Professional driver mortality in 9 countries: a systematic review and meta-analysis

A systematic review, combining analysis (on means after deleting outliers from samples) and meta-analysis for Standardized mortality ratio (SMR) versus the general population for total and all-cancer mortality for professional drivers (men only) of various countries (cohorts of Great Britain, Denmark, Iceland, Italy, Canada, Russia, Singapore, Switzerland and Sweden (1988–2002); data for the USA (1978) were not available; 13 papers in total) were conducted. The criteria for the search and selection of sources (PubMed, Google, Cochrane Systematic Reviews and reference lists of publications) were: a) a cohort of drivers only, without adding other employees of auto enterprises; b) the presence in the study of index of total mortality (‘all causes’) and/or mortality from all malignant neoplasms (‘all cancer’); c) the expression of mortality rates only in the SMR index.

A combined analysis and meta-analysis showed a weak healthy worker effect (HWE; meta-analysis: SMR=0.92, 95% confidence intervals (CI): 0.85, 0.99, the presence of HWE was judged by the value of the upper CI<1.0). There are also trends towards HWE for overall mortality for taxi and truck drivers (SMR=0.9–0.93), but the samples are too small to draw conclusions. For other groups of drivers HWE was not found.

In both types of synthetic studies, no SMR for HWE was observed for mortality from all malignancies, either for the general group of drivers (8 countries; 16 cohorts) or for individual occupational groups. There were slight increases in SMR (by 3–10%), the magnitude of which, according to epidemiological canons, is difficult to prove, and according to the risk scale by R.R. Monson corresponds to no effect.

The absence of significant risks both in terms of the integral indicator of well-being (life expectancy, inversely proportional to SMR), and in terms of mortality from all types of malignant neoplasms for professional drivers makes it unlikely that the population of Russia will experience increased mortality due to ever-increasing mass motorization.

Contribution:
Koterov A.N. — the concept and design of the study, data collection and processing, writing the text, editing;
Ushenkova L.N. — data collection and processing, editing.

Funding. As part of the broader budget theme of the FMBA of Russia; without other sources of funding and sponsorship.

Conflict of interests. The authors declare no conflict of interests.

Received: 17.01.2023 / Accepted: 24.01.2023 / Published: 05.05.2023

1. Monson R.R. Observations on the healthy worker effect. J. Occup. Med. 1986; 28(6): 425–33. https://doi.org/10.1097/00043764-198606000-00009

2. Maksimov S.A., Skripchenko A.E., Artamonova G.V. Role of healthy worker effect in Epidemiology of arterial hypertension of miners. Ekologiya cheloveka. 2015; 22(9): 15–20 (in Russian).

3. Trubetskov A.D., Zhyrov K.S. ‘The effect of healthy worker’ in various areas of occupational medicine: the publications review. Probl. Sotsialnoi. Gig. Zdravookhran. Istor. Med. 2021; 29(2): 254–9. https://doi.org/10.32687/0869-866X-2021-29-2-254-259 (in Russian)

4. Mastrangelo G., Marzia V., Marcer G. Reduced lung cancer mortality in dairy farmers: is endotoxin exposure the key factor? Am. J. Ind. Med. 1996; 30(5): 601–9. https://clck.ru/34Guzs

5. Kornysheva E.A., Platonov D.Y., Rodionov A.A., Shabashov A.E. Epidemiology and Statistics as Tools of Evidence-Based Medicine. 2nd Edition. Tver; 2009 (in Russian.)

6. A Dictionary of Epidemiology. Ed. by J.M. Last. Oxford: Oxford University Press; 2001. (in Russian)

7. Vlasov V.V. Epidemiology. 2nd Edition. — Moscow: GEOTAR-Media, 2006 (in Russian).

8. Bukhtiyarov I.V., Zibarev E.V., Betz K.V. An epidemiological study on the analysis of the mortality of civil aviation pilots in the Russian Federation. Aviakosm. Ekolog. Med. 2022; 56(4): 83–8. https://doi.org/10.21687/0233-528X-2022-56-4-83-88 (in Russian)

9. Kalinkin D.E., Karpov A.B., Maksimov D.E., Kiriakidi E.N., Takhauov R.M. Assessment of lymphoid neoplasm risk factors in people occupationally exposed to prolonged ionizing radiation. Siberian Journal of Oncology. 2020; 19(6): 7–18. https://doi.org/10.21294/1814-4861-2020-19-6-7-18 (in Russian).

