A meta-analysis of cohort studies including dose-response relationship between shift work and the risk of diabetes mellitus

  • Wenzhen Li
  • Zhenlong Chen
  • Wenyu Ruan
  • Guilin Yi
  • Dongming WangEmail author
  • Zuxun LuEmail author


Previous reviews have suggested that shift work is associated with an increased risk of diabetes mellitus (DM); however, the results should be interpreted with caution due to differences in study designs and non-comprehensive literature searches. In addition, the quantitative dose-response relationship between years of shift work and DM risk is still unknown. We aimed to conduct an updated meta-analysis with cohort studies and to evaluate the relationship between the duration of shift work and the risk of DM in a dose-dependent manner. The PubMed and Web of Science databases were searched through 15 August 2019, and multivariate-adjusted relative risks (RRs) were pooled using random-effects models. Restricted cubic spline analysis with three knots was used to explore the relationship of years of shift work and risk of DM. Twelve cohort studies with 28 independent reports involving 244,266 participants and 15,906 DM cases were included. The summarized adjusted RR for the relationship between shift work and DM risk was 1.14 (95% CI 1.10 to 1.19; I2 = 38.9%, P = 0.028). The summary RR of a 5-year increase in shift work was 1.07 (95% CI 1.04 to 1.09), without heterogeneity (I2= 0.0%, P = 0.829) for the female population. Shift work is associated with an increased risk of DM, and a strong and highly significant linear dose-response relationship between the duration of shift work and the risk of DM in women was observed. Further studies are needed to confirm the results, establish causality and elucidate the underlying mechanisms.


Shift work Diabetes mellitus Cohort Meta-analysis Dose-response relationship 


Author contributions

WZL proposed the study. WZL, DMW and WYR performed the searching, data extraction, and quality assessment. ZXL helped to develop search strategies. WZL analyzed the data. WZL wrote the first manuscript; DMW, ZLC and GLY revised the draft. All authors contributed to reviewing or revising the paper and read and approved the final version.


The study was supported by the Young Scientists Fund of the National Natural Science Foundation of China (81903291), the Fundamental Research Funds for the Central Universities (2019kfyXJJS032), China Postdoctoral Science Foundation (2019T120666), and Key project of Wuhan Municipal Health Committee (WG16B08). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interests

The authors declare no conflict of interest.


Data for the present meta-analysis were acquired through previously published articles, and the study did not involve participants or patients.

Supplementary material

10654_2019_561_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Social Medicine and Health Management, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  2. 2.Wuhan Prevention and Treatment Center for Occupational DiseasesWuhanPeople’s Republic of China
  3. 3.Shangluo Central HospitalShangluoPeople’s Republic of China
  4. 4.Department of Occupational & Environmental Health, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  5. 5.Key Laboratory of Environment and Health Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

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