Where We Work Correlates with Whether We Receive Cardiorespiratory Preventive Care Services

Background: More than 20% of Americans do not regularly receive cholesterol screening and flu shots, the two important preventive services for cardiorespiratory self-care. Uncontrolled dyslipidemia leads to cardiovascular diseases (CVD), the leading cause of death and disability among American workers, while influenza contributes to health-related workplace absenteeism. Despite the loss of productivity in workers due to cardiorespiratory illness, only a few studies examined occupational disparities in cardiorespiratory preventive care services. This study aimed to examine the association between occupational characteristics and the utilization of cholesterol screening and flu shots.
Methods: The Health and Retirement Study (HRS) is a longitudinal survey of middle-aged and older adults in the U.S. This study focused on 3,222 participants in the HRS from 2004 to 2018, representing the past and current working population. Respondents who did not report cholesterol screening, influenza vaccination, or job information, passed away by 2019, never worked for pay, or had CVD/stroke were excluded from the analysis. Occupation was coded based on the U.S. Census 2000 and configured into five groups: (1) management/science, (2) social services, (3) general services, (4) health services, and (5) industrial workers. Job characteristics, including psychological and physical strains at work, ergonomic risk, lifting of heavy loads, and job stability, were based on self-reported questions. The multivariable logistic and ordered logistic regression models were used for analysis.
Results: Compared to the management/science workers, industrial and general services workers were less likely to have optimal cholesterol screening and influenza vaccination. For cholesterol screening behaviors, frequent heavy lifting at work (p=0.010), lower job mental strain (p=0.004), and lower job stability (p=0.025) were associated with a lower likelihood of optimal cholesterol screening, after the adjustment for demographic and health covariates. For flu-shot intake, higher job physical strain (p<0.001) and lower job stability (p=0.002) were associated with a lower likelihood of optimal influenza vaccination.
Conclusion: Findings highlight the underutilization of cholesterol screening and flu shots among industrial workers and general services workers. Multi-level stakeholder engagement is warranted to gauge the return on investment and sustainability of preventive health programs at workplaces.