10. Ogle W. Letter to the Registrar-General on the mortality in the registration districts of England and Wales during the ten years 1871–80. Supplement to the 45th Annual Report of the Registrar-General of Births, Deaths, and Marriages, in England. London; 1885.

11. McMichael A.J., Spirtas R., Kupper L.L. An epidemiologic study of mortality within a cohort of rubber workers, 1964–72. J. Occup. Med. 1974; 16(7): 458–64.

12. Chen R., Seaton A. The influence of study characteristics on the healthy worker effect: a multiple regression analysis. Occup. Med. (Lond). 1996; 46(5): 345–50. https://doi.org/10.1093/occmed/46.5.345

13. McMichael A.J. Standardized mortality ratio and the ‘healthy worker effect’: scratching beneath the surface. J. Occup. Med. 1976; 18(3): 165–8. https://doi.org/10.1097/00043764-197603000-00009

14. Fox A.J., Collier P.F. Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. Br. J. Prev. Soc. Med. 1976; 30(4): 225–30. https://doi.org/10.1136/jech.30.4.225

15. Wen C.P., Tsai S.P., Gibson R.L. Anatomy of the healthy worker effect: a critical review. J. Occup. Med. 1983; 25(4): 283–9.

16. Sheikh K. A review of the healthy worker effect in occupational epidemiology. Occup. Med. (Lond). 2000; 50(2): 146. https://doi.org/10.1093/occmed/50.2.146

17. Monson R.R. Occupational Epidemiology. 2nd Edition. Florida: Boca Raton, CRC Press Inc., 1990.

18. Greenberg R.S., Mandel J.S., Pastides H., Britton N.L., Rudenko L., Starr T.B. A meta-analysis of cohort studies describing mortality and cancer incidence among chemical workers in the United States and western Europe. Epidemiology. 2001; 12(6): 727–40. https://doi.org/10.1097/00001648-200111000-00023

19. Alder N., Fenty J., Warren F. et al. Meta-analysis of mortality and cancer incidence among workers in the synthetic rubber-producing industry. Am. J. Epidemiol. 2006; 164(5): 405–20. https://doi.org/10.1093/aje/kwj252

20. Dell L., Teta M.J. Mortality among workers at a plastics manufacturing and research and development facility: 1946–1988. Am. J. Ind. Med. 1995; 28(3): 373–84. https://doi.org/10.1002/ajim.4700280307

21. Atkinson W.D., Law D.V., Bromley K.J., Inskip H.M. Mortality of employees of the United Kingdom Atomic Energy Authority, 1946–97. Occup. Environ. Med. 2004; 61(7): 577–85. https://doi.org/10.1136/oem.2003.012443

22. Deltour I., Tretyakov F., Tsareva Y. et al. Mortality of populations potentially exposed to ionising radiation, 1953–2010, in the closed city of Ozyorsk, Southern Urals: a descriptive study. Environ. Health. 2015; 14: Article 91. https://doi.org/10.1186/s12940-015-0078-8

23. Koterov A.N., Ushenkova L.N., Kalinina M.V., Biryukov A.P. Brief review of world researches of radiation and non-radiation effects in nuclear industry workers. Medical and Biological Problems of Life Activity (Gomel). 2020; (1): 17–31 (in Russian).

24. Lutz W., Striessnig E., Dimitrova A., Ghislandi S., Lijadi A., Reiter C. et al. Years of good life is a well-being indicator designed to serve research on sustainability. Proc. Natl. Acad. Sci. USA. 202123; 118(12): Article e1907351118. https://doi.org/10.1073/pnas.1907351118

25. Lai D., Guo F., Hardy R.J. Standardized mortality ratio and life expectancy: a comparative study of Chinese mortality. Int. J. Epidemiol. 2000; 29(5): 852–5. https://doi.org/10.1093/ije/29.5.852

26. Ushakov I.B., Voronkov Y.I., Bukhtiyarov I.V. Tikhonova G.I., Gorchakova T.Yu., Bryleva M.S. A cohort mortality study among Soviet and Russian cosmonauts, 1961–2014. Aerosp. Med. Hum. Perform. 2017; 88(12): 1060–5. https://doi.org/10.3357/AMHP.4701.2017

