 당뇨 및 당뇨병 전단계 발생률이 유의하게 높았다. 공변량을 보정한 후에도 2교대 근무는 당뇨(조정 위험비 1.43, 95% 신뢰구간 1.10–1.87) 및 당뇨병 전단계(조정 위험비 1.34, 95% 신뢰구간 1.20–1.48) 발생의 독립적인 위험 요인으로 나타났다. 층화 분석 결과, 2교대 근무와 관련된 당뇨 발생 위험의 증가는 주당 40시간 및 41~51시간 근무자에서 두드러진 반면, 52시간 이상 근무자에서는 그 연관성이 통계적으로 유의하지 않았다.
결론
2교대 근무는 3교대 근무에 비해 당뇨 및 당뇨병 전단계의 발생 위험과 유의한 연관성이 있는 것으로 나타났다. 본 연구 결과는 교대 근무표를 설계할 때, 단순히 생산성이나 근무자의 선호도에만 초점을 맞출 것이 아니라 특정 교대 근무 일정의 구조와 건강에 미치는 잠재적 영향을 고려해야 함을 시사한다.
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Original Article
- Association between shift work and the risk of hypothyroidism in adult male workers in Korea: a cohort study
- Seonghyeon Kwon, Yesung Lee, Eunhye Seo, Daehoon Kim, Jaehong Lee, Youshik Jeong, Jihoon Kim, Jinsook Jeong, Woncheol Lee
- Ann Occup Environ Med 2023;35:e41. Published online October 19, 2023
- DOI: https://doi.org/10.35371/aoem.2023.35.e41
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Abstract
Abstract in Korean
PDFSupplementary Material
Background Shift work has been reported to have several harmful effects on the human body. However, a small number of studies have evaluated the association between shift work and adverse effects on the thyroid. In our longitudinal study, we examined the causal association between shift work and the risk of hypothyroidism.
Methods A Kangbuk Samsung Cohort Study was conducted on 112,648 men without thyroid disease at baseline who were followed up at least once between 2012 and 2019. Shift work status and shift schedule types were categorized using standardized questionnaires. Hypothyroidism was defined using the reference ranges of serum thyroid-stimulating hormones and free thyroxine levels. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident hypothyroidism were estimated using Cox proportional hazards regression analyses with the daytime work group as the reference.
Results During the 501,237 person-years of follow-up, there were 6,306 incident cases of hypothyroidism (incidence density, 1.26 per 100 person-years). The multivariable-adjusted HR of incident hypothyroidism for the shift work total group that included all shifts compared with the daytime work group was 1.27 (95% CI: 1.15–1.40). For the fixed evening, fixed night, rotating shift, and other shift workers, the multivariable-adjusted HRs (95% CI) were 1.11 (0.76–1.61), 2.18 (1.20–3.93), 1.39 (1.23–1.56), and 1.00 (0.82–1.22), respectively. In subgroup analyses by age, the association between shift work and hypothyroidism was more pronounced in younger participants (< 40 years; HR: 1.31; 95% CI: 1.16–1.47).
Conclusions Our large-scale cohort study showed an association between shift work and the incidence of hypothyroidism, especially in younger workers with night shifts.
- 한국 성인 남성 근로자에서 교대근무와 갑상선 기능 저하증 위험의 연관성: 코호트 연구
목적
교대 근무는 인체에 여러 가지 해로운 영향을 미치는 것으로 보고되어 왔다. 그러나 소수의 연구만이 교대 근무와 갑상선에 대한 이상 반응 사이의 연관성을 평가하였다. 따라서 이번 종단 연구에서는, 교대 근무와 갑상선 기능 저하증의 위험 간의 인과 관계를 평가하고자 한다.
방법
본 강북삼성 코호트 연구는 2012년과 2019년 사이에 최소 한 번 이상 추적 검사를 받았고, 연구 시작 시점에서 갑상선 질환이 없는 112,648명의 남성을 대상으로 수행되었다. 표준화된 설문지를 이용하여 교대근무 현황 및 교대근무 유형을 분류하였다. 갑상선 기능 저하증은 혈청 갑상선 자극 호르몬과 유리 티록신 수치의 참고치를 기준으로 정의되었다. 갑상선 기능 저하증에 대한 위험비(HR)와 95% 신뢰구간(CI)은 주간 근무 그룹을 기준으로 콕스 비례위험 회귀분석을 사용하여 추정되었다.
결과
501,237인년의 추적 조사 기간 중 6,306건의 갑상선 기능 저하증 케이스가 발생하였다 (발생밀도, 100인년당 1.26). 주간 근무 그룹과 비교하여 모든 교대 근무 유형을 포함한 그룹에 대한 갑상선 기능 저하증의 다변량 조정 위험비는 1.27 (95% 신뢰구간, 1.15–1.40)이었다. 고정 저녁, 고정 야간, 윤번 교대 및 기타 교대 근무 그룹의 경우 다변량 조정 위험비 (95% 신뢰구간)는 각각 1.11 (0.76–1.61), 2.18 (1.20–3.93), 1.39 (1.23–1.56) 및 1.00 (0.82–1.22)이었다. 연령에 따른 하위집단 분석에서 교대근무와 갑상선 기능 저하증의 연관성은 젊은 참가자들에게서 더 두드러졌다 (<40세; 위험비, 1.31; 95% 신뢰구간, 1.16–1.47).
결론
본 대규모 코호트 연구를 통해 특히 야간 근무를 하는 젊은 근로자들에서, 교대 근무와 갑상선 기능 저하증 발생 사이의 연관성을 확인할 수 있었다. -
Citations
Citations to this article as recorded by
- Outdoor light at night exposure was associated with hypothyroidism in pregnant women: A national study in China
Hong-Xing Zou, Li-Wen Hu, Zheng Zhang, Alexander E.P. Heazell, Xueran Wang, Wentao Yue, Xiao-Fan Lu, Xiao-Yi Liu, Shuo Zhang, Le-Bing Wang, Enjie Zhang, Shaofei Su, Shen Gao, Shuanghua Xie, Jianhui Liu, Yue Zhang, Ruixia Liu, Guang-Hui Dong, Chenghong Yin
Science of The Total Environment.2025; 958: 178017. CrossRef
- Outdoor light at night exposure was associated with hypothyroidism in pregnant women: A national study in China
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Research Article
- Effect of night shift work on the control of hypertension and diabetes in workers taking medication
- Juha Park, Sang-Yeop Shin, Yangwon Kang, Jeongbae Rhie
- Ann Occup Environ Med 2019;31:e27. Published online October 10, 2019
- DOI: https://doi.org/10.35371/aoem.2019.31.e27
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Abstract
PDF
Background Night shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes.
Methods Subjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL).
Results Among 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (
p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers.Conclusions Night shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.
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- Variable shift work in family medicine residents is associated with a non-dipper pattern and reduced phase angle: possible adaptive blood pressure mechanisms and body composition imbalance
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