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Occupational and environmental medicine
Research
Mediation analysis for new recognition criteria, working hours and overwork-related disease: a nationwide ecological study using 11-year follow-up data in Taiwan
  1. Sheng-Hsuan Lin1,
  2. Meng-Ying Chou1,
  3. Ro-Ting Lin2
  1. 1 Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
  2. 2 Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
  1. Correspondence to Dr Ro-Ting Lin; roting{at}ntu.edu.tw

Abstract

Objectives Taiwan revised its criteria for overwork-related cerebrovascular and cardiovascular disease (CCVD) in 2010. A new definition of overwork increased the number of recognised cases. Meanwhile, actual average working hours decreased. We estimated the effects of the revised criteria on the number of overwork-related CCVD cases and the mediation effect through reduced working hours.

Methods From the Labor Insurance of Taiwan, we collected data on the total number of overwork-related CCVD cases from 2006 to 2016 and average monthly working hours for 13 industry groups. We conducted causal mediation analysis to investigate the mechanism of the effect of new criteria on CCVD mediated by working hours.

Results From 2006 to 2016, 594 overwork-related cases of CCVD were recognised across 13 industry groups. After introducing the new criteria, overwork-related CCVD increased by 8.40 cases (per one million person-years) (95% CI 4.53 to 15.05), which resulted from a decrease of 1.54 (95% CI 0.22 to 3.82) cases due to reduced working hours (mediation effect) and an increase of 9.93 (95% CI 5.24 to 18.17) cases related to the effect of the criteria change and other covariates excluding working hours (alternative effect).

Conclusions Working hours are an important mediator of the effect of policy on the rate of overwork-related CCVD. Introducing new criteria for recognising overwork-related disease might raise awareness and prompt reductions in working hours, which also help to reduce CCVD. Our findings suggest that understanding mediation effects is important to evaluating national health policies.

  • working hours
  • health policy
  • overwork
  • cardiovascular disease
  • cerebrovascular disorders
  • disease prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-028973

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    Footnotes

    • Contributors RTL contributed to idea formulation, study design, data preparation, data analysis, reporting results, data interpretation and writing of the manuscript. SHL contributed to data analysis, reporting results, data interpretation and writing of the manuscript. MYC contributed to data analysis and reporting results.

    • Funding This work was supported by grants 106-2314-B-039-048, 107-2314-B-039-062-MY3 and 107-2636-B-009-001 from the Ministry of Science and Technology of Taiwan.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study has been approved by the Research Ethics Committee, China Medical University & Hospital, Taichung, Taiwan (No. CMUH106-REC1-010). Our study involves comparison and analysis of variables at the population level (industry groups) rather than at the individual level. No personal data were handled.

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

    • Data availability statement Data are available in a public, open access repository.