Does working long hours increase the risk of cardiovascular disease for everyone?

It has been suggested that long working hours are associated with cardiovascular disease (CVD). Although studies on health inequality caused by income inequality have been performed, income levels of workers have been considered only as an adjusting factor in the relationship between long working hours and CVD. In the present study, we investigated the modifying effects of household income level in the relationship between working hours and estimated risk of CVD. We analysed a total of 11,602 Koreans who were randomly enrolled in the Korea National Health and Nutrition Examination Survey (2007‐2016) with complete data. Nonparametric associations between weekly working hours and estimated risk of CVD were explored according to quartiles of equalised household income by gender, and the size of linear associations among weekly working hours and estimated CVD risk after stratifying for equalised household income by gender was considered. A 4.1% increased risk of CVD was associated with 10 hours or longer per day weekly working hours among males with the highest household income after adjusting for age, equalised household income, occupation, and shift work, but such was not associated among lower income groups. Negative associations between equalised household income and estimated CVD risk were observed only among low household income males. Long working hours and household income level can have differential effects on the risk of CVD by socioeconomic status. This study shows that positive income effect may dominate the potential negative effect of long working hours with respect to the risk of CVD in the low‐income group.