Occupational physical activity and cardiovascular disease mortality in the United States, 1988-2019

Although leisure time physical activity (LTPA) is a beneficial factor for cardiovascular disease (CVD) mortality, relationships between occupational physical activity (OPA) and CVD mortality are inconclusive. We aimed to examine prospective associations of OPA with CVD mortality using a large representative sample of adult workers in the United States (US), and explore how socioeconomic status (SES) may influence these associations.

This cohort study included US workers (≥ 18 years) participating in the 1988 National Health Interview Survey (NHIS) and passively followed until December 31, 2019. Time (minutes/week) on strenuous OPA (e.g., lifting, pushing, or pulling heavy objects) was assessed at baseline by a questionnaire and categorized into 4 groups [i.e., none, low, medium, and high]. CVD mortality was identified by International Classification of Diseases, Tenth Version (ICD-10) and collected by the National Death Index database. We examined the association of OPA with CVD mortality using multivariable Cox proportional hazard regressions, controlling for age, sex, race/ethnicity, marital status, education, annual household income, occupation type, and pre-existing cardiometabolic disorders.

In 28,604 participants (46.2% women; mean age 37.86 years), adjusted hazard ratios (95% CIs) of none, low, medium, and high OPA groups were 1.39 (1.01-1.91), 1.00 (reference), 1.18 (0.83-1.66) and 1.58 (1.12-2.22) for CVD mortality. The associations were stronger in workers with low education level (i.e., high school or less) [estimates of none, low, medium, and high OPA groups were 1.74 (1.09-2.78, P = 0.02), 1.00, 1.49 (0.92-2.42), and 1.87 (1.16-3.00)] or annual household income <$30,000 [estimates of OPA groups were 1.73 (1.16-2.56), 1.00, 1.29 (0.83-2.01), and 1.73 (1.14-2.65)].

We observed that workers with either high or no strenuous OPA had higher CVD mortality compared to those with low strenuous OPA, demonstrating a U-shaped association in the US. This association was particularly pronounced among workers with lower SES.