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Background Cardiometabolic diseases (CMDs) are the leading cause of death in China. This study aims to investigate the association between employment status and cardiometabolic morbidity among Chinese middle-aged and older workers.Methods Individual-level data from the core survey of China Health and Retirement Longitudinal Study (2011–2018) were utilised. Analytical sample comprised 7,862 participants aged 45 years or over who were free of CMDs at baseline. Assuming the censoring was non-informative, Cox proportional-hazards models using Breslow method to handle tied failures were estimated to investigate associations of employment status with cardiometabolic mono- and multimorbidity. Given the large number of agricultural workers in China, employment status was categorised into six groups (non-agricultural groups: employed, self-employed, and retired, and agricultural groups: employed, self-employed, and retired) to incorporate workforce from both agricultural and non-agricultural industries. Cardiometabolic multimorbidity was defined as the coexistence of at least two of hypertension, dyslipidaemia, diabetes or high blood sugar, heart attack or other heart problems, and stroke. Sociodemographic factors including age, sex, education, yearly household income (quartiles), marital status, residence type (urban, migrant, or rural based on official household registration), and regions, and health behaviours including smoking and alcohol consumption were added to the model using a forward stepwise strategy. Results were adjusted for survey weights to account for the complex survey design.Results 2,034 participants developed a single type of CMDs during an average follow-up time of 5.7 years, and 631 participants developed cardiometabolic multimorbidity during an average follow-up time of 6.2 years. The global test of Schoenfeld residuals indicated that the proportional hazards assumption was satisfied. When fully adjusted, compared with non-agricultural employees, both non-agricultural and agricultural retirees had higher hazards of cardiometabolic mono-morbidity (HR=1.48 and 1.41, respectively) and multimorbidity (HR=2.30 and 1.64, respectively), and participants who were non-agriculturally self-employed had a higher hazard of cardiometabolic multimorbidity (HR=1.58, 95% CI, 1.11–2.23) but not mono-morbidity (HR=1.06, 95% CI, 0.86–1.30). In the subgroup analysis, compared with rural residents, migrant residents had 1.32 times (95% CI, 1.02–1.70) higher hazard of cardiometabolic multimorbidity after full adjustment.Conclusion Among Chinese non-agricultural workers, self-employed workers faced a higher risk of cardiometabolic multimorbidity than employees. Both agricultural and non-agricultural retirees had a higher risk of cardiometabolic morbidity than non-agricultural employees. Formulation of disease prevention policies should consider the employment characteristics of the population.