Cardiovascular disease risk across subsectors and occupations in the transportation and storage industry: a national cohort study

Cardiovascular disease (CVD) is a major contributor to global morbidity and mortality. While the transportation industry is recognized as high-risk for CVD, variation across subsectors and occupations remains unclear. We evaluated CVD risk across subsectors and occupations in South Korea's transportation industry. This retrospective cohort study used linked data from Korean National Health Insurance Service and Employment Insurance databases. Male workers aged 35-54 years in 2013 who remained in the same occupation during 2012 and underwent health screening in 2012-2013 were included. Follow-up continued through 2022. We calculated age-standardized incidence rates, standardized incidence ratios (SIRs), and population-attributable fractions across industries, with stratified analyses by subsector, occupation and lifestyle factors. Among 2 300 512 workers, transportation industry exhibited the highest age-standardized CVD incidence rate (558.9 per 100 000 person-years) and population-attributable fraction (1.49%) of all industries. Within 182 551 transportation workers, driving-related occupations showed the highest SIRs, especially in land and freight subsectors. Aviation subsectors had lower CVD incidence and more favorable health indicators. These patterns remained consistent after stratification by obesity and smoking status. Substantial heterogeneity exists in CVD risk across transportation subsectors and occupations. Targeted prevention strategies are needed for high-risk groups, particularly drivers.