Developmental trajectories and associated factors of cardiovascular disease risk among chinese miners: a 5-year prospective cohort study

Abstract

To examine temporal patterns in cardiovascular disease (CVD) risk among miners, identify distinct latent trajectory classes, and evaluate factors associated with trajectory membership. We analyzed data from a miner health cohort in Huaibei, Anhui Province, China. Of 4,560 miners initially identified from the occupational health-examination system, 1,701 had complete consecutive annual examination records from 2020 to 2024, met the analytic criteria, and were included in the final analytic cohort. FRS-based cardiovascular risk was assessed using the Framingham Risk Score (FRS) point score. Growth mixture modeling (GMM) was used as the primary framework to identify heterogeneous longitudinal FRS trajectory profiles, and mixed-effects models were used as supporting analyses of overall and covariate-associated score changes. Unadjusted multinomial logistic regression and BIC-guided adjusted multinomial logistic regression, with age and sex retained a priori, evaluated factors associated with posterior trajectory-class membership. Retention and missingness were assessed in supplementary analyses. A total of 1,701 miners (94.9% male; mean age 41.8 years, SD 6.4) were analyzed. GMM identified three FRS trajectory profiles: low-risk increasing (6.0%), high-risk increasing (70.7%), and moderate-risk transitional (23.3%). The high-risk increasing class was characterized by a higher baseline FRS point score and a continued increase during follow-up. In the revised predictor pool, which excluded direct or near-direct components of the FRS point score, current drinking, dust exposure, higher pulse rate, higher BMI, and higher blood glucose were associated with higher FRS point scores, whereas higher FEV₁/predicted FEV₁ and higher direct bilirubin were associated with lower FRS point scores. In the BIC-selected adjusted multinomial model, current drinking was associated with lower odds of low-risk increasing membership (OR = 0.23, 95% CI 0.12–0.45) and higher odds of high-risk increasing membership (OR = 4.23, 95% CI 3.13–5.71), using the moderate-risk transitional class as the reference. Direct bilirubin was associated with lower odds of high-risk increasing membership (OR = 0.78, 95% CI 0.72–0.85). FRS-based cardiovascular risk among miners showed heterogeneous longitudinal trajectory profiles. These findings support trajectory-informed occupational health surveillance and subgroup-specific cardiovascular risk management in miner populations.