Assessment of non-communicable disease risk factors among Andhra Pradesh state road transport corporation bus drivers of Vijayawada

INTRODUCTION

In 2021, non-communicable diseases (NCDs) comprising cardiovascular diseases (17.9 million or 44%), cancer (9.3million or 16%), chronic respiratory diseases (4.1million or 9.5%), diabetes (1.5million or 2%) would contribute to 41million (71%) total deaths globally.¹ Around 6 million (60%) of all deaths in India in 2021 was attributed to NCDs.² Rapid urbanization has contributed to increase burden of NCDs in India in recent years.³ Among NCD risk factor tobacco, harmful use of alcohol, insufficient physical activity, unhealthy diet, and work-related stress often affects the individual's health leading to diseases like hypertension, diabetes, and obesity. The lifestyle and related non-communicable disease risk factors are influenced by occupation and workplace culture.⁴ Some of the common risk factors among bus drivers include prolonged sitting, work-related stress, irregular sleep patterns, and irregular eating patterns. The early detection and treatment of NCDs, as well as changing risky lifestyle choices, can avert almost 40 to 50 percent of NCDs.⁵ There is a significant knowledge gap among APSRTC bus drivers on risk factors and their combined effects on non-communicable diseases. Therefore, research on NCD risk factors in APSRTC bus drivers is necessary. The main objective of the study was to assess the socio-demographic profile, prevalence, and association between demographic profile and major NCD risk factors among APSRTC (Andhra Pradesh state road transport corporation) bus drivers.

METHODS

A cross-sectional study conducted on bus drivers aged above 20 years currently working in APSRTC and the study was carried out from July to October 22 in APSRTC bus stand Vijayawada. The sample size was estimated to be 117 based on the study conducted by WHO-ICMR in 2011 in which the prevalence of the NCD risk factor was 25%. The sample size was calculated by using 4pq/l² with an absolute precision of 8% and the final sample was rounded to 120.⁶ Systematic random sampling technique was applied for selecting a sample of 120 out of 380 bus drivers who were currently working in the APSRTC bus stand in Vijayawada. The first study participant was selected randomly by using currency note. Study participants who were suffering from stroke, rheumatic heart disease, ischemic heart disease, and cancer were excluded from the study.

A pre-designed modified semi-structured WHO Questionnaire consisting of demographic details and major risk factors including tobacco, harmful use of alcohol, insufficient physical activity, overweight and obesity, unhealthy diet, work-related stress, and driving problems leading to diseases like hypertension, diabetes, accidents, and obesity was applied.^4-9 Height and weight were recorded using standardized methods.¹⁰ BMI was calculated using the Quetelet index, classified as per the South Asian BMI classification.¹¹ Blood pressure was recorded using the electronic OMRON-HEM 7120 machine. The blood pressure (BP) is assessed from the participant’s right arm after they have taken five-minute rest. A “current smoker” was defined as a person who was consuming any form of tobacco for the past 30 days. For alcohol consumption, a “current user” was a person who was consuming alcohol for the past 30 days.³

Statistical analysis

Data was collected and entered into Microsoft excel sheet and was analyzed using the IBM SPSS 23version (trial version) by using appropriate statistical tests (Chi-square test or fisher exact test, p value and odds ratio).

RESULTS

Among 120 study participants, 45% were in the age group of 36-50 years, 39.2% were aged >50 years with mean age of 46.4±10.9. 60.8% have completed secondary education, 65.8% were Hindus, 80% belong to nuclear type of family, and 60% belong to lower middle class (III) according to the modified Kuppuswamy classification 2021 in the below (Table 1).

In (Table 2), 49.2% of study participants were overweight, 30.8% were obese, 24.2% had diabetes, and 37.5% had hypertension. 26.7% were alcoholics and 25% were current smokers. Only 31.7% of subjects regularly ate meals, and only 12.5% exercised regularly and consumed fruits and vegetables often. 28% of drivers practice daily walks of at least 30 minutes. In (Table 3), 69.2% of drivers have more than ten years of experience, 61.7% drive for fewer than ten hours, 65.8% work a single shift, 54.2% have insufficient sleep, 79.2% have stressful jobs, 85.0% maintain speeds below the 70 km/h limit and are wearing seat belts but using a mobile phone while driving 89.2% obey traffic signals and have no history of accidents and 50% are suffering with any musculoskeletal disorders. In (Table 4), The majority of study participants are above the age of 40, which carries a 2.2 times risk of becoming obese (p value=0.108), as well as a 1.4 times risk of being hypertensive (p value=0.038) is statistically significant. Secondary education have shown statistically significance for developing obesity (p-value = 0.04) and not statistically significant for developing diabetes and hypertension (p value=1.2). Most of them are not practicing daily exercise for at least 30 minutes at a time (1.3 times), which increases their risk of developing diabetes, hypertension, and obesity but is not statistically significant (p value=0.144). Bus drivers who don't get enough sleep are 1.5 times more likely to become fat (p value=0.109), which is not statistically significant.

