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Associations between chronotype, morbidity and mortality in the UK Biobank cohort

Knutson, Kristen and von Schantz, Malcolm (2018) Associations between chronotype, morbidity and mortality in the UK Biobank cohort Chronobiology International, 35 (8). pp. 1045-1053.

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Abstract

Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease. However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433,268 adults aged 38-73 at the time of enrolment and an average 6.5- year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question defining participants as definite morning types, moderate morning types, moderate evening types, or definite evening types. The primary outcomes were all-cause mortality and mortality due to cardiovascular disease (CVD). Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86 to 2.02, p=<.001), followed by diabetes (OR 1.30, 95% CI 1.24 to 1.36, p=<.001), neurological disorders (OR 1.25, 95% CI 1.20 to 1.30, p=<.001), gastrointestinal/ abdominal disorders (OR 1.23, 95% CI 1.19 to 1.27, p=<.001), and respiratory disorders (OR 1.22, 95% CI 1.18 to 1.26, p=<.001). The total number of deaths was 10,534, out of which 2,127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004 to 1.05, p=.017) and CVD mortality (HR 1.04, 95% CI 1.00 to 1.09, p=.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02 to 1.18, p=.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological, and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Knutson, Kristen
von Schantz, MalcolmM.Von.Schantz@surrey.ac.uk
Date : 11 April 2018
Identification Number : 10.1080/07420528.2018.1454458
Copyright Disclaimer : © 2018 The Author(s). Published by Taylor & Francis Group, LLC This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc- nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way
Uncontrolled Keywords : Epidemiology; Circadian Preference; Diurnal Preference; Circadian Rhythms; Risk Factors; Sleep
Depositing User : Clive Harris
Date Deposited : 16 Mar 2018 14:14
Last Modified : 04 Sep 2018 14:13
URI: http://epubs.surrey.ac.uk/id/eprint/846041

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