Abstract
Hypertension is a risk factor for cardiovascular disease, which is the leading cause of death in the United States. Taxi and for‐hire vehicle (FHV) drivers, a largely male, immigrant and medically underserved population, are at increased risk of cardiovascular disease, in part due to the nature of their work. This study examined demographic and lifestyle predictors of hypertension diagnosis awareness, objectively measured blood pressure (hypertensive‐range vs non‐hypertensive‐range readings), medication use, and hypertension control. A cross‐sectional assessment was conducted with 983 male taxi/FHV drivers who attended health fairs in New York City from 2010 to 2017. Twenty‐three percent self‐reported a hypertension history and 46% had hypertensive‐range BP readings. Approximately, half the drivers lacked health insurance (47%) and a usual care source (46%). Thirty percent did not self‐report hypertension and had hypertensive‐range BP readings. Medication use was reported by 69% of hypertension‐aware drivers, and being older and having health care access (insurance, a usual care source, and seeing a doctor in the past year) was significantly associated with medication use. Hypertension‐unaware drivers with hypertensive‐range BP readings were less likely to have a usual care source. Over 60% of drivers who were hypertension‐aware and on medication had hypertensive‐range readings. There is a need for community‐based and workplace driver and provider interventions to address BP awareness and management and to provide health care navigation for vulnerable populations such as taxi/FHV vehicle drivers.
Keywords: blood pressure, hypertension awareness, immigrant population, taxi drivers
1. INTRODUCTION
Uncontrolled hypertension may be worse for certain occupational groups, including taxi and for‐hire vehicle (FHV) drivers. In 2015, one in three US adults had hypertension, 1 based on hypertensive values at systolic blood pressure (SBP) >140 mm Hg and/or diastolic blood pressure (DBP) 90 mm Hg. 2 Approximately, 50% (35 million) of those with hypertension had uncontrolled hypertension. 1 The 2017 American College of Cardiologists/American Heart Association guidelines lowered the hypertensive‐range values such that hypertensive‐range blood pressure (BP) starts at SBP 130 mm Hg or DBP 80 mm Hg; the prehypertensive range is now SBP 120‐129 mm Hg and DBP <80 mm Hg. 3 , 4 Hypertension is a major risk factor for stroke, coronary artery disease, and renal failure, among other conditions. 5 The Centers for Disease Control and Prevention (CDC) estimate that 33% of people with uncontrolled hypertension may be unaware of their condition. 1 In one study, 20% of participants self‐reported hypertension yet biometric measurements revealed 35% of all participants had hypertensive values. 6
Health insurance and health care access are significantly associated with hypertension awareness; 30% of hypertensive adults without insurance were hypertension‐unaware compared with 14% of those with insurance; more health visits over the past year were associated with a lower percentage of hypertension‐unaware adults. 7 As independent contractors, US taxi/FHV drivers have low rates of insurance and health care access, documented in New York City (NYC), 8 , 9 Chicago, 10 Los Angeles, 11 and San Francisco. 12
Cardiovascular disease (CVD) is the leading cause of death among US men. 13 Taxi/FHV drivers, predominantly male and immigrant, may be at higher CVD risk due to lifestyle and health behaviors, including poor nutrition and physical activity, 10 , 12 , 14 and to air pollutant exposure. 15 , 16 NYC has over 185 000 taxi/FHV licensed drivers (96% men, over 91% born outside the United States). 17 Immigrants are also at increased risk of undiagnosed and uncontrolled hypertension, even when accounting for age, gender, income, education, and insurance status. 18
Self‐reported hypertension rates among taxi/FHV drivers range from 15% to 38%, 12 , 15 , 19 , 20 but the diagnosis may be underreported. Over 50% of NYC drivers screened at health fairs had hypertensive‐range readings, 8 , 21 and over 45% reported no hypertension history yet had hypertensive‐range readings. 20 , 21 Even among those aware of a hypertension diagnosis, uncontrolled BP may persist, due to lifestyle, economic, and adherence factors 22 , 23 , 24 ; drivers frequently report limited physical activity, poor nutrition, and lack of sleep. 10 , 14 , 25 , 26
Drivers' limited BP status awareness and their health behaviors present potentially surmountable barriers to hypertension control, with dire consequences if left unattended. This study examines the hypertension diagnosis awareness, hypertension control, and medication use predictors among taxi/FHV drivers attending community health fairs. Results can contribute to the design of programs and policy recommendations to increase hypertension awareness and management among large, immigrant, male, mobile, and/or marginalized populations, such as taxi/FHV drivers.
