Cardiovascular Disease Risk Factors Among Blue and White-collar Workers in Indonesia

Nurhayati A Prihartono, Fitriyani Fitriyani, Woro Riyadina


Background: cardiovascular diseases (CVD) is the most common cause of death in Indonesia. We aimed to examine risks of CVD in workers aged 40 to 69 year related to their occupational status. Methods: a cross-sectional study in all provinces of Indonesia. Data from a large-scale national health survey called RISKESDAS were used to analyze factors associated with CVD. Analysis was restricted to the working population aged 40 to 69 year. There were 137,378 subjects included in the analysis. Cox’s regression analysis was modified to calculate prevalence ratio for the association of CVD with diabetes mellitus (DM), hypertension, stress, body mass index (BMI), smoking, and particular demographic factors. Results: CVD was associated with occupation; white collar workers were about 1.6 times as likely to be diagnosed with CVD as to blue collar workers.  However, blue collar workers were more likely to report symptoms of CVD than white collar workers. Prevalence of CVD was higher in women than men, increasing by age and education attainment. Hypertension, DM, stress, and increased BMI added the prediction of CVD: prevalence ratio (PR) was 1.72 (95% CI 1.59-1.86), 3.89 (95% CI 3.43-4.44), 3.02 (95% CI 2.77-3.29) and 1.42 (95% CI 1.28-1.57) for BMI ≥27 relative to <25 kg/m2, respectively. The study could not explain the association with smoking. Conclusion: this study added evidence of major risk factors which could be modified to reduce CVD. Some associations were likely to reflect access to health care.


cardiovascular disease; worker; population-based study; Indonesia


Ministry of Health, Republic of Indonesia, “Report of national basic health research (Riskesdas 2007)”. Jakarta: Indonesia; 2008.

Ministry of Health, Republic of Indonesia, “Indonesian Health Profile 2003”. Jakarta: Indonesia; 2003.

World Health Organization, “Global atlas on cardiovascular disease prevention and control”. ISBN 978 92 4 156437 3. World Health Organization. Geneva, 2011.

HS Buttar, T Li, N Ravi, “Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation”. Exp Clin Cardiol, 10(4):229-49, 2005.

Pyakuel P, Karki P, Lamsal M, Ghimire A, Phokarel K, “Cardiovascular risk factors among industrial workers: a cross-sectional study from eastern Nepal”. Journal of Occupational Medicine abd Toxicology, 11(25):1-7, 2016.

Kaur P, Rao TV, Sankarasubbaiyan S, Narayanan AM, Ezhil R, Rao SR, et al, “Prevalence and distribution of cardiovascuar risk factors in an urban industrial population in south India”. J Assoc Physicians India, 55: 771-6, 2007.

Davey Smith,G., Carroll,D., Rankin, S, “Socio-economic differentials in mortality: evidence from Glasgow graveyards”. BMJ, 305:1554-7, 1992.

Fukuda,Y., Nakamura,K., Takano,T, “Accumulation of health risk behaviours is associated with lower socio-economic status and women’s urban residence: a multilevel analysis in Japan”. BMC Public Health, 5(53):1-10, 2005.

World Health Organization, “Global status report on non-communicable disease 2014”. ISBN 9789241564854. WHO Press, World Health Organization. Switzerland, 2014.

The National Institute of Health Research and Development, Ministry of Health. Republic of Indonesia, “Result of National Basic Health Research (RISKESDAS 2007)”. Jakarta, Indonesia, 2008.

Lee J, Tan CS, Chia KS. A practical guide for multivariate analysis of dichotomous outcomes,, 2009.

Nakamura,S., Nakamura,K., Tanaka,M. Increased risk of coronary heart disease among in Japanesse blue-collar workers. Occup. Med, 50(1):11-7, 2000.

Buring JE, Evans DA, Fiore M, Rosner B, Hennekens CH, “Occupation and risk of death from coronary heart disease”. JAMA, 258: 791-792, 1987.

Lukhaupt SE & Calvert GM,”Prevalence of Coronary Heart Disease or Stroke Among Workers Aged <55 Years - United States, 2008–2012”. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report, 60(30):645-9, 2014.

Clougherty JE, Souza K, Cullen MR, “Work and its role in shaping the social gradient in health”. Ann N Y Acad Sci, 1186:102-24, 2010.

Davey Smith G, Hart C, Blane D, “Lifetime socioeconomic position and mortality: prospective observational study”. BMJ, 314:547-52, 1997.

Lynch JW, Kaplan GA, Shema SJ, “Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning”. N Eng J Med, 337:1889-95, 1997.

Greenlund, K.J., Zheng, Z.J., Keenan, N.L., Giles, W.H., Casper, M.L., Mensah, G.A. and Croft, J.B, “Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991-1999”. Ar-chives of Internal Medicine, 164:181-188, 2004.

Bhatnagar A, “Environmental cardiology: studying mechanistic links between pollution and heart disease”. Circulation research, 99:692–705. [PubMed: 17008598], 2006.

Suka M, Miwa Y, Ono Y, Yanagisawa H, “Impact of weight gain on cardiovascular risk factors in Japanese male worker”. J Occup Environ Med, 54:1288-1292, 2012.

Kokkinos, Peter, “Pysical Activity and Cardiovascular Disease Prevention”. United States:Jones and Bartlett Publisher. 2010.

Harrell J.S. and Gore, S.V, “Cardiovascular risk factors and socioeconomic status in African American and Caucasian women”. Research in Nursing & Health, 21:285-95, 1998.

Conen David, Ridker PM, Buring JE, Glynn RJ, “Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: prospective cohort study”. BMJ, 335:452, 2007.

Brownson, Ross C., Patrick L. Remington, and James R. Davis, “Chronic Disease and Control: Diabetes”. Washington: American Public Health Association. 1993

Hirokawa, K., Ohira,T., Nagayoshi,M., et al, “Occupational status and job stress in relation to cardiovascular stress reactivity in Japanese workers”. Preventive medicine reports 4: 61-17, 2016.

Green, K.L., Johnson, J.V, “The effect of social work organization on patterns of cigarette smoking among male chemical plant employees”. Am J Public Health, 80:1368-71, 1990.

National Center for Cardiovascular Diseases, China, “Report on cardiovascular diseases in China (2010)”, 3. Encyclopedia of China Publishing House, 62, 2011.

Full Text: PDF


  • There are currently no refbacks.