27. Reynolds R.J., Day S.M. Mortality of US astronauts: comparisons with professional athletes. Occup Environ Med. 2019; 76(2): 114–7. https://doi.org/10.1136/oemed-2018-105304

28. Gajewski A.K., Poznanska A. Mortality of top athletes, actors and clergy in Poland: 1924–2000 follow-up study of the long-term effect of physical activity. Eur. J. Epidemiol. 2008; 23(5): 335–40. https://10.1007/s10654-008-9237-3

29. Metz-Flamant C., Rogel A., Caer S., Samson E., Laurier D., Acker A., Tirmarche M. Mortality among workers monitored for radiation exposure at the French nuclear fuel company. Arch. Environ. Occup. Health. 2009; 64(4): 242–50. https://doi.org/10.1080/19338240903348246

30. Dupree E.A., Cragle D.L., McLain R.W., Crawford-Brown D.J., Teta M.J. Mortality among workers at a uranium processing facility, the Linde Air Products Company Ceramics Plant, 1943–1949. Scand. J. Work Environ. Health. 1987; 13(2): 100–7. https://doi.org/10.5271/sjweh.2074.

31. Birdsey J., Alterman T., Li J., Petersen M.R., Sestito J. Mortality among members of a truck driver trade association. AAOHN J. 2010; 58(11): 473–80. https://doi.org/10.3928/08910162-20101018-01

32. Merlo D.F., Stagi E., Fontana V., Consonni D., Gozza C., Garrone E. et al. A historical mortality study among bus drivers and bus maintenance workers exposed to urban air pollutants in the city of Genoa, Italy. Occup. Environ. Med. 2010; 67(9): 611–9. https://doi.org/10.1136/oem.2009.050377

33. Laden F., Hart J.E., Smith T.J., Davis M.E., Garshick E. Cause-specific mortality in the unionized U.S. trucking industry. Environ. Health Perspect. 2007; 115(8): 1192–6. https://doi.org/10.1289/ehp.10027

34. Mannocci A., Lojodice B., Boccia A., La Torre G. Systematic review of the literature regarding the risk of mortality, cancer and cardiovascular diseases in professional drivers. Ig. Sanita Pubbl. 2013; 69(2): 155–70 (in Italian).

35. Lawin H., Fanou L.A., Hinson A.V., Stolbrink M., Houngbegnon P., Kedote N.M. et al. Health risks associated with occupational exposure to ambient air pollution in commercial drivers: a systematic review. Int. J. Environ. Res. Public Health. 2018; 15(9): 2039. https://doi.org/10.3390/ijerph15092039

36. Koh D., Guanco-Chua S., Ong C.N. A study of the mortality patterns of taxi drivers in Singapore. Ann. Acad. Med. Singap. 1988; 17(4): 579–82.

37. Luepker R.V., Smith M.L. Mortality in unionized truck drivers. J. Occup. Med. 1978; 20(10): 677–82.

38. Paradis G., Theriault G., Tremblay C. Mortality in a historical cohort of bus drivers. Int. J. Epidemiol. 1989; 18(2): 397–402. https://doi.org/10.1093/ije/18.2.397

39. Borgia P., Forastiere F., Rapiti E., Rizzelli R., Magliola M.E., Perucci C.A., Axelson O. Mortality among taxi drivers in Rome: a cohort study. Am. J. Ind. Med. 1994; 25(4): 507–17. https://doi.org/10.1002/ajim.4700250405

40. Boffetta P., Silverman D.T. A meta-analysis of bladder cancer and diesel exhaust exposure. Epidemiology. 2001; 12(1): 125–30. https://doi.org/10.1097/00001648-200101000-00021

41. Garshick E., Laden F., Hart J.E., Rosner B., Davis M.E., Eisen E.A., Smith T.J. Lung cancer and vehicle exhaust in trucking industry workers. Environ. Health Perspect. 2008; 116(10): 1327–32. https://doi.org/10.1289/ehp.11293

42. Hart J.E., Garshick E., Smith T.J., Davis M.E., Laden F. Ischaemic heart disease mortality and years of work in trucking industry workers. Occup. Environ. Med. 2013; 70: 523–8. https://doi.org/10.1136/oemed-2011-100017

43. Jadad A.R., Enkin M.W. Randomized Controlled Trials. Questions, Answers, and Musings. 2nd edition. — Malden, Oxford, Carlton: BMJ Books; 2007.