2. METHODS
2.1. Study design
A cross‐sectional analysis was conducted with taxi/FHV drivers participating in health fairs, which included an intake assessment; biometric screenings: resting BP (participants were asked to rest for at least 5 minutes before a measurement was taken), glucose, cholesterol, height and weight; health education; and health care access navigation. This protocol was determined to be exempt research by the Center's Institutional Review Board/Privacy Board.
2.2. Recruitment and participants
Health fairs (n = 220) were conducted from December 2010 through November 2017 at community sites, taxi garages, airport holding lots, and app‐based driver centers. Inclusion criteria for the current analysis: male, aged 18 or older, licensed taxi/FHV driver, responded to a query on high BP/hypertension history, and participated in at least one health fair BP measurement.
2.3. Measures
Sociodemographic and occupational variables were captured (Table 1). Medical history questions included high BP/hypertension history and current BP medication usage. Participants were asked about health insurance and a usual care source and how long it had been since they last saw a doctor or had a routine check‐up.
TABLE 1.
Sociodemographic and health care access demographics
| Characteristic | N (%) a , a /µ (SD) b , b |
|---|---|
| Years of age (n = 978) |
47 (11) Range: 19.89‐76.69 |
| Birth region (n = 974) | |
| East Asia/Tibet/Southeast Asia | 15 (2%) |
| Latin America | 118 (12%) |
| North Africa/Middle East | 57 (6%) |
| South Asia | 235 (24%) |
| Sub‐Saharan Africa | 482 (50%) |
| Other c , c | 67 (7%) |
| Education (n = 890) | |
| None through primary | 86 (10%) |
| Secondary completed | 231 (26%) |
| Some college | 211 (24%) |
| College completed or more | 362 (41%) |
| Length of time in United States (n = 935) | |
| ≤2 y | 23 (2%) |
| 3‐9 y | 191 (20%) |
| 10‐15 y | 195 (21%) |
| ≥16 y | 526 (56%) |
| English proficiency: speak (n = 917) d , * | |
| Very well | 454 (50%) |
| Well/not well/not at all | 463 (50%) |
| English proficiency: understand (n = 879) d , * | |
| Very well | 431 (49%) |
| Well/not well/not at all | 448 (51%) |
| English proficiency: read (n = 879) | |
| Very well | 422 (48%) |
| Well/not well/not at all | 457 (52%) |
| Driver type (n = 713) | |
| Taxi drivers | 683 (96%) |
| For‐hire vehicle (FHV) drivers | 30 (4%) |
| Driving shift (n = 774) | |
| Day | 342 (44%) |
| Night | 337 (44%) |
| Varies | 95 (12%) |
| Hours driven per week (n = 628) |
55 (14) Range: 12‐105 |
| Usual care source (n = 973) | |
| Yes | 528 (54%) |
| Last time doctor seen (n = 947) | |
| Never | 55 (6%) |
| Within past year | 512 (54%) |
| Within past 2 y | 180 (19%) |
| Greater than 2 y | 200 (21%) |
| Health insurance (n = 964) | |
| Yes | 507 (53%) |
Percentages may not add to 100% due to rounding.
µ (SD): Mean and standard deviation for continuous variable.
Other: Bulgaria, Croatia, France, Georgia, Greece, Grenada, Guyana, Jamaica, Kazakhstan, Russia, Slovakia, Tajikistan, Trinidad & Tobago, Ukraine, United States.
To be considered English proficient, a response of “very well” for speaking English is required; we applied this standard across the three dimensions.
Health fairs conducted prior to February 2015 collected one BP reading; the protocol was later altered to include three readings. For consistency, we used the first BP reading as the outcome variable for these analyses. There was no significant difference between the first and averaged (second and third) BP readings in the sample. Drivers' SBP and DBP readings were obtained using a Welch Allyn ProBP 3400 Digital Blood Pressure device. Participants were classified into two BP reading categories, according to the guidelines at the time of the study 2 : consistent with normal/prehypertensive‐range BP, SBP ≤139 mm Hg and DBP ≤89 mm Hg, and consistent with hypertensive‐range BP (Stage 1/Stage 2), SBP ≥140 mm Hg and/or DBP ≥90 mm Hg.
