Occupational Disparities in Cardiovascular Risk and Management in Contemporary China

BACKGROUND: Although occupational disparities in cardiovascular health are increasingly recognized, a comprehensive understanding of cardiovascular health across contemporary occupational contexts-particularly in rapidly transitioning economies-remains limited. OBJECTIVES: This study aimed to characterize geographic and occupational patterns of cardiovascular risk, risk-factor management, and potential prevention opportunities among employed adults in contemporary China. METHODS: In this nationwide cross-sectional study, we analyzed 1,421,390 employees aged 20 to 65 years who underwent health examinations at 167 centers across 24 provinces in China between 2021 and 2023. Eighteen occupations were defined based on participants' employer registration and industry affiliation, and were classified into primary, secondary, and tertiary sectors, with the tertiary sector further subclassified into modern, public, and life services. Age- and sex-standardized prevalence of coronary heart disease (CHD) and cardiometabolic risk factors was estimated, along with age- and sex-standardized rates of treatment and control for hypertension and diabetes, and treatment for hypercholesterolemia and low-density lipoprotein cholesterol (LDL-C) control. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated using the Prediction for ASCVD Risk in China model. We then assessed changes in the proportion of individuals classified as having moderate-to-high 10-year ASCVD risk under simulated scenarios that set elevated blood pressure and total cholesterol to target levels and current smoking to noncurrent smoking and compared these reductions across occupations. RESULTS: The mean age of participants was 33.8 years, and 53.4% were male. Overall, the age- and sex-standardized prevalence of CHD was 1.33% (95% CI: 1.29%-1.37%) and demonstrated a pronounced north-south gradient (P < 0.001), with the highest in the North and the lowest in the South. Cardiometabolic risk factors also exhibited a similar geographic distribution. Employees in modern service sectors exhibited the lowest age- and sex-standardized prevalence of CHD and cardiometabolic risk factors, particularly those in "information transmission, software, and information technology," whereas the highest burdens were concentrated in the secondary sector, especially in "production and supply of electricity, heat power, gas and water." The age- and sex-standardized rates of treatment and control were 29.5% and 20.8% for hypertension, 36.6% and 21.9% for diabetes, and 17.0% and 9.5% for hypercholesterolemia treatment and LDL-C control, respectively. Modern services in the tertiary sector had the lowest treatment rates for all 3 cardiometabolic conditions and the lowest control rates for hypertension and LDL-C. Among individuals aged ≥35 years without prior ASCVD, 23.3% were classified as having moderate-to-high 10-year ASCVD risk, with marked occupational variation, highest in "agriculture, forestry, animal husbandry, and fishery" (30.4%) and lowest in "service to advanced manufacturing" (14.7%). Simulated control of elevated blood pressure, hypercholesterolemia, and current smoking revealed substantial occupational variation in potential ASCVD risk reduction. CONCLUSIONS: Occupational context may provide a practical framework for identifying patterns of cardiovascular risk, management gaps, and prevention opportunities among China's working population. Despite lower observed disease burden, modern occupational sectors showed suboptimal risk-factor management, whereas simulated ASCVD risk reductions varied across occupations, highlighting distinct prevention needs and opportunities across occupational contexts.