Attributes of hypertension among industrial workers in Northern India - An alarming signal

ABSTRACT

Context:

There has been an increasing prevalence of hypertension (HTN) affecting all populations of the world including the special occupational groups and industries workers.

Aims:

To estimate the prevalence of hypertension and to determine the associated factors among industrial workers in the Haryana state of India.

Settings and Design:

A cross-sectional study was conducted among 323 industrial workers of Faridabad, Haryana.

Materials and Methods:

A semi-structured and validated questionnaire was used to collect information regarding sociodemographic characteristics of the workers, their personal habits, and occupational history. The investigator also recorded the height, weight, blood pressure, blood glucose, and lipid profile of the workers.

Statistical Analysis Used:

Analysis of the data was done using SPSS Vs 21.

Results:

The prevalence of hypertension among industrial workers was 48.6%. Age of the worker, presence of smoking or alcohol consumption, having a longer duration of employment, and having deranged total cholesterol/TG/LDL-C levels, diabetes, or obesity were found to be independently associated with hypertension.

Conclusion:

Screening is required for early detection and prevention of complications. Lifestyle modification is of utmost importance. Employers should implement guidelines issued by the government to protect the health of the productive population.

Introduction

Hypertension is reported to be the major cause of cardiovascular disease and deaths worldwide, especially in low-income and middle-income countries accounting for 10.8 million cardiovascular (CV) deaths and 11.3 million deaths overall in 2021.[1] In 2019, around 1.28 billion adults aged between 30 and 79 years are estimated to be affected by hypertension worldwide.[2,3,4] The prevalence of hypertension in adult Indians is estimated to be 30%.[5,6,7] The all-cause disability adjusted life years (DALYs) due to high blood pressure were 2,770 per 100,000 people.[1] The burden of hypertension is alarmingly rising posing imminent risk for an epidemic of noncommunicable diseases.

In recent decades, most Asian-African countries including India have been undergoing an epidemiological transition which manifested by the early emergence of hypertension in the young age group.[6,8] Moreover, industrial workers are exposed to various hazards in industries that might result in different ailments, enhancing their preponderance for developing hypertension.[9,10] Specifically, factors such as work-related stress, noise pollution, alcohol consumption, tobacco smoking, and long duration of employment contribute to the development of hypertension among the workers.[9,11] This chronic debilitation might make workers less productive, more prone to injury that leads to significant suffering, and add huge financial and service challenges to healthcare systems.[12,13] Furthermore, it is witnessed that collective monetary losses related to hypertension and diabetes mellitus in low-income and middle-income countries are estimated to be more than $7 trillion during the years 2011-2025 that moving millions of individuals below the poverty line.[14]

There is a dire need to focus on strict enforcement of the existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases, especially hypertension.[15] Even if various risk factors of hypertension have been identified through numerous studies, most of the studies are population-based.[16,17,18] The burden of hypertension in industrial workers comprising the major chunk of the productive workforce in the country has been neglected as a whole with poor availability of workplace data. Therefore, the objective of this study was to estimate the prevalence of hypertension and to determine the associated factors among industrial workers in the Haryana state of India.

Materials and Methods

Study design, setting and duration

A cross-sectional study was conducted among industrial workers of Faridabad, Haryana for a period of 3 months.

Inclusion and exclusion criteria

All those workers who were aged >18 years and consented to the study were included.

Sample size and sampling technique

Taking prevalence of hypertension among industrial workers as 26%,[19] z statistic at 95% level of confidence as 1.96, and allowable error of 5 the sample size was calculated to be 294. Taking 10% nonresponse, the final sample size was calculated as approximately 323.

Ten industries were randomly selected from the available list of industries (Regional Office, Faridabad, Haryana). The selected industries were then visited and, all workers fulfilling the selection criteria were enrolled for the study till the attainment of the desired sample size.

Data collection and analysis

Data collection was done by interview method using a structured questionnaire. The tool collected information regarding the sociodemographic characteristics of the workers, occupational history, addictions, general physical examination including blood pressure, anthropometry, and blood investigations including lipid profile and RBS, etc., The diagnosis of hypertension, diabetes, and dyslipidemia was made based on the standard guidelines.[20,21,22]

Blood pressure (BP)

Blood pressure of the study participants was measured with a calibrated aneroid sphygmomanometer, using the appropriate cuff size in a sitting position in the left arm. Three blood pressure measurements were taken and the mean of the three readings was calculated. Subjects with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg along with previously diagnosed hypertension and the ones taking antihypertensive drugs were considered hypertensive.

Blood glucose

Capillary blood was drawn using an aseptic procedure. Subjects with random blood glucose ≥200 mg/dL were considered diabetic.

