Abstract
Purpose
To explore the transition patterns among different levels of blood pressure for bus drivers.
Methods
A follow-up study was conducted to investigate the transition probabilities of three blood pressure states, the sojourn time in each state, the survival probabilities, and the risk factors affecting hypertension progression. Based on 5618 blood pressure measurements of 1883 Chinese bus drivers from 2017 to 2021, a multi-state Markov model was established.
Results
The mean age of participants was 41.43 ± 6.71 years, and 82.37% were male. The probabilities from normal state to hypertension within 1-year follow-up were 4.60% (male) and 2.13% (female); however, the corresponding changes over a 3-year follow-up had a significant increase to 20.27% (male) and 7.98% (female). The sojourn time of normal state and elevated state was 1.82 ± 0.09 years and 1.98 ± 0.08 years, respectively. The male participants, the increasing age, BMI, CHOL and TG were risk factors for progression from normal state to elevated state, and/or from elevated state to hypertensive state (HR: 1.04–2.53).
Conclusions
Early preventive measures on the progression of hypertension should be taken for Chinese bus drivers, and at least one physical examination per year is strongly recommended. The government and bus companies should pay more attention to these kinds of bus drivers with high probabilities of hypertension: male, older than 40 years, with the higher values of BMI and blood lipid. The derived findings of sojourn time, transition probabilities and survival probabilities can provide reference for health professionals to make targeted intervention to reduce bus drivers’ hypertension occurrence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
AFL-CIO/CLC (2019) Driving a bus is harzardous to your health amalgamated transit union. https://www.atu.org/media/news/driving-a-bus-is-harzardous-to-your-health. Accessed 03 Mar 2022
Bellomo R, Warrillow SJ, Reade MC (2009) Why we should be wary of single-center trials. Crit Care Med 37(12):3114–3119. https://doi.org/10.1097/CCM.0b013e3181bc7bd5
Brookmeyer R, Abdalla N (2019) Multistate models and lifetime risk estimation: application to Alzheimer’s disease Statist. Med 38(9):1558–1565. https://doi.org/10.1002/sim.8056
CDC (2021) Measure Your Blood Pressure. https://www.cdc.gov/bloodpressure/measure.htm. Accessed 04 Mar 2022
Chen CF, Hsu YC (2020) Taking a closer look at bus driver emotional exhaustion and well-being: evidence from Taiwanese urban bus drivers. Saf Health Work 11:353–360. https://doi.org/10.1016/j.shaw.2020.06.002
Chung YS, Wong JT (2011) Developing effective professional bus driver health programs: an investigation of self-rated health. Accid Anal Prev 43(6):2093–2103. https://doi.org/10.1016/j.aap.2011.05.032
Davis J, Juarez D, Hodges K (2013) Relationship of ethnicity and body mass index with the development of hypertension and hyperlipidemia. Ethn Dis 23(1):65–70. https://doi.org/10.1111/jphd.12008
Di Palo KE, Barone NJ (2020) Hypertension and heart failure: prevention, targets, and treatment. Heart Fail Clin 16:99–106. https://doi.org/10.1016/j.hfc.2019.09
Faulkner JL, de Chantemèle EJB (2018) Sex differences in mechanisms of hypertension associated with obesity. Hypertension 71(1):15–21. https://doi.org/10.1161/HYPERTENSIONAHA.117.09980
Golinko V, Cheberyachko S, Deryugin O, Tretyak O, Dusmatova O (2020) Assessment of the risks of occupational diseases of the passenger bus drivers. Saf Health Work 11:543–549. https://doi.org/10.1016/j.shaw.2020.07.005
Grover G, Sabharwal A, Kumar S, Thakur AK (2019) A multi-state markov model for the progression of chronic kidney disease. Türkiye Klinikleri Biyoistatistik 11(1):1–14. https://doi.org/10.5336/biostatic.2018-62156
Jackson CH (2011) Multi-state models for panel data: the msm package for R. J Stat Soft 38:1–28. https://doi.org/10.18637/jss.v038.i08
Jan YT, Tsai PS, Longenecker CT, Lin DC, Yun CH, Sung KT, Liu CC, Kuo JY, Hung CL, Wu TH et al (2021) Thoracic aortic calcification and pre-clinical hypertension by new 2017 ACC/AHA hypertension guidelines. Diagnostics 11:1027
Kasemsan A, Joseph L, Paungmali A, Sitilertpisan P, Pirunsan U (2021) Prevalence of musculoskeletal pain and associated disability among professional bus drivers: a cross-sectional study. Int Arch Occ Env Hea 4:1263–1270. https://doi.org/10.1007/s00420-021-01683-1
Khaja SU, Mathias KC, Bode ED, Stewart DF, Jack K, Moffatt SM, Smith DL (2021) Hypertension in the United States fire service. Int J Environ Res Public Health 18:5432. https://doi.org/10.3390/ijerph18105432