DISCUSSION

In the current study a majority of 45% were aged above 40 years with mean age of 46.6 years comparable to Audichya et al study 51.5% aged above 40 years with mean age of 48 years and in Rao et al study 47.8% were aged above 40 years with mean age of 40.2 years.^13,14

In the present study 60% completed secondary school education, similar to Rao et al 66.7%, Audichya et al 76%. In the present study, 37.5% are current smokers and 26.5% are current alcoholics, similar to Audichya et al, 26.5% are current smokers and 33.5% were alcoholics, Lakshman et al 46% were current smokers, 86.3% were alcoholic, Jadhav et al 79.8% were current smokers, 24.2% were alcoholics, Hungund et al 24.9% were current smokers, the alcohol consumption rate was 35.1.^4,1516 12.5% of study participants were performing routine exercise similar to Jadhav et al. in contrary Audichya et al showed that 63.5% were performing of light physical activity.

High salt intake of >5 grams per day was observed among 81.7% study participants and 12.5% were consuming vegetables and fruits, whereas only 18% of study subjects were consuming high salt intake and 72% were consuming vegetables daily and 22% were consuming fruits daily in Audichya et al. In the current study 42.5% are at risk of getting obese, 37.5% hypertension, 24.2% diabetes similar to Rao et al 42.2% obese, 28.9% hypertensives, 11.1% diabetic and 41.3% of the study population was found to be hypertensive in Lakshman et al study.

69.2% of bus drivers had >10 years of driving experience which is comparable to Lakshman et al. Insufficient sleep was observed among 54.2% of drivers which is comparable to Lakshman et al, Jadhav et al 53.1%, and 66.3%.

Work stress along with increasing age and long duration of driving of >10 hours per day, lack of insufficient sleep leads to early initiation of smoking and alcohol consumption which in turn leads to development of NCDs among bus drivers.

Limitations

Limitations of the current study was that the study sample size was not representative to the general population.

CONCLUSION

The study concluded that there is a huge gap in knowledge regarding risk factors and their cumulative effects on non-communicable diseases. Many of the study participants were not known hypertensive and were found with increased levels of blood pressure, obesity, and diabetes.

Recommendation

Regular periodic screening for the presence of NCD risk factors and diseases in the workplace should be conducted for early diagnosis and treatment.

ACKNOWLEDGEMENTS

Authors would like to thank Andhra Pradesh state road transport corporation, Vijayawada for their support and cooperation and sincerely thank all the study participants (bus drivers) for their presence and cooperation.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Global health estimates 2016: non-communicable diseases of deaths by cause, age, sex, by country and by region, 2000-2016. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed on 20 June 2022.
2. 2. Sivanantham P. Profile of risk factors for non-communicable diseases (NCDs) in a highly urbanized district of India: Findings from Puducherry district-wide STEPS Survey, 2019-20. PloS One. 2021;16(1):254-9.
3. 3. Sayyad AP, Chivukula SK, Jonnalagodda RK, Ravi Kumar MS. Behavioural risk factors of NCDs Among adults residing in rural aras of Krishna District: A study based on WHO STEPS Approach. Int J Res Med Sci. 2022;5(2):12-25.
4. 4. Jadhav AV. Non-communicable diseases risk profile of bus drivers in rural Maharashtra: an exploratory comparative study. Natl J Community Med. 2017;8(12):737-40.
5. 5. Yosef T. Prevalence and associated factors of chronic non-communicable diseases among cross-country truck drivers in Ethiopia. BMC Public Health. 2020;20(1):1564.
6. 6. Deepa M, Pradeepa R, Anjana R, Mohan V. Noncommunicable diseases risk factor surveillance: experience and challenge from India. Indian J Community Med. 2011;36:50-6.
7. 7. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American academy of sleep medicine and sleep research society. Sleep. 2015;38(6):843-4.
8. 8. Alcohol use disorders identification test consumption. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684826/Alcohol_use_disorders_identification_test_for_consumption_AUDIT_C_.pdf. Accessed on 20 June 2022.
9. 9. Park K. Noncommunicable diseases (Hypertension). In: Park Textbook of Preventive and Social Medicine. 26th ed. India: Banarsidas Bhanot Publishers; 2021: 420-6.
10. 10. National health and nutrition examination survey (NHANES). Available at: https://www.cdc.gov/nchs/nhanes/index.htm. Accessed on 20 November 2021.
11. 11. WHO Expert Consultation. Appropriate body mass index for Asia populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-63.
12. 12. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104.
13. 13. Audichya S, Pavithra H, Harikrishnan V, Akshaya KM. Risk factors for non communicable diseases among transport and security personnel of a health sciences university in coastal Karnataka. Int J Community Med Public Health 2020;7:872-6.
14. 14. Rao CR, Kumar U, Mishra S, Kamath V. Screening for non-communicable Diseases among transport employees of a university: a descriptive analysis. Indian J Comm Health. 2016;28(1):100-5.
15. 15. Lakshman A, Manikath N, Rahim A, Anilakumari VP. Prevalence and risk factors of hypertension among male occupational bus drivers in North Kerala, South India: a cross-sectional study. Int Schol Res Not Prevent Med. 2014.
16. 16. Hungund B, Joshi A, Katti SM, Shetty AK, Karikatti SS. The pattern of alcohol and tobacco consumption among transport personnel in North Karnataka. Med Legal Update. 2012;12(2):23-9.