# Employment status and cardiometabolic multimorbidity: results from China health and retirement longitudinal study

## TL;DR

This study explores how employment status affects the development of multiple cardiometabolic diseases in older Chinese adults.

## Contribution

The study introduces a multistate model to analyze how employment status influences the transition to cardiometabolic multimorbidity in China.

## Key findings

- Non-agricultural retirees had higher risks of cardiometabolic diseases compared to non-agricultural employees.
- Agricultural self-employed workers showed only marginal increases in cardiometabolic risks.
- Adjusting for various factors showed non-agricultural retirees still had higher transition rates to mono-morbidity.

## Abstract

Globally, cardiometabolic diseases (CMDs) are major health issues that affect the health of workforce. This study aimed to investigate the impact of employment status on transition from a healthy state to cardiometabolic multimorbidity in Chinese population. Data from China Health and Retirement Longitudinal Study (2011–2020) was utilised. Analytical sample comprised 7,681 men and women (≥ 45 years) free of CMDs at baseline. A multistate model was applied to investigate the impact of baseline employment status on the transition rates from a healthy state to cardiometabolic mono-morbidity and subsequently to multimorbidity. Inverse probability weighting was applied to account for the complex survey design. During an average follow-up time of 5.7 years, 3,324 (43.28%) participants developed one or more CMDs. After adjusting for age and sex, compared to non-agricultural employees, non-agricultural retirees had significantly higher risks and agricultural self-employed workers had only marginally higher risk of CMDs. After further adjustment for sociodemographic factors, health behaviours, and BMI, non-agricultural retirees remained significantly associated with a higher rate of transition from a healthy state to cardiometabolic mono-morbidity [HR 1.24 (95% CI 1.01–1.54)] compared to non-agricultural employees. There was no statistically significant increase in transition to multimorbidity risk in any group. Control of CMDs in Chinese older population should consider people’s employment characteristics.

The online version contains supplementary material available at 10.1186/s12963-026-00459-4.