Document Type : Research articles


1 1 Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 3 Social Determinantss of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

3 1 Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran 4 Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 5 Immunology of Infectious Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

5 2 Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality across the globe. Activity status is used as a social class marker of CVDs.
Objectives: The present study aimed to analyze the associations between occupational status and CVDs in Iranian population.
Methods: The present cross-sectional study was conducted on 9,990 subjects aged 35-70 years enrolled in the Rafsanjan Cohort Study (RCS), as one of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Occupational status, socio-demographic characteristics, physical activity, cigarette and hookah smoking, opium use, and alcohol consumption were assessed through six pre-designed questionnaires. Anthropometric, body mass index (BMI), medical history, and laboratory tests were also performed. CVDs were defined as the presence of ischemic heart disease (IHD) or myocardial infarction (MI). Prevalence ratios were calculated for each activity status and CVD using Poisson regression models.
Results: The occupational activities were assigned to two classes: homemaker (40.17%) was the largest group of class I, followed by self-employed (34.44%), employed (13.03%), retired (10.38%), and unemployed (1.62%). In class II, the largest group included pistachio farmers (12.61%), copper miners (3.62%), and others (83.76%). A percentage of people were illiterate (9.50%), especially in the homemaker group (61.39%). In general, 8.71% and 2.98% of participants suffered from IHD and MI, respectively. After adjusting the socio-demographic and other characteristics, there was no significant association between occupational status and CVDs.
Conclusion: As evidenced by the obtained results, activity status was not associated with the risk of IHD and MI.


