Journal of Occupational

Introduction
Indian truck drivers contribute significantly to the transportation sector [1]. However, the mobile lifestyle of these truckers compromises their health [2], and the nature of their profession creates a variety of health conditions, with most of which remaining either undiagnosed or worsening over time [3, 4].
Being on the road for long hours and days nonstop restricts their awareness of and access to proper healthcare services [4]. The disease pattern observed in the Indian truckers is similar to that in the United States [5, 6], which includes visual disorders, watering eyes, coughing, diabetes, breathlessness, dermatological conditions, and gastric problems, like hyperacidity [7]. In fact, risk factors for metabolic syndrome are considered a key finding achieved in their health profiles [3].
Lack of sleep is associated with an increase in the prevalence of hypertension [8]. Among behavioural risk factors leading to hypertension, one could refer to tobacco use and obesity [9]. In addition, occupations leading to a sedentary routine life, family history of hypertension, and alcohol addiction are other causative factors of hypertension [10]. Hypertension has been shown to exert highly deleterious effects on the executive function as well as on the speed of reactions [11], with both of which directly affecting truck drivers.
The Driver Care Program (DCP) was conceptualised by our organization, i.e. Dr Shroff’s Charity Eye Hospital, in 2016 to provide better eye care services to truck drivers at their rest hubs in the national capital region. This was done in cooperation with a partner active in manufacturing vehicles, especially trucks. While it is primarily focused on improving accessibility and affordability of quality eye care services for truck drivers, the DCP provides basic screening services for systemic conditions, such as hypertension and diabetes.
A national survey conducted in the United States reported the high prevalence of hypertension and diabetes in truck drivers [12]. In India, a systematic review and meta-analysis determined the prevalence of hypertension (high blood pressure) to be around 29-30% in adults [13]. It also highlighted a difference in the prevalence rate between urban (33.8%) and rural populations [27.6%]. Similarly, the prevalence of diabetes in the adult population was estimated by the International Diabetes Federation to be 8.8% [14]. Both hypertension and diabetes are risk factors for metabolic syndrome shown to exist primarily in the 40-69 age group [15]. A national study reported that hypertension is common among the 18-25 age group [16], and the World Health Organisation reported that diabetes affects Indians in the 25-40 age group [17]. All of the aforementioned reports indicate that these productive Indian age groups suffer from diabetes and hypertension, which could negatively affect work performance among this mobile population, i.e. truck drivers.
The DCP included screening for hypertension and diabetes because the majority of truckers catered to by the program fall under this productive and susceptible age group. Opportunistic screening for hypertension has proved fruitful in earlier research [18]. Thus, this technique was used in the present study to target this unique population. The first step in developing a long-term program in this study was to analyse the first-year data of the program to assess the need for hypertension and diabetes screening among the truck drivers. This would also help plan for additional resources and equipment that might be required.
 
Materials and Methods
The present cross-sectional study was approved by the Institutional Review Board (IRB/2019/OCT/08) and adheres to the tenets of the Declaration of Helsinki. Data were collected from the routine eye camps for truck drivers during the study period from July 2017 to June 2018. Next, the data were entered into Microsoft Excel. No sample size calculation was required because all truck drivers accessing camp services during the study period were included in the analysis, and         non-drivers, i.e. auto mechanics and helpers, accessing services were excluded. Driver data were authenticated by the government for commercial driver identification which is a category of driver’s license issued by the government for commercial drivers of heavy motor vehicles.
The eye camps were held across the national capital region, including parking lots owned by fleet owners and big transporters, workshops, filling stations, and transport colonies (residential locations of long-term truck drivers). Before launching each camp, awareness activities were done to encourage drivers to attend the camp. Upon arrival, the patients went through the registration process. Next, some personnel were sent to the camp after receiving training and being credentialed by senior nurses at the hospital, who checked their blood pressure and blood sugar at random. Accordingly, blood pressure (BP) was measured by the NoCoding 1 Plus device, and random blood sugar was checked using the automatic blood sugar monitoring machine. The check-ups were only done for truckers giving consent for the process. In addition, the instruments were regularly calibrated on a weekly basis. Besides, hypertension was defined as the systolic blood pressure of ≥140mmHg or the diastolic blood pressure of ≥90 mmHg [19]. Similarly, diabetes was defined as the random blood sugar of ≥200 mg/dl [20]. Patients diagnosed with blood pressure exceeding the normal range were asked about their hypertension history. In addition, the suspected hypertensives and diabetics were provided with Information, Education, and Communication (IEC) material and referred to a physician nearby.
The basic age profiles of the drivers, the proportion of the drivers suffering from hypertension, the proportion of the drivers with previously undiagnosed hypertension, and the proportion of the drivers with high blood sugar were analysed. Besides, the age-specific risk of hypertension as well as the relative risk (RR) were calculated. The former was calculated as the percentage of the drivers diagnosed with hypertension for each age category. The latter was used for the age group below 30 as a basis for measuring increased susceptibility of a person to a disease for different age categories. In addition, confidence intervals at a 95% level were calculated for the point estimates of age-specific risks and relative risks. Next, statistical analysis was performed using a Z-test and a Chi-square test by SPSS version 24 and Microsoft Excel 2013. In addition, a p-value of less than 0.05 was considered significant.
 
Results
A total of 4,059 truck drivers were examined at the eye camps in a mobile van during the study period. Most of the drivers belonged to the 20-50 year age group with the maximum (1622, 40.0%) number of drivers in the 20-30 year age group. The mean age of the truck drivers in the present study was 34.16 ± 10.09 years with the median age of 32 years and the age range of 17-74 years. All of the truck drivers were male, for male dominance is observed in this occupation in India.
A total of 3,496 truck drivers (86.13% of the total 4,059 drivers) consented to have their blood pressure examined, and 865 of them (24.7%, 95% CI: 23.31-26.17%) were diagnosed with high BP. The average age of the truck drivers with high BP was found to be 38.65 ± 10.35 years, which was significantly higher than that of those with BP within the normal range (33.02 ± 9.77 years, p<0.001). The risk of hypertension increased with aging (Table 1). Using the relative risk of hypertension in truck drivers less than 30 years of age as a baseline for comparison, the risk of acquiring hypertension in drivers 30-39 years of age was 1.76 times more. The relative risk of hypertension among the truck drivers aged above 60 years was estimated to be 3.25 compared to the risk of hypertension below the age of 30 years.
Those diagnosed with hypertension were asked about their hypertension history, with 816 out of the 865 (94.3%) drivers having responded to the questions. Out of them, 401 (49.1%,95% CI, 45.7-52.6%) had their blood pressure examined earlier, and only 102 out of the 401 drivers (25.4%, 95% CI, 21.2-29.7%) were known hypertensive drivers who would receive the advised treatment.