An outcome variable was created comprised of four potential categories of self‐reported hypertension history and BP readings: (1) no self‐reported hypertension and SBP ≥140 mm Hg and/or DBP ≥90 mm Hg (unaware, hypertensive‐range reading), (2) self‐reported hypertension and SBP ≥140 mm Hg and/or DBP ≥90 mm Hg (aware, hypertensive‐range reading), (3) self‐reported hypertension and SBP ≤139 mm Hg and DBP ≤89 mm Hg (aware, non‐hypertensive‐range reading), and (4) no self‐reported hypertension and SBP ≤139 mm Hg SBP and DBP ≤89 mm Hg (normal).
2.4. Data analyses
Bivariate analyses were conducted to determine major covariate associations (ie, age, birth region, education, years in the United States, English proficiency, driver shift, hours driven per week, health insurance coverage, usual care source status, and last doctor visit) with the outcome variable (ie, self‐reported hypertension and non‐hypertensive‐range or hypertensive‐range BP readings). Statistically significant covariates were included in the multivariate model. Correlates associated with BP history and measured BP values were identified using a multinomial logistic regression; the hypertension not reported and SBP ≤139 mm Hg, and DBP ≤89 mm Hg (normal) category was chosen as the reference. The model was adjusted for covariates and checked for multicollinearity using Durbin‐Watson tests for autocorrelation. Missing values were excluded. All statistical associations were evaluated at a significance level of 0.05 (2‐sided type I error rate). Analyses were conducted using IBM SPSS Statistics 25 and R statistical software 3.5.2.
3. RESULTS
There were 2059 total health fair attendees, 2015 were male, and 983 underwent a BP reading and reported their hypertension history and were included in the analyses (Figure 1). The mean age was 47 years (SD = 11) (Table 1). Birth regions included the following: Sub‐Saharan Africa (50%), South Asia (24%), and Latin America (12%). Most drivers had completed secondary school or higher education (90%) and reported living in the United States for 10 or more years (77%). Half of the drivers spoke English “very well,” 49% understood English “very well,” and 48% read English “very well.” Forty‐four percent of drivers drove the night shift, and 12% worked varied shifts (day and/or night). On average, drivers worked 55 hours per week (SD = 14). Nearly half the drivers lacked health insurance (47%), 46% lacked a usual care source, and 54% had seen a doctor within the past year (54%). Additionally, among driver type, for‐hire vehicle (FHV) (n = 30) drivers were significantly less educated, less proficient in reading English, and less proficient in understanding English compared with taxi drivers (n = 683). Driver type was unavailable for the remaining participants. Due to the disproportionate driver type samples sizes, further analysis was conducted with all the drivers as one sample.
FIGURE 1.
Profile of blood pressure status, hypertension history, and health access. Note: HTN = hypertension. *226 was reported in overall calculations; 218 responded to medication use
Almost half of the sample had hypertensive‐range readings (46%; Figure 1). Drivers with hypertensive‐range BP readings (n = 456), compared to those with non‐hypertensive‐range BP readings (n = 527), were significantly on average older (50 years vs 44 years), more likely to be from Sub‐Saharan Africa (53% vs 47%), less likely to be from South Asia (20% vs 28%), and more likely to have lived in the United States for 16 years or more (64% vs 49%). Average systolic and diastolic blood pressure was not significantly associated with hours driven per week. Approximately one quarter (23%) of drivers self‐reported a hypertension history. Examining the four drivers’ self‐reported hypertension/BP reading categories, we found that: (1) 30% did not self‐report hypertension and had hypertensive‐range BP readings, (2) 16% self‐reported hypertension and had hypertensive‐range BP readings, (3) 7% self‐reported hypertension and had non‐ hypertensive‐range BP readings, and (4) 47% did not self‐report hypertension and had non‐hypertensive‐range BP readings.
The vast majority (73%) of hypertension‐aware drivers were significantly more likely to have seen their doctor within the past year. Awareness of hypertension was not significantly associated with education level. Furthermore, among hypertension‐aware drivers (n = 226), 69% reported BP medication use. Being older, having health insurance, having a usual care source, and seeing a doctor in the past year were significantly associated with medication use. Among the 156 hypertension‐aware drivers on medication, 67% (n = 104) had hypertensive‐range readings, and birth region was associated with hypertensive‐range readings: 80% of 55 Sub‐Saharan African, 71% of 31 Latin American, 51% of 49 South Asian drivers had hypertensive‐range readings.
