title: Health assessment of commercial drivers: a meta-narrative systematic review.
abstract: BACKGROUND
  Motor vehicle accidents associated with commercial driving are an important cause of occupational death and impact public safety.
  
  
  OBJECTIVE
  We summarise the evidence regarding the type, prevalence and impact of medical conditions discovered during health assessment of commercial drivers.
  
  
  METHODS
  We conducted a systematic review of multiple electronic databases and made a manual search for relevant studies that enrolled commercial drivers in any country and reported the outcomes of health assessment carried out in the context of commercial driving through November 2012. Data were extracted by a pair of independent reviewers and synthesised using a metanarrative approach.
  
  
  RESULTS
  We identified 32 studies of moderate methodological quality enrolling 151 644 commercial drivers (98% men). The prevalence of multiple health conditions was high (sleep disorders 19%, diabetes 33%, hypertension 23% and obesity 45%). Some conditions, such as sleep disorders and obesity, were linked to increased risk of crashes. Evidence on several other highly relevant medical conditions was lacking. Cost-effectiveness data were sparse.
  
  
  CONCLUSIONS
  Several medical conditions are highly prevalent in commercial drivers and can be associated with increased risk of crashes, thus providing a rationale for health assessment of commercial drivers.
authors.affiliation: Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Abd Moain
authors.initials: AM
authors.lastname: Abu Dabrh
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.forename: Clayton T
authors.initials: CT
authors.lastname: Cowl
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Steinkraus
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000063:Accidents, Traffic; D001334:Automobile Driving; D002908:Chronic Disease / Q000453:epidemiology; D003132:Commerce; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010809:Physical Fitness; D012449:Safety; D012893:Sleep Wake Disorders / Q000150:complications / Q000453:epidemiology
keywords: Occupational & Industrial Medicine; Preventive Medicine; Qualitative Research