Xia Tong, Chen Liwei, Li Jian
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA.
BMC Public Health. 2025 Jan 7;25(1):77. doi: 10.1186/s12889-024-21225-x.
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.
尽管休闲时间体力活动（LTPA）是心血管疾病（CVD）死亡率的一个有益因素，但职业体力活动（OPA）与CVD死亡率之间的关系尚无定论。我们旨在使用美国成年工人的大型代表性样本，研究OPA与CVD死亡率的前瞻性关联，并探讨社会经济地位（SES）如何影响这些关联。
这项队列研究纳入了参加1988年全国健康访谈调查（NHIS）的美国工人（≥18岁），并对其进行被动随访直至2019年12月31日。通过问卷调查在基线时评估剧烈OPA（例如，搬运、推或拉重物）的时间（分钟/周），并将其分为4组[即无、低、中、高]。通过国际疾病分类第十版（ICD-10）确定CVD死亡率，并由国家死亡指数数据库收集。我们使用多变量Cox比例风险回归分析OPA与CVD死亡率的关联，同时控制年龄、性别、种族/民族、婚姻状况、教育程度、家庭年收入、职业类型和既往存在的心脏代谢疾病。
在28604名参与者中（46.2%为女性；平均年龄37.86岁），无、低、中、高OPA组CVD死亡率的调整风险比（95%CI）分别为1.39（1.01-1.91）、1.00（参照）、1.18（0.83-1.66）和1.58（1.12-2.22）。在教育水平较低（即高中及以下）的工人中，这种关联更强[无、低、中、高OPA组的估计值分别为1.74（1.09-2.78，P = 0.02）、1.00、1.49（0.92-2.42）和1.87（1.16-3.00）]，或家庭年收入<$30,000的工人中[OPA组的估计值分别为1.73（1.16-2.56）、1.00、1.29（0.83-2.01）和1.73（1.14-2.65）]。
我们观察到，与低强度剧烈OPA的工人相比，高强度或无剧烈OPA的工人CVD死亡率更高，在美国呈现出U型关联。这种关联在SES较低的工人中尤为明显。