Kokubo Y, Matsumoto C (2017) Hypertension is a risk factor for several types of heart disease: review of prospective studies. Adv Exp Med Biol 956:419–426. https://doi.org/10.1007/5584_2016_99
Liu LS (2011) 2010 Chinese guidelines for the management of hypertension. Zhonghua Xin Xue Guan Bing Za Zhi 39:579–615. in Chinese
Mills KT, Obst KM, Wei S, Sandra M, Zhang HJ, Hua H, Cooper LA, Jiang H (2018) Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis. Ann Internal Med 168(2):110–120. https://doi.org/10.7326/M17-1805
Mohsen A, Hakim S (2019) Workplace stress and its relation to cardiovascular disease risk factors among bus drivers in Egypt. East Mediterr Health J 25(12):878–886. https://doi.org/10.26719/emhj.19.056
Nanfan Daily (2021) Remembering responsibility to give bus drivers a sense of professional honor. https://www.chinabuses.com/keyun/2021/0303/article_97661.html. Accessed 13 Mar 2022
Oparil S, Acelajado MC, Bakris GL et al (2018) Hypertension. Nat Rev Dis Primers 4(18014):1–21. https://doi.org/10.1038/nrdp.2018.14
Tada T, Kumada T, Toyoda H, Ohisa M, Akita T, Tanaka J (2018) Long term natural history of liver disease in patients with chronic hepatitis b virus infection: an analysis using the markov chain model. J Gastroenterol 53(11):1196–1205. https://doi.org/10.1007/s00535-018-1467-x
Tu ZH, He JW, Zhou N, Shen XH (2021) Driver-passenger communicative stress and psychological distress among Chinese bus drivers: the mediating effect of job burnout. BMC Public Health. https://doi.org/10.1186/s12889-021-10618-x
Useche SA, Ortiz VG, Cendales BE (2017) Stress-related psychosocial factors at work, fatigue, and risky driving behavior in bus rapid transport (BRT) drivers. Accid Anal Prev 104:106–114. https://doi.org/10.1016/j.aap.2017.04.023
Wang YF, Ma ZM, Xu CN, Wang ZK, Yang XH (2018) Prediction of transfer among multiple states of blood pressure based on Markov model: an 18-year cohort study. J Hypertens 36:15061513. https://doi.org/10.1097/HJH.0000000000001722
Wei C, Gerberich SG, Ryan AD, Alexander BH, Church TR, Manser M (2017) Risk factors for unintentional occupational injury among urban transit bus drivers: a cohort longitudinal study. Ann Epidemiol 27:763–770. https://doi.org/10.1016/j.annepidem.2017.09.011
WHO (2017) The WHO STEPwise approach to non-communicable disease risk factor surveillance. WHO STEPS Surveillance Manual. https://www.who.int/ncds/surveillance/steps/STEPS_Manual.pdf?ua=1. Accessed 26 June 2020
Wong LY, Toh MPHS, Tham LWC (2017) Projection of prediabetes and diabetes population size in singapore using a dynamic markov model. J Diabetes 9(1):65–75. https://doi.org/10.1111/1753-0407.12384
Wu WT, Tsai SS, Wang CC, Lin YJ, Wu TN, Shih TS, Liou SH (2019) Professional driver’s job stress and 8-year risk of cardiovascular disease: the taiwan bus driver cohort study. Epidemiology 30:S39–S47. https://doi.org/10.1097/EDE.0000000000001003
Yang JM, Liu F, Wang B, Chen CY, Church T, Dukes L, Smith JO (2021) Blood pressure states transition inference based on multi-state Markov model. IEEE J Biomed Health 25(1):237–246. https://doi.org/10.1109/JBHI.2020.3006217
Ye XX, Yi Q, Shao J, Zhang Y, Zha MM, Yang QW, Xia W, Ye ZH, Song P (2021) Trends in prevalence of hypertension and hypertension phenotypes among Chinese children and adolescents over two decades (1991–2015). Front Cardiovasc Med 8:627741. https://doi.org/10.3389/fcvm.2021.627741
Acknowledgements
We would like to thank all Chinese bus drivers who voluntarily participated in this study.
Funding
JX was supported by the National Natural Science Foundation of China (grant no. 81903412), the Medical Scientific Research Foundation of Guangdong Province of China (A2020405).
Author information
Authors and Affiliations
Contributions
Conceptualization: YW, JX, and XZ; methodology: JX and XZ; data collection: YW and WW; data analysis: JX and YL; writing—original draft preparation: XZ; writing—review and editing: XZ and JX.
Corresponding authors
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
The study was ethically approved by a hospital institutional ethics committee (Ethical approval number: LL-KY-202224) as per the Helsinki declarations).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wu, Y., Wu, W., Lin, Y. et al. Blood pressure states transitions among bus drivers: the application of multi-state Markov model. Int Arch Occup Environ Health 95, 1995–2003 (2022). https://doi.org/10.1007/s00420-022-01903-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-022-01903-2