Hired taxi businesses had 1.761 times greater risk of fractures than businesses in the railroad and track industry, even after adjusting for age. In addition, the airline industry, general cargo transportation, bus lines, and other road freight forwarding businesses were not significantly different from the railroad and track industry.
Taxi driving is one of the predominantly male occupations in Japan, with a high proportion of older workers. It is well known that male workers are at higher risk of occupational injuries (Varacallo and Knoblauch 2019). Previous research has found that taxi drivers are at risk of various health concerns, such as back pain (Pickard et al. 2022), knee pain, hypertension, fatigue, and sleep disorders (Muray et al. 2019). In Japan, there have been many reports of coronary heart disease among taxi drivers for a long time (Uehata et al. 1985; Hattori 1988; Ueda et al. 1989). These concerns are associated with limited physical activity, highly sedentary work, and poor nutrition. The low socioeconomic status of taxi drivers also contributes to a high number of health problems (Bawa and Srivastav 2013). A recent study reported that taxi driving is characterized by poor eating habits, ongoing stress from driving, exposure to various health hazards, such as air pollution, and lack of physical activity (Kurosaka et al. 2000). These various health hazards of taxi drivers might be associated with the susceptible to falls and bone fragility. A recent study found that lifestyle factors, such as fewer sleeping hours, smoking many cigarettes every day, consumption of alcohol and sugar-sweetened beverages, consuming a lot of street food, and being sedentary, impacted the metabolic health of minibus taxi drivers (Mabetwa et al. 2022). These factors may also be associated with bone diseases, such as osteoporosis.
To prevent falls, individual worker factors (age, balance, strength, pharmacology, tiredness, eyesight, etc.) and work environment factors (state of floors, light, icy roads, etc.) should be considered. The findings of a recent study indicated that older workers are likely to suffer from severe accidents, slips, and fall-related injuries. Therefore, interventions focusing on reducing slips and falls among older workers are necessary (Peng and Chan 2019). Gillespie et al. (2012) summarized interventions for preventing falls among older people and indicated that exercise programs (e.g., Tai Chi) could reduce the rate of falls (Gillespie et al. 2012).
Falls result in hazardous injuries and this is especially exacerbated in unfamiliar surroundings. Unlike other transport workers, taxi drivers must travel to unfamiliar environments at the request of their customers. Our finding of a greater likelihood of serious injury from outdoor falls on hard surfaces, such as roads has been reported by others. It may be useful to incorporate a warning about the possible increased risk of unfamiliar surroundings in public health messages.
There are reports that professional drivers are affected by the health effects of air pollution (dust, volatile organic substances, nitrogen oxides, sulfur oxides, polycyclic aromatic hydrocarbons, heavy metals, dioxins, furans, etc.) (Kozłowska et al. 2019). Previous research has indicated that exposure to environmental air pollution increases the risk of cardiovascular diseases and lung cancer (Burgaz et al. 2002). A recent study reported that chronic occupational exposure to atmospheric pollution by taxi drivers could be an additional contributor to atherogenesis, leading to impaired vascular health (Brucker et al. 2014). Professional drivers spend many hours daily inside a car and are exposed to vehicle exhaust, which significantly induces cytogenetic damage to the peripheral lymphocytes of taxi drivers (Brucker et al. 2014).
Much evidence has been reported in recent years regarding air pollution, osteoporosis, and bone fractures. (Zhang et al. 2022; Pang et al. 2021; Mousavibaygei et al. 2023; Shin et al. 2021; Yu et al. 2023; Yang et al. 2023; Nguyen 2017; Prada et al. 2017; Lin et al. 2020). Taxi driving is one of the occupations that involves frequently working on the roadside or on the road, and therefore, it poses a high risk of air pollution. Therefore, it is necessary to tailor occupational safety interventions for each occupational group.
There are three limitations in this study. First, although we observed a statistically significant high risks of fracture occurrence in taxi driver industry, without direct measurements on more specific physical and environmental exposures, the contribution of any individual exposure cannot be ascertained. Second, there may be fractures that were not explicitly mentioned during the creation of the national database. Finally, gender was not included in the national database.