During the hot rolling process, the work roll experiences cyclic contact stress due to the deformation of the strip steel, as well as thermal stress from periodic heating and cooling. The surface failure of the work roll results from the combined effects of wear and fatigue damage. This study proposes a comprehensive approach to analyzing coupled wear and fatigue damage using a method based on the Manson-Coffin equation, modified slope formula, and the Miner criterion. Finite element models were developed to simulate simplified heat transfer and thermal coupling, taking into account the actual rolling parameters and high-temperature material properties of the work roll. The evolution of the physical field of the work roll during the rolling process was analyzed. The analysis of these models revealed that the maximum strain on the work roll occurred at the rolling exit and was predominantly influenced by temperature. The effects of rolling speed and temperature on work roll strain varied, with fatigue damage being significantly reduced when wear was considered compared to scenarios where wear was not accounted for, under the same number of cycles.