  1. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: the impact of demographic changes. Iran J Public Health. 2017;46(4):506-16. [PubMed: 28540267].
  2. Sarrafzadegan[S1]  N, Mohammadifard N. Cardiovascular disease in iran in the last 40 years: prevalence, mortality, morbidity, challenges and strategies for cardiovascular prevention. Arch Iran Med. 2019;22(4):204-10. [PubMed: 31126179].
  3. Movsisyan NK, Vinciguerra M, Medina-Inojosa JR, Lopez-Jimenez F. Cardiovascular diseases in central and eastern Europe: a call for more surveillance and evidence-based health promotion. Ann Global Health. 2020;86(1):21. doi: 10.5334/aogh.2713. [PubMed: 32166066].
  4. Suglia SF, Campo RA, Brown AG, Stoney C, Boyce CA, Appleton AA, et al. Social determinants of cardiovascular health: Early life adversity as a contributor to disparities in cardiovascular diseases. J Pediatr. 2020;219:267-73. doi: 10.1016/j.jpeds.2019.12.063. [PubMed: 32111376].
  5. Akioyamen LE, Genest J, Chu A, Inibhunu H, Ko DT, Tu JV. Risk factors for cardiovascular disease in heterozygous familial hypercholesterolemia: A systematic review and meta-analysis. J Clin Lipidol. 2019;13(1):15-30. doi: 10.1016/j.jacl.2018.10.012. [PubMed: 30527766].
  6. Nocon M, Keil T, Willich SN. Education, income, occupational status and health risk behaviour. J Public Health. 2007;15(5):401-5. doi: 10.1007/s10389-007-0120-6.
  7. Feng M, Darabi M, Tubeuf E, Canicio A, Lhomme M, Frisdal E, et al. Free cholesterol transfer to high-density lipoprotein (HDL) upon triglyceride lipolysis underlies the U-shape relationship between HDL-cholesterol and cardiovascular disease. Eur J Prev Cardiol. 2020;27(15):1606-16. doi: 10.1177/2047487319894114. [PubMed: 31840535].
  8. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee MC, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244-53. doi: 10.1016/S0140-6736(11)60749-6. [PubMed: 21846575].
  9. Easterlin RA. Industrial revolution and mortality revolution: two of a kind? J Evolut Econ. 1995;5(4):393-408. doi: 10.1007/BF01194368.
  10. Sassen B, Cornelissen VA, Kiers H, Wittink H, Kok G, Vanhees L, et al. Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors. Eur J Cardiovasc Prev Rehabil. 2009;16(6):677-83. doi: 10.1097/HJR.0b013e3283312e94. [PubMed: 19734792].
  11. Sarrafzadegan N, Mohammadifard N. Cardiovascular disease in iran in the last 40 years: prevalence, mortality, morbidity, challenges and strategies for cardiovascular prevention. Arch Iran Med. 2019;22(4):204-10. [PubMed: 31126179].
  12. Davis-Lameloise N, Philpot B, Janus ED, Versace VL, Laatikainen T, Vartiainen EA, et al. Occupational differences, cardiovascular risk factors and lifestyle habits in South Eastern rural Australia. BMC Public Health. 2013;13(1):1090. doi: 10.1186/1471-2458-13-1090. [PubMed: 24266886].
  13. Bulka CM, Daviglus ML, Persky VW, Durazo-Arvizu RA, Lash JP, Elfassy T, et al. Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos. Heart. 2019;105(6):439-48. doi: 10.1136/heartjnl-2018-313463. [PubMed: 30538094].
  14. Hwang WJ. Cardiovascular disease in Korean blue-collar workers: actual risk, risk perception, and risk reduction behavior. [Doctoral Dissertation]. San Francisco, California: University of California San Francisco; 2010.
  15. Frankenhaeuser M, Lundberg U, Fredrikson M, Melin B, Tuomisto M, Myrsten AL, et al. Stress on and off the job as related to sex and occupational status in white‐collar workers. J Organ Behav. 1989;10(4):321-46. doi: 10.1002/job.4030100404.
  16. Berg ZK, Rodriguez B, Davis J, Katz AR, Cooney RV, Masaki K. Association between occupational exposure to pesticides and cardiovascular disease incidence: the Kuakini Honolulu Heart Program. J Am Heart Assoc. 2019;8(19):e012569. doi: 10.1161/JAHA.119.012569. [PubMed: 31550966].
  17. Sun W, Gong F, Xu J. Individual and contextual correlates of cardiovascular diseases among adults in the United States: a geospatial and multilevel analysis. Geo J. 2020;85(6):1685-700. doi: 10.1007/s10708-019-10049-7.
  18. Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321-9. doi: 10.1056/NEJMoa1012848. [PubMed: 22276822].
  19. Hakimi H, Ahmadi J, Vakilian A, Jamalizadeh A, Kamyab Z, Mehran M, et al. The profile of Rafsanjan cohort study. Eur J Epidemiol. 2020;In Press. doi: 10.1007/s10654-020-00668-7. [PubMed: 32725579].
  20. Eghtesad S, Mohammadi Z, Shayanrad A, Faramarzi E, Joukar F, Hamzeh B, et al. The PERSIAN cohort: providing the evidence needed for healthcare reform. Arch Iran Med. 2017;20(11):691-5. [PubMed: 29480734].
  21. Aguilar-Farias N, Brown WJ, Skinner TL, Peeters GG. Metabolic equivalent values of common daily activities in middle-age and older adults in free-living environments: a pilot study. J Phys Act Health. 2019;16(3):222-9. doi: 10.1123/jpah.2016-0400. [PubMed: 30669937].
  22. Paglione L, Angelici L, Davoli M, Agabiti N, Cesaroni G. Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study. BMJ Open. 2020;10(6):e033776. doi: 10.1136/bmjopen-2019-033776. [PubMed: 32499259].
  23. Kivimäki M, Kawachi I. Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep. 2015;17(9):630. doi: 10.1007/s11886-015-0630-8. [PubMed: 26238744].
  24. Virtanen M, Heikkilä K, Jokela M, Ferrie JE, Batty GD, Vahtera J, et al. Long working hours and coronary heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2012;176(7):586-96. doi: 10.1093/aje/kws139. [PubMed: 22952309].
  25. Zimmermann MV, González MG, Galán IL. Cardiovascular risk profiles by occupation in Madrid region, Spain. Rev Esp Salud Publica. 2010;84(3):305-20. doi: 10.1590/s1135-57272010000300008. [PubMed: 20661528].
  26. TavakolianFerdosieyeh V, Karimifared M, Esmaeili A, Hassanshahi G, Vazirinejad R. Pesticide induced complications among pistachio farmers: in the rural area of Rafsanjan, Iran (2010). J Occup Health Epidemiol. 2012;1(2):111-7. doi: 10.18869/acadpub.johe.1.2.111.
  27. Harari R, Julvez J, Murata K, Barr D, Bellinger DC, Debes F, et al. Neurobehavioral deficits and increased blood pressure in school-age children prenatally exposed to pesticides. Environ Health Perspect. 2010;118(6):890-6. doi: 10.1289/ehp.0901582. [PubMed: 20185383].
  28. Andersen HR, Wohlfahrt-Veje C, Dalgård C, Christiansen L, Main KM, Nellemann C, et al. Paraoxonase 1 polymorphism and prenatal pesticide exposure associated with adverse cardiovascular risk profiles at school age.PLoS One. 2012;7(5):e36830. doi: 10.1371/journal.pone.0036830. [PubMed: 22615820].
  29. Covey LS, Zang EA, Wynder EL. Cigarette smoking and occupational status: 1977 to 1990. Am J Public Health. 1992;82(9):1230-4. doi: 10.2105/ajph.82.9.1230. [PubMed: 1503163].
  30. Burke RJ. Work stress and women's health: occupational status effects. J Busin Ethics. 2002;37(1):91-102.