Association Between Employment Factors and Prevalence of Cardiovascular Disease in US Law Enforcement Workers: The National Health Interview Survey, 2006–2018

BACKGROUND: Law enforcement workers face a higher risk of cardiovascular disease (CVD), however, employment factors impacting CVD remain systematically understudied, particularly in a national US sample. We describe temporal trends in prevalent CVD including coronary heart disease (CHD), angina, myocardial infarction (MI) and other heart disease; and investigate associations of select employment factors with CVD among law enforcement workers using the National Health Interview Survey (NHIS) from 2006 to 2018. METHODS: We analyzed prevalent CVD in law enforcement workers employed in local, state, and federal establishments using the NHIS, a nationally representative sample of US workers. We estimated odds ratios (OR [95% confidence interval, CI]) of CVD in relation to employment factors using survey-weighted multivariable logistic regression models adjusted for sociodemographic and traditional CVD risk factors. RESULTS: Among 2177 law enforcement workers, mean age 46 years, 19% female, prevalence of CVD was higher among disabled (OR = 5.37; 95% CI: 2.53, 11.38 for aggregate CVD outcome) and retired (OR = 2.14; 95% CI: 1.18, 3.88 for aggregate CVD outcome) workers compared to currently employed workers. Workers employed in smaller (1-24 employees) or larger (≥ 500 employees) departments and those with tenure > 20 years also demonstrated higher prevalence odds of select CVD outcomes. Although not statistically significant, higher prevalence odds across CVD outcomes were observed in local government employees, hourly paid workers, and workers with 10-19 years of tenure. CONCLUSIONS: Our study highlights that select employment factors, some previously underexplored, may be associated with prevalent CVD in law enforcement workers. Leveraging national surveys and worker cohorts to enhance surveillance of identified groups in this high-risk population could help elucidate the role of employment on CVD development and inform workplace interventions.