Abstract

Background
The COVID-19 pandemic imposed unprecedented psychosocial and behavioral burdens on workers; however, the trajectories of cardiometabolic diseases by occupational vulnerabilities remain unclear. This study examined longitudinal health deterioration across industrial sectors and shift workers in South Korea.
Methods
A retrospective cohort of 22,458 workers was followed at three time points (2019, 2021, and 2023). Generalized linear mixed models with year × industry and year × night shift interactions assessed the prevalence of cerebro-cardiovascular disease (CCVD), metabolic syndrome components, obesity, job stress, and lifestyle behaviors across industries and shift work. Generalized estimating equations evaluated the incidence of cardiometabolic risk factors across pandemic periods.
Results
The prevalence of CCVD, metabolic syndrome components, and obesity increased significantly over time (all P < 0.001). Dyslipidemia incidence rose during the early pandemic period (2019–2021), whereas hypertension risk was higher during the late pandemic period (2021–2023). Despite declining overall job stress across the cohort, health/medical workers showed increased job stress in 2021 relative to manufacturing workers. Compared with day workers, night shift workers showed a smaller increase in strength training participation and a greater increase in obesity prevalence by 2023, as well as higher diabetes incidence during the late pandemic period.
Conclusions
The pandemic was associated with distinct cardiometabolic health declines linked to occupational characteristics. Health/medical workers experienced increased psychosocial stress, whereas night shift workers showed a smaller increase in strength training participation and a greater increase in obesity prevalence than day workers. These findings suggest the need for occupational health policies moving from broad to targeted interventions, including cardiovascular screening and psychological support for health/medical workers and flexible health programs for shift workers.

• Keywords: COVID-19; occupational health; cardiometabolic risk factors; longitudinal studies; Republic of Korea