44. Koterov A.N., Ushenkova L.N., Kalinina M.V., Biryukov A.P. Comparison of the risk of mortality from solid cancers after radiation incidents and occupational exposures. Meditsina truda i promyshlennaia ekologiia. 2021; 61(9): 580–7. https://doi.org/10.31089/1026-9428-2021-61-9-580-587 (in Russian).

45. Blettner M., Sauerbrei W., Schlehofer B. et al. Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int. J. Epidemiol. 1999; 28(1): 1–9. https://doi.org/10.1093/ije/28.1.1

46. Gul M., Kotak Y., Muneer T., Ivanova S. Enhancement of albedo for solar energy gain with particular emphasis on overcast skies. Energies. 2018; 11: Article 2881. https://doi.org/10.3390/en11112881

47. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. Brit. Med. J. 2003; 327(7414): 557–560. https://doi.org/10.1136/bmj.327.7414.557

48. Axelson O. Negative and non-positive epidemiological studies. Int. J. Occup. Med. Environ. Health. 2004; 17(1): 115–21.

49. Gerosa A., Ietri E., Belli S., Grignoli M., Comba P. High risk of pleural mesothelioma among the state railroad carriage repair workers. Epidemiol Prev. 2000; 24(3): 117–9 (in Italian).

50. Nakashima E., Neriishi K., Minamoto A. A reanalysis of atomic-bomb cataract data, 2000–2002: a threshold analysis. Health Phys. 2006; 90(2): 154–60. https://doi.org/10.1097/01.hp.0000175442.03596.63

51. Neriishi K., Nakashima E., Minamoto A., Fujiwara S., Akahoshi M., Mishima H.K. et al. Postoperative cataract cases among atomic bomb survivors: radiation dose response and threshold. Radiat Res. 2007; 168(4): 404–8. https://doi.org/10.1667/RR0928.1

52. Solenova L.G., Smulevich V.B., Dymova E.G., Beresneva A.D. General and oncologic morbidity in Moscow municipal transport drivers. Gig. Sanit. 2000; (6): 17–20 (in Russian).

53. Balarajan R., McDowall M.E. Professional drivers in London: a mortality study. Br J Ind Med. 1988; 45(7): 483–6. https://doi.org/10.1136/oem.45.7.483

54. Schnatter A.R., Katz A.M., Nicolich M.J., Theriault G. A retrospective mortality study among Canadian petroleum marketing and distribution workers. Environ. Health Perspect. 1993; 101(6): 85–99. https://doi.org/10.1289/ehp.93101s685

55. Rafnsson V., Gunnarsdottir H. Mortality among professional drivers. Scand. J. Work Environ. Health. 1991; 17(5): 312–7. https://doi.org/10.5271/sjweh.1697

56. Hansen E.S. A follow-up study on the mortality of truck drivers. Am. J. Ind. Med. 1993; 23(5): 811–21. https://doi.org/10.1002/ajim.4700230514

57. Hedberg G., Jacobsson K.A., Langendoen S., Nystrom L. Mortality in circulatory diseases, especially ischaemic heart disease, among Swedish professional drivers: a retrospective cohort study. J. Hum. Ergol. (Tokyo). 1991; 20(1): 1–5.

58. Guberan E., Usel M., Raymond L., Bolay J., Fioretta G., Puissant J. Increased risk for lung cancer and for cancer of the gastrointestinal tract among Geneva professional drivers. Br. J. Ind. Med. 1992; 49(5): 337–44. https://doi.org/10.1136/oem.49.5.337

59. Sorahan T., Nichols L., Harrington J.M. Mortality of United Kingdom oil refinery and petroleum distribution workers, 1951–1998. Occup. Med (Lond). 2002; 52(6): 333–9. https://doi.org/10.1093/occmed/52.6.333.

