Examining the Association Between Occupational Strain and Risk of Angina Pectoris Among Older Working Adults in India Using Karasek's Job Demand Control Model

Background Occupational strain is a well-known predictor of cardiovascular diseases (CVDs), yet limited evidence exists for older workers in India. Using the Job Demand–Control (JDC) model, this study examines the association between job strain and the risk of Angina Pectoris (AP) among older workers, focusing on psychosocial workplace conditions linked to later life AP risk. Method We used Wave 1 (2017-18) of the Longitudinal Aging Study in India (LASI), a nationwide survey, focusing on working older adults ( n = 66,331). Occupational strain was conceptualised using the JDC model (high strain, active, passive, low strain), while AP was assessed using the Rose Angina Questionnaire. We employed a multivariable logistic regression model to examine the association between job strain and AP while adjusting for socioeconomic and health-related variables. Results After adjusting for socioeconomic and health factors, individuals in both active (OR=0.77, 95% CI: 0.64–0.92) and passive jobs (OR=0.84, 95% CI: 0.74–0.96) exhibited a significantly lower likelihood of AP, whereas low-strain jobs showed a marginally protective but non-significant association compared to high-strain jobs. Early labour force participation (before age 14) and poorer self-rated health were associated with a higher risk of AP. Regional variation was significant, while socioeconomic variables were not significant after adjustment. Conclusion This study highlights the role of psychosocial conditions, including occupational strain, in the development of angina in later life. The findings point to the need for better work environments that allow employees more control, decision-making autonomy, and greater skill discretion in their roles. At the same time, early identification and management of job stress and burnout may reduce the burden of angina and other cardiac events among India’s aging workforce.