Labour-type physical activity, alcohol use and hypertension in rural older adults in Northeast China

Hypertension is highly prevalent in older adults, yet evidence from resource-limited rural settings remains limited. In Northeast China, older residents are chronically exposed to cold-climate stress, labour-intensive agricultural routines, and entrenched social drinking norms, which may shape blood pressure risk profiles differently from urban cohorts.

We analysed data from the 2025 Rural Elderly Health Examination Programme in Wangkui County, Heilongjiang, using a community-based cross-sectional design. Participants aged ≥65 years (N = 2,270) completed standardised examinations including bilateral blood pressure measurement, anthropometrics, and questionnaires assessing workload-related physical activity frequency-dominated by farming and domestic labour in this setting (hereafter termed occupational/labour-type physical activity, OPA; sessions/week)-and alcohol drinking frequency (occasions/week). Hypertension was defined as higher-arm SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg. Associations were estimated using multivariable logistic regression with HC3 robust standard errors, adjusting for age, sex, body mass index, haemoglobin concentration, and winsorized resting heart rate (complete-case N = 2,194).

Higher OPA frequency and alcohol drinking frequency were independently associated with greater odds of hypertension. Each additional OPA session per week was associated with a 23% higher odds of hypertension (adjusted OR [aOR] = 1.23, 95% CI: 1.16-1.32), and each additional drinking occasion per week was associated with a 20% higher odds (aOR = 1.20, 95% CI: 1.04-1.40). Estimated population-attributable fractions suggested a substantial potential burden associated with high-frequency OPA (≥3 sessions/week; 34.8%) and a smaller burden associated with any weekly drinking (>0/week; 4.7%); these estimates were interpreted cautiously given the cross-sectional design and the use of odds ratios for a common outcome. Sensitivity analyses using alternative hypertension definitions and continuous SBP/DBP models yielded directionally consistent findings, with steeper OPA gradients at older ages.

In this rural older-adult cohort, workload-related physical activity-reflecting largely non-volitional labour rather than leisure-time exercise-and alcohol use were associated with higher hypertension likelihood. Prevention strategies in cold-climate rural communities may benefit from workload-modification and recovery-protection approaches, safer organisation of labour tasks, and targeted reduction of weekly alcohol use.