60. Netterstrom B. Cancer incidence among urban bus drivers in Denmark. Int. Arch. Occup. Environ. Health. 1988; 61(3): 217–21. https://doi.org/10.1007/BF00381022

61. Band P.R., Le N.D., Fang R., Deschamps M., Coldman A.J., Gallagher R.P., Moody J. Cohort study of Air Canada pilots: mortality, cancer incidence, and leukemia risk. Am. J. Epidemiol. 1996; 143(2): 137–43. https://doi.org/10.1093/oxfordjournals.aje.a008722

62. Zeeb H., Hammer G.P., Langner I., Schafft T., Bennack S., Blettner M. Cancer mortality among German aircrew: second follow-up. Radiat. Environ. Biophys. 2010; 49(2): 187–94. https://doi.org/10.1007/s00411-009-0248-6

63. Hill A.B. Medical ethics and controlled trials. Br. Med. J. 1963; 1(5337): 1043–9. https://doi.org/10.1136/bmj.1.5337.1043

64. Koterov A.N., Ushenkova L.N., Zubenkova E.S., Wainson A.A., Kalininna M.V., Biryukov A.P. Strength of association. Report 1. Graduation of relative risk. Medits. Radiologiia Radiat. Bezopasnost. (Medical Radiology and Radiation Safety; Moscow). 2019; 64(4): 5–17. https://doi.org/10.12737/article_5d1adb25725023.14868717 (in Russian).

65. Koterov A.N. Causal criteria in medical and biological disciplines: history, essence and radiation aspect. Report 3, Part 1: first five Hill’s criteria: use and limitations. Radiats. Biol. Radioecol. 2021; 61(3): 300–2. https://doi.org/10.31857/S0869803121030085 (in Russian).

66. Smoking and Heart Disease and Stroke. CDC. Centers for Disease Control and Prevention. NCHS. National Center for Health Statistics, Classification of Diseases, Functioning, and Disability. World Health Organization (WHO). 2022. https://www.cdc.gov/tobacco/campaign/tips/diseases/heart-disease-stroke.html (дата обращения 18.11.2022).

67. Szklo M., Nieto F.J. Epidemiology. Beyond the Basics. 4th Edition. Burlington: Jones & Bartlett Learning, 2019. — 577 p.

68. Boffetta P. Causation in the presence of weak associations. Crit. Rev. Food Sci. Nutr. 2010; 50(1): 13–6. https://doi.org/10.1080/10408398.2010.526842

69. Jensen O.M., Wahrendorf J., Knudsen J.B., Sorensen B.L. The Copenhagen case-referent study on bladder cancer: risks among drivers, painters and certain other occupations. Scand. J. Work Environ. Health. 1987; 13(2): 129–34. https://doi.org/10.5271/sjweh.2070

70. Tyner S.D., Venkatachalam S., Choi J. et al. p53 mutant mice that display early ageing-associated phenotypes. Nature. 2002; 415(6867): 45–53. https://doi.org/10.1038/415045a

71. Van Heemst D., Mooijaart S.P., Beekman M., Schreuder J., de Craen A.J.M., Brandt B.W. et al. (Long Life study group) Variation in the human TP53 gene affects old age survival and cancer mortality. Exp. Gerontol. 2005; 40(1–2): 11–5. https://doi.org/10.1016/j.exger.2004.10.001

72. Moher D., Liberati A., Tetzlaff J., Altman D.G. (PRISMA Group). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): Article e1000097. https://doi.org/10.1371/journal.pmed.1000097

73. Omelyanovsky V.V., Avxentyeva M.V., Sura M.V., Khachatryan G.R., Fedyaeva V.K. Guidelines for conducting a meta-analysis. M.: FSBI ‘Center for Healthcare Quality Assessment and Control’ of the Ministry of Health of the Russian Federation, 2017 (in Russian).

74. Chau N., Bertrand J.P., Mur J.M., Figueredo A., Patris A., Moulin J.J., Pham Q.T. Mortality in retired coke oven plant workers. Br. J. Ind. Med. 1993; 50(2): 127–35. https://doi.org/10.1136/oem.50.2.127

75. Dalager N.A., Kang H.K. Mortality among Army Chemical Corps Vietnam veterans. Am. J. Ind. Med. 1997; 31(6): 719–26. https://clck.ru/34GwDx

76. McLaughlin R., Nielsen L., Waller M. An evaluation of the effect of military service on mortality: quantifying the healthy soldier effect. Ann. Epidemiol. 2008; 18(12): 928–36. https://doi.org/10.1016/j.annepidem.2008.09.002

77. UNSCEAR 2000. Report to the General Assembly, with Scientific Annex. Annex G. Biological effects at low radiation doses. New York, 2000: 73–175.

78. Symons M.J., Taulbee J.D. Practical considerations for approximating relative risk by the standardized mortality ratio. J. Occup. Med. 1981; 23(6): 413–6. https://doi.org/10.1097/00043764-198106000-00013