Analysis of the data was done using SPSS Vs 21. Data were presented as percentages, means, and standard deviations. Univariate and multivariate logistic regression analyses were used to determine relationships among variables. P value of <.05 was taken as significant.

Ethical approval was obtained from the Institutional Ethics Committee vide EC file no: 1f1734 X/11/13/2022-IEC-44 dated September 1, 2022.

Result

The present study was conducted among adult industrial workers employed in manufacturing factory settings in Haryana.

Forty two percent of the study participants were in the younger age group (18-29 years). The majority (83.9%) of them were males. About one-fifth of the participants were illiterate or had a primary level of educational qualification. Smoking and alcohol consumption were reported in about 30% and 36% of the participants, respectively [Table 1].

Table 1.

Sociodemographic profile of the study participants (n=323)

Variable	Frequency (n)	Percentage
Age group
18-29	135	41.9%
30-39	67	20.7%
40-49	67	20.7%
50 and more	54	16.7%
Sex
Male	271	83.9%
Female	51	16.1%
Education
Illiterate	26	8.1%
Primary	33	10.4%
High school	83	25.8%
Intermediate	77	23.9%
Graduate and above	103	31.9%
Smoking
Yes	97	30.0%
No	196	60.7%
Ex	29	8.9%
Alcohol
Yes	116	36.0%
No	190	60.0%
Ex	16	5.0%

Occupational history revealed that the majority of the participants were workers (74.9%) by designation. Approximately three-fourths of the participants were employed for more than a year (72%) and had less than equal to eight hours of shift daily (77.6%) [Table 2].

Table 2.

Work-related characteristics of study participants (n=323)

Variable	Frequency (n)	Percentage
Designation
Worker	242	74.9%
Supervisor	49	15.2%
Manager	32	9.9%
Duration of employment
≤12 months	89	27.8%
>12 months	233	72.2%
Duration of daily shifts
≤8 h	250	77.6%
>8 h	72	22.4%

The prevalence of hypertension among the study participants was 48.6%. The reported lipid profile of the study participants was deranged cholesterol (29.1%), deranged triglycerides (44.9%), deranged HDL-C (28.4%), deranged LDL-C (47.3%), and deranged VLDL (29.0%). Impaired glucose tolerance and diabetes were reported in 3.4% and 10.5% of the participants. On anthropometry, about one-third (31.8%) of the participants were obese [Figure 1].

Figure 1.

Distribution participants on the basis of laboratory, anthropometry, and physiological parameters (n = 323)

The factors found independently associated with hypertension were age more than 40 years (adjusted odds ratio [AOR] 2.24 [95% confidence interval {CI}: 1.05-5.33]), employment on lower designations, that is, workers (AOR 1.32 [95% CI: 1.01-4.10]), having longer service duration, that is, >12 months (AOR 4.87 [95% CI: 1.17-13.51]), smoking (AOR 3.98 [95% CI: 2.08-7.60]), alcohol consumption (AOR 4.26 [95% CI: 1.35-16.94]), having high total cholesterol levels (AOR 6.64 [95% CI: 2.45-14.66]), high TGs (AOR 4.99 [95% CI: 1.46-10.52]), high LDL-C levels (AOR 5.14 [95% CI: 3.62-21.36]), impaired glucose/diabetic status (AOR 3.43 [95% CI: 1.76-13.11]), and having obesity (AOR 4.70 [95% CI: 1.20-16.96]) [Table 3].

Table 3.

Univariate and multivariate logistic regression for attributes of hypertension in study participants (n=323)

Variable	Unadjusted odds ratio [95% CI]	Adjusted odds ratio [95% CI]
Age group
18-39	Reference
40 and more	2.13 (1.06-4.99)	2.24 (1.05-5.33)
Sex
Male	1.70 (0.08-6.93)	-
Female	Reference
Education
Illiterate	Reference
Literate	0.54 (0.45-1.22)	-
Designation
Worker	Reference
Supervisor/Manager	1.73 (1.11-4.19)	1.32 (1.01-4.10)
Smoking
Yes	3.20 (2.33-6.62)	3.98 (2.08-7.60)
No	Reference
Alcohol
Yes	5.84 (1.27-20.02)	4.26 (1.35-16.94)
No	Reference
Duration of employment
≤12 months	Reference
>12 months	7.78 (1.31-19.01)	4.87 (1.17-13.51)
Duration of daily shifts
≤8 h	Reference
>8 h	2.39 (0.77-4.7)	-
Deranged Total Cholesterol
Yes	3.26 (1.82-10.8)	6.64 (2.45-14.66)
No	Reference
Deranged TG
Yes	2.41 (1.43-13.5)	4.99 (1.46-10.52)
No	Reference
Deranged HDL-C
Yes	2.85 (0.04-6.66)	-
No	Reference
Deranged LDL-C
Yes	2.9 (1.80-11.87)	5.14 (3.62-21.36)
No	Reference
Deranged VLDL
Yes	2.04 (0.83-6.91)	-
No	Reference
DM/Impaired glucose tolerance
Yes	4.52 (1.6-15.38)	3.43 (1.76-13.11)
No	Reference
Obesity
Yes	7.47 (4.48-18.17)	4.70 (1.20-16.96)
No	Reference

