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. 2024 Dec 17:387:e082194.
doi: 10.1136/bmj-2024-082194.

Alzheimer's disease mortality among taxi and ambulance drivers: population based cross sectional study

Vishal R Patel  1   2 , Michael Liu  1 , Christopher M Worsham  1   3 , Anupam B Jena  4   3   5
Affiliations

Alzheimer's disease mortality among taxi and ambulance drivers: population based cross sectional study

Vishal R Patel et al. BMJ. .

Abstract

Objective: To analyze mortality attributed to Alzheimer's disease among taxi drivers and ambulance drivers, occupations that demand frequent spatial and navigational processing, compared with other occupations.

Design: Population based cross-sectional study.

Setting: Use of death certificates from the National Vital Statistics System in the United States, which were linked to occupation, 1 January 2020-31 December 2022.

Participants: Deceased adults aged 18 years and older.

Main outcomes measures: Among 443 occupations studied, percentage of deaths attributed to Alzheimer's disease for taxi drivers and ambulance drivers and each of the remaining 441 occupations, adjusting for age at death and other sociodemographic factors.

Results: Of 8 972 221 people who had died with occupational information, 3.88% (348 328) had Alzheimer's disease listed as a cause of death. Among taxi drivers, 1.03% (171/16 658) died from Alzheimer's disease, while among ambulance drivers, the rate was 0.74% (10/1348). After adjustment, ambulance drivers (0.91% (95% confidence interval 0.35% to 1.48%)) and taxi drivers (1.03% (0.87% to 1.18%)) had the lowest proportion of deaths due to Alzheimer's disease of all occupations examined. This trend was not observed in other transportation related jobs that are less reliant on real time spatial and navigational processing or for other types of dementia. Results were consistent whether Alzheimer's disease was recorded as an underlying or contributing cause of death.

Conclusions: Taxi drivers and ambulance drivers, occupations involving frequent navigational and spatial processing, had the lowest proportions of deaths attributed to Alzheimer's disease of all occupations.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: funding to CMW by the Agency for Healthcare Research and Quality; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. ABJ reports receiving (in the past 36 months) consulting fees unrelated to this work from Analysis Group. ABJ also reports receiving (in the past 36 months) income unrelated to this work from hosting the podcast Freakonomics, MD, from book rights to Doubleday Books, and authorship income from The New York Times, The Wall Street Journal, and Los Angeles Times. CMW reports receiving (in the past 36 months) consulting fees unrelated to this work from Alosa Health, Analysis Group, Atheneum, Berkshire Hathaway Home Companies, Chronius, FVC Health, GLG, Guidepoint, NuvoAir, Ogilvy, Philips, Simbo, Substack, Tell Health, The New York Times, and The Wall Street Journal, and income unrelated to this book from book rights to Doubleday Books.

Figures

Fig 1
Fig 1
Mortality from Alzheimer’s disease among ambulance drivers, taxi drivers, and other occupations. Risk adjusted percentages and mortality odds ratios were adjusted for age at death, sex, race, ethnic group, and educational attainment using logistic regression. In the bottom graph, a logarithmic scale was used for the y axis to allow for accurate visual comparison of effect sizes between occupations, as the logarithmic scale equalizes the distances between ratios and their reciprocals. Adjusted odds ratios were calculated using chief executives (US Census Bureau occupation code 0010) as an arbitrary reference group
Fig 2
Fig 2
Mortality from Alzheimer’s disease as underlying or contributing cause of death by occupation. Risk adjusted mortality odds ratios were adjusted for age at death, sex, race, ethnic group, and educational attainment using logistic regression A logarithmic scale was used for the y axis to allow for accurate visual comparison of effect sizes between occupations, as the logarithmic scale equalizes the distances between ratios and their reciprocals. Adjusted odds ratios were calculated using chief executives (US Census Bureau occupation code 0010) as an arbitrary reference group
Fig 3
Fig 3
Mortality from Alzheimer’s disease among bus drivers, aircraft pilots, ship captains, and other occupations. Risk-adjusted percentages and mortality odds ratios were adjusted for age at death, sex, race, ethnicity, and educational attainment using logistic regression. In the bottom graph, a logarithmic scale was used for the y axis to allow for accurate visual comparison of effect sizes between occupations, as the logarithmic scale equalizes the distances between ratios and their reciprocals. Adjusted odds ratios were calculated using chief executives (US Census Bureau occupation code 0010) as an arbitrary reference group
Fig 4
Fig 4
Mortality from other forms of dementia among ambulance drivers, taxi drivers, and other occupations. Risk-adjusted mortality odds ratios were adjusted for age at death, sex, race, ethnicity, and educational attainment using logistic regression A logarithmic scale was used for the y axis to allow for accurate visual comparison of effect sizes between occupations, as the logarithmic scale equalizes the distances between ratios and their reciprocals. Adjusted odds ratios were calculated using chief executives (US Census Bureau occupation code 0010) as an arbitrary reference group
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