To identify the sociodemographic and health care access variables that significantly predicted being in one of the two at‐risk categories: (1) hypertension‐unaware, hypertensive‐range reading, or (2) hypertension‐aware, hypertensive‐range reading, we conducted bivariate analyses and multivariate multinomial logistic regressions (Table 2). Bivariate associations showed that Category (1) hypertension‐unaware, hypertensive‐range reading was positively associated with older age; drivers in this category were more likely to be from other regions than from North Africa/Middle East or South Asia, less likely to be insured, and less likely to have a usual care source (Table 2). Category (2) hypertension‐aware, hypertensive‐range reading was also positively associated with older age; drivers in this category were more likely to have a usual care source, and more likely to work the day shift compared with the night shift. Among the two categories with hypertensive‐range readings, hypertension‐unaware drivers (Category 1) had lower rates of insurance (45%) and of having a usual care source (42%) than hypertension‐aware drivers (Category 2; 58% insured, 70% usual care source). Both groups had lower rates of health care coverage than hypertension‐aware drivers with non‐hypertensive‐range readings (Category 3; 66% insured, 82% usual care source).
TABLE 2.
Multinomial logistic regression analysis for self‐reported hypertension awareness and measured pressure a , a
| (1) Hypertension‐unaware/hypertensive‐range BP readings b , b (n = 297) | (2) Hypertension‐aware/hypertensive‐range BP readings b , b (n = 159) | (3) Hypertension‐aware/non‐hypertensive‐range BP readings b , b (n = 67) | (4) Hypertension not reported/non‐hypertensive‐range BP readings (n = 460) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
N (%) µ (SD) |
Bivariate OR (95% CI) | Multivariate OR (95% CI) |
N (%) µ (SD) |
Bivariate OR (95% CI) | Multivariate OR (95% CI) |
N (%) µ (SD) |
Bivariate OR (95% CI) | Multivariate OR (95% CI) |
N (%) µ (SD) |
|
| Age | 48 (11) | 1.69 (1.44‐1.98) *** | 1.94 (1.59‐2.38) *** | 53 (10) | 2.88 (2.32‐3.58) *** | 2.81 (2.16‐3.65) *** | 51 (10) | 2.39 (1.79‐3.19) *** | 2.77 (1.93‐3.99) *** | 43 (11) |
| Region (Ref: Other) | ||||||||||
| East Asia/Tibet/SE Asia c , c | 6 (2%) | 1.35 (0.36‐4.99) | 1.19 (0.26‐5.45) | 4 (3%) | 2.16 (0.48‐9.70) | 3.68 (0.62‐22.04) | 0 (0%) | 0 (0.00‐Inf) | 0 (0.00‐0.00) *** | 5 (1%) |
| Latin America | 33 (11%) | 0.83 (0.41‐1.68) | 0.47 (0.21‐1.03) | 29 (18%) | 1.74 (0.73‐4.12) | 1.18 (0.45‐3.12) | 11 (17%) | 1.1 (0.36‐3.32) | 0.68 (0.19‐2.45) | 45 (10%) |
| North Africa/Middle East | 11 (4%) | 0.36 (0.15‐0.87) d , * | 0.46 (0.18‐1.16) | 8 (5%) | 0.64 (0.22‐1.83) | 0.9 (0.28‐2.92) | 4 (6%) | 0.53 (0.14‐2.07) | 0.51 (0.10‐2.57) | 34 (7%) |
| South Asia | 49 (17%) | 0.48 (0.25‐0.90) d , * | 0.76 (0.36‐1.60) | 39 (25%) | 0.91 (0.40‐2.04) | 1.8 (0.68‐4.77) | 31 (47%) | 1.2 (0.46‐3.17) | 2.54 (0.77‐8.34) | 116 (25%) |
| Sub‐Saharan Africa | 170 (58%) | 0.83 (0.46‐1.49) | 1.01 (0.53‐1.94) | 68 (43%) | 0.8 (0.37‐1.73) | 1.36 (0.56‐3.32) | 14 (21%) | 0.27 (0.10‐0.77) d , * | 0.45 (0.13‐1.52) | 230 (50%) |
| Driving shift (Ref: Day) | ||||||||||
| Night | 99 (45%) | 0.92 (0.65‐1.32) | 1.14 (0.77‐1.68) | 42 (33%) | 0.57 (0.37‐0.89) d , * | 0.85 (0.52‐1.39) | 24 (46%) | 0.83 (0.46‐1.50) | 1.32 (0.68‐2.58) | 172 (46%) |
| Varies | 25 (11%) | 0.85 (0.49‐1.48) | 0.94 (0.53‐1.68) | 21 (16%) | 1.04 (0.58‐1.88) | 1.32 (0.69‐2.52) | 2 (4%) | 0.25 (0.06‐1.10) | 0.4 (0.09‐1.83) | 47 (13%) |
| Usual care source | 125 (42%) | 0.66 (0.49‐0.89) ** | 0.64 (0.42‐0.98) d , * | 111 (70%) | 2.08 (1.41‐3.06) *** | 1.84 (1.08‐3.13) d , * | 53 (82%) | 3.97 (2.07‐7.63) *** | 2.88 (1.18‐7.04) d , * | 239 (53%) |
| Insured | 132 (45%) | 0.7 (0.52‐0.94) ** | 0.87 (0.57‐1.32) | 92 (58%) | 1.2 (0.83‐1.73) | 0.79 (0.47‐1.32) | 41 (66%) | 1.68 (0.96‐2.93) | 0.91 (0.41‐2.00) | 242 (54%) |
Boldface indicates statistical significance (P < .05).
