Duration of employment within occupations and incident stroke in a US general population cohort 45 years of age or older (REGARDS study)

Tran B. Huynh, Leslie A. McClure, Virginia J. Howard, Monika M. Stafford, Suzanne E. Judd, Igor Burstyn

Research output: Contribution to journalArticlepeer-review


Background: The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Methods: We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population-based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two-digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre-1975 vs. post-1975), and region. Results: Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. Conclusions: Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work-related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers.

Original languageEnglish (US)
Pages (from-to)142-154
Number of pages13
JournalAmerican Journal of Industrial Medicine
Issue number2
StatePublished - Feb 2023
Externally publishedYes

Bibliographical note

Funding Information:
We are grateful for Dr. Leslie A. McDonald's tremendous help with understanding the occupational ancillary data and her guidance on the analysis. We thank the investigators, staff, and participants of the REGARDS study for their valuable contributions. A full list of participating investigators and institutions can be found at https://www.uab.edu/soph/regardsstudy/ . Dr. Huynh was supported by the K01OH011191 from the National Institute for Occupational Safety and Health (NIOSH) during the early analysis of the data. REGARDS is supported by cooperative agreement U01 NS041588 co‐funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA), National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS or the NIA. Representatives of the NINDS were involved in the review of the manuscript but were not directly involved in the collection, management, analysis or interpretation of the data. The occupational ancillary study was supported by intramural funding from the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Representatives from NIOSH did not have any role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, or the preparation or approval of the manuscript.

Publisher Copyright:
© 2022 Wiley Periodicals LLC.


  • employment duration
  • occupations
  • sex differences
  • stroke
  • stroke belt

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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