Long working hours and mortality outcomes: A systematic review with outcome-specific evidence synthesis

Long working hours are a major occupational health concern, but whether their associations differ across mortality outcomes remains unclear. We searched six databases from inception to January 31, 2026 and conducted a systematic review with outcome-specific evidence synthesis of longitudinal studies. Seven original cohort studies were included. Long working hours, commonly defined as 55 or more hours per week, were associated with higher cardiovascular mortality, whereas the pooled association with all-cause mortality was not statistically significant. The only eligible prospective cohort study suggested increased suicide mortality at 45-52 and more than 52 h per week, while no significant association was observed for accident mortality. These findings indicate that mortality associations of long working hours are outcome specific and highlight the need for prospective studies with standardized exposure definitions and clearer classification of cause-specific mortality.