Abbreviation: OR (95% CI), odds ratio (95% confidence intervals).
Reference category: “(4) Hypertension not reported/non‐hypertensive‐range BP readings b , b ” (n = 460).
BP = measured blood pressure.
SE = south east.
<0.05;
<0.01;
<0.001.
In the multivariate model, we included all covariates with significant bivariate associations with the outcome variable. Only age, birth region, and having a usual care source remained significant predictors of belonging to a specific outcome category. Compared to the reference category (normal), older participants had significantly higher odds of being in one of the other three categories: (1) hypertension‐unaware, hypertensive‐range reading (OR = 1.94; 95% CI, 1.59‐2.38), (2) hypertension‐aware, hypertensive‐range reading (OR = 2.81; 95% CI, 2.16‐3.65), or (3) hypertension‐aware, non‐hypertensive‐range reading (OR = 2.77; 95% CI, 1.93‐3.99) (Table 2). Compared with drivers in the reference category, hypertension‐unaware drivers with hypertensive‐range readings were less likely to have a usual care source (OR = 0.64; 95% CI, 0.42‐0.98). The opposite was found for hypertension‐aware drivers. Hypertension‐aware drivers with hypertensive‐range readings (OR = 1.84; 95% CI, 1.08‐3.13) and with non‐hypertensive‐range readings (OR = 2.88; 95% CI, 1.18‐7.04) were significantly more likely to have a usual care source.
4. DISCUSSION
Taxi/FHV drivers are a predominantly immigrant, medically underserved population with known health issues, including high CVD risk. 12 Within this convenience sample of 983 NYC taxi/FHV drivers, 46% had hypertensive‐range BP readings according to guidelines current at the time of the study: 65% of these 456 drivers were hypertension‐unaware and 35% were hypertension‐aware. Not surprisingly, drivers who did not have a known hypertension history yet had hypertensive‐range readings were less likely to have a usual care source (42%) than hypertension‐aware drivers with hypertensive‐range readings (70%) and hypertension‐aware with non‐hypertensive‐range readings (82%).
We found that hypertension‐aware drivers were more likely to have seen their doctor in the past year and were more likely to have a usual source of care. Hypertension awareness is associated with recent health care access, 27 and increased preventive care is tied to insurance coverage. 28 Taxi/FHV drivers’ uninsurance rates have previously ranged from 20% to 70%. 8 , 9 , 10 , 12 , 21 The Affordable Care Act has improved NYC taxi/FHV driver insurance rates. 29 In our sample, 47% of drivers lacked health insurance, 46% lacked a usual care source, and 46% had not seen a doctor within the past year, with lower rates of insurance coverage and a usual care source found among hypertension‐unaware drivers.
The high rate of potential hypertension‐unaware drivers requires action. Because of the high hypertension risk among taxi/FHV drivers, they necessitate a facilitated pathway to hypertension screening and health care access. This would include community‐based screening and health care navigation programs, affordable health insurance coverage, low associated fees, responsive provider telephone lines, providers who speak the drivers’ language, or who have ready access to covered medical interpretation, and taxi/FHV‐friendly hours of operation and locations