Long work hours, suboptimal diabetes management, and differences by sex and race/ethnicity, NHANES (2011-2018)

Authors

• Tailisha Gonzalez, CUNY Lehman CollegeFollow
• Margrethe Horlyck-Romanovsky, CUNY Brooklyn College
• Terry T.-K. Huang, CUNY Graduate School of Public Health and Health Policy
• Sandra E. Echeverria, University of North Carolina at Greensboro

Document Type

Article

Publication Date

4-20-2026

Abstract

In the United States (US), occupational segregation by sex and race/ethnicity can contribute to health disparities. Although work schedule characteristics have been previously linked to elevated cardiovascular risk, little is known about the effects on chronic disease management in women and minoritized workers. We examined the association between work hours and diabetes management among US workers, testing for differences by sex and race/ethnicity. We utilized 2011–2018 National Health and Nutrition Examination Survey (NHANES) data on working adults (age ≥20 years) with diagnosed diabetes (n = 1041). Suboptimal diabetes management was defined as HbA1c ≥7%. Work hours were categorized per WHO guidelines (< 35hrs/week, 35–40, 41–54, ≥55). We conducted additional analyses with the US-standard (< 35hrs/week, 35–40,>40). Log binomial regression models generated crude and adjusted prevalence ratios (aPR). We tested for interaction by sex and race/ ethnicity. Significance levels were set at p < 0.05. More than half (54.6%) of US workers with diabetes had HbA1c ≥7% (p < 0.001). Pooled analyses showed no significant associations between work hours and diabetes management. In stratified models with WHO categorized work hours, working ≥55 h/week increased the prevalence of suboptimal diabetes management among women (aPR:1.85; 95%CI: 1.28–2.67), Latino (aPR: 1.37; 95%CI: 1.03–1.82), and White (aPR: 1.50; 95%CI: 1.04–2.15) workers compared to similar groups working 35–40 h/week. The analysis with US-standard hours masked differences for racial/ethnic groups, but not women and men. In both analyses, < 35 h/week was protective for men only. This study highlights the urgent need to examine how and for whom work conditions contribute to health inequities.