Discussion

The present study reported a high prevalence of hypertension in industrial workers. Similar findings have been reported in a study done by Bosu WK among workers in West Africa.[23] The findings were much higher than various other studies done globally with prevalence of HTN ranging from 24.7%-31.1%.[24] However, in a study done by Shittu et al., prevalence was much higher (77.4%) than the present study.[25] Only a few studies have been conducted in industrial settings in India. The high prevalence of hypertension reported in the present study may be due to the type of industry selected, as workers in manufacturing industries are under constant stress to achieve production targets. Furthermore, most of the employees in manufacturing industries experience occupational heat, sound, or vibration stress.

Factors found independently associated with hypertension were the age of the worker above 40 years, personal habits including smoking and alcohol consumption, prolonged duration of employment, having deranged cholesterol/TG/LDL-C levels, diabetes, and obesity.

The odds of having hypertension were about 2.5 times higher in workers of >40 years’ age group as compared to those in 18-39 years’ age group. This is comparable to researches done worldwide.[23,26]

Similar to the findings of the present study, Prajapati et al.[27] reported the association between hypertension and education level as nonsignificant. However, significant association have been reported in a study done in Rajasthan.[24] This difference in the prevalence of HTN with educational status may be due to education affecting the level of awareness about HTN and ultimately affecting their general attitude toward lifestyle modifications and health-seeking behavior.

The prevalence was higher among workers employed on lower designations than those having supervisory job profile, and this association was statistically significant. Higher prevalence of HTN could be attributed to increased workload and responsibilities leading to stress. Bosu WK[23] and Gamage et al. also observed a positive correlation between work stress and hypertension among workers.[28] A significant association was also observed between the duration of service and the prevalence of HTN.

Hypertension was significantly more frequent in alcohol consumers than in abstainers and smokers than nonsmokers. Similar findings were observed by Bosu WK.[23]

Deranged total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL levels were observed in 29.1%, 44.9%, 28.4%, 47.3%, and 29.0% of study subjects, respectively.[16,29] In the present study, the findings of elevated total cholesterol are consistent with that reported in Africa, 25.5%,[8] Venezuela, 22.2%,[30] and Nigeria, 23%[31] The reported triglycerides levels were higher than the findings reported in other studies conducted in Africa, 17%,[8] India, 27%,[29] Venezuela, 39.7%,[30] Nigeria, 5%,[31] Mekelle, 40.2%,[32] Ethiopia, 21%,[33] China, 22.5%,[34] and Saudi Arabia, 44%.[35] The observed HDL-C levels were higher than the findings reported in Mekelle, 16.5%,[32] China, 20.8%,[34] Togo, 16.4%,[36] and lower than the findings from India, 62%,[29] and Ethiopia, 68.7%.[33] Similarly, levels of LDL-C were found higher than the study findings reported in Africa, 21.4%,[8] Ethiopia, 21%,[18] India, 15.8%,[29] Venezuela, 23.3%,[30] and China, 8.3%.[34] The odds of having hypertension were significantly higher in those with any lipid derangements and the findings are coherent with various other studies.[16,17,29] The high prevalence of dyslipidemia among these workers could be due to work-related stress and faulty lifestyle.

The odds of being hypertensive were higher in diabetics (AOR 3.43 95% CI 1.76-13.11) and among obese (AOR 4.70 95% CI 1.20-16.96). Similar findings were reported in a study conducted in Dakar (OR 3.9, 95% CI 2.2-6.9).[23]

The present study had certain limitations. As the study was cross-sectional in nature, it may not show the causal relationship between hypertension and the assessed factors. Moreover, hypertension is a multifactorial disease and all the confounders were not addressed, which limits the generalizability of the study findings.

Conclusion and Recommendations

The present study revealed a high prevalence of hypertension among industrial workers employed in the manufacturing industries of Haryana. Several modifiable risk factors such as smoking, alcohol consumption, work stress related to higher designation and longer duration of employment, and comorbidities like deranged total cholesterol/TG/LDL-C levels, diabetes, and obesity were significantly associated with hypertension. Old age was the only nonmodifiable risk factor having a significant association.

Measures to reduce mean blood pressure should include worksite strategies to reduce workplace stress and enhance awareness about cardiovascular health. Regular screening for timely detection and appropriate management is needed along with effective promotion of a healthy lifestyle. Furthermore, research with prospective study designs is needed to assess the temporal association.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.