8278903 Occupational Physical demands associated with cardiovascular disease mortality in the U.S. workforce

<h3>Objective</h3> Occupational physical activity may paradoxically increase cardiovascular disease (CVD) risk. However, specific physical occupational demands associated with risk remain unclear and may inform future interventions. We aimed to identify specific types of physical occupational demands associated with CVD mortality. <h3>Material and Methods</h3> We designed a prospective cohort study by linking National Health Interview Survey (NHIS) 2004–2018 data (n=207,478 working adults, baseline age=43.7±16.5, 47.3% female) to the National Death Index for mortality follow-up to 2019. Major occupation groups of each participant were categorized into levels (high/medium/low) of 21 physical occupational demands using tertiles of continuous demand variables (e.g.,% work requiring the demand, max weight lifted, etc.) within the 2018 U.S. Bureau of Labor Statistics Occupational Requirements Survey. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for CVD mortality across demand levels after adjusting for demographic, socioeconomic, and health-related factors. <h3>Results</h3> Higher occupational demands related to standing, walking, stairs, heavy lifting, and reaching overhead were consistently associated with elevated CVD mortality risk. Workers with high levels of standing and walking hours/day had a 27% higher CVD mortality risk (HR=1.27, CI: 1.11–1.44) versus low. Similarly, the high level of maximum weight lifted/carried had a 25% higher CVD mortality risk versus low (HR=1.25, CI: 1.09–1.44). Exposures emphasizing seated work or fine motor manipulation were associated with neutral or reduced risk. Workers in the highest tertile of sitting hours/day had a 16% lower CVD mortality risk compared to the lowest tertile (HR=0.84, CI: 0.75–0.94). <h3>Conclusion</h3> These findings suggest that certain physical occupational demands, particularly those involving upright postures, heavy loads, or dynamic movement, may contribute to higher CVD risk. This study advances the physical activity health paradox literature by identifying specific harmful occupational demands, supporting the need for targeted workplace interventions protecting cardiovascular health.