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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
44
VOLUME 15 NUMBER 2 • NOVEMBER 2018
Prevalence of cardiometabolic risk factors among
professional male long-distance bus drivers in Lagos,
south-west Nigeria: a cross-sectional study
Casmir E Amadi, Tim P Grove, Amam C Mbakwem, Obianuju B Ozoh, Oyewole A Kushimo,
David A Wood, Michael Akinkunmi
Correspondence to: Casmir E Amadi
Department of Medicine, College of Medicine, University of Lagos, Nigeria
e-mail:
acetalx@yahoo.comAmam C Mbakwem, Obianuju B Ozoh
Department of Medicine, College of Medicine, University of Lagos, Nigeria
Tim P Grove, David A Wood
National Heart and Lung Institute, Imperial College, London
Oyewole A Kushimo, Michael Akinkunmi
Department of Medicine, Lagos University Teaching Hospital, Nigeria
Previously published in
Cardiovasc J Afr
2018;
29
(2): 106–114
S Afr J Diabetes Vasc Dis
2018;
15
: 44–51
Abstract
Background:
Professional drivers are known to be at high risk
of cardiovascular disease (CVD). This study was carried out to
highlight these risk factors and their predictors among male
long-distance professional bus drivers in Lagos, southwest
Nigeria, with a view to improving health awareness in this
group.
Methods:
Socio-demographic data, anthropometric indices,
blood pressure, fasting plasma blood glucose levels and lipid
and physical activity profiles of 293 drivers were measured.
Results:
Mean age of the study population was 48 ± 9.7
years; 71.0 and 19.5% of the drivers used alcohol and were
smokers, respectively; and50.9%werephysically inactive. The
prevalence of overweight and obesity was 41.7 and 21.1%,
respectively, while 39.7 and 13.9% were hypertensive and
diabetic, respectively. Ninety (31.3%) subjects had impaired
fasting glucose levels while 56.3% had dyslipidaemia.
Predictors of hypertension were age and body mass index
(BMI). BMI only was a predictor of abnormal glucose profile.
Conclusion:
Professional male long-distance bus drivers
in this study showed a high prevalence of a cluster of risk
factors for CVD.
Keywords:
cardiovascular disease, risk factors, long-distance
drivers
Atherosclerotic cardiovascular disease (CVD), typified by coronary
heart disease (CHD) and stroke, is a pre-eminent cause of
preventable and premature mortality globally, accounting for about
30% of global deaths.
1
This is expected to increase by almost 50%
by 2030.
2
It is also a major cause of mass disability and a somatic
cause of loss of productivity globally, with over 150 million disability
adjusted life years (DALYS).3 About 80% of this burden from CVD
is borne by low- and middle-income countries (LMIC).
1
Globally, CVD prevalence is on the increase, remarkably so in the
LMIC. This is largely due to increased urbanisation and its corollary
of better socio-economic opportunities and Westernisation of
lifestyles, such as sedentary living, unhealthy dietary choices,
tobacco use, psycho-social stress and harmful use of alcohol.
4
These
behavioural risk factors predispose to intermediary or metabolic risk
factors, such as hypertension, abnormalities in blood glucose levels,
dyslipidaemia, overweight and obesity.
5,6
One of the socio-economic consequences of urbanisation is
mass transit of people, goods and services across regions and long
distances via land, air and waterways. The consequence of this is
the creation of effective road transport systems in urban areas,
with an increase in the number of people engaged in professional
driving.
Professional drivers as an occupational group are at increased risk
of CVD. Morris
et al
., in their seminal research in 1953, documented
that London bus drivers were at increased risk for CHD compared
to the more active bus conductors.
7
Several other occupational
epidemiological studies have provided evidence that professional
drivers (short- and long-distance drivers) suffer more and die from
CVD.
8-11
This excess of CVD morbidity and mortality risk among this
group is attributable to a high prevalence of CVD risk factors, such
as obesity, hypertension, sedentary living, diabetes, smoking and
unhealthy diets found in them.
12-14
Beyond these conventional risk factors for CVD, various driving-
related activities, such as traffic congestion, ergonomic factors,
long-distance driving, shift work, and anxiety and tension from the
job of driving have also been implicated. These are known to cause
various neuroendocrine and neurocardiological responses, such as
increased secretion of cortisol and catecholamines, and decreased
heart rate variability, which may also be possible mediators of
CVD.
15,16
They can also be considered a vulnerable group with
social gradients of inequalities; they usually belong to the lower
socio-economic class, are not well educated/informed and are not
usually covered by public health policies. They also work under
immense anxiety and stress. These further heighten their risk for
CVD. Lagos is the second most populous city in Nigeria, the second
fastest growing city in Africa and the seventh in the world.
17
It is
the economic hub of the country with well-developed intra-city,
inter-city and trans-African highway routes for easy mass transit of
people, goods and services across geographical barriers,
18
making
road transportation and the transportation business important
features of its economy. Therefore many companies engage in
long-distance transportation, with professional drivers employed to
provide this service.
In Nigeria there are few studies on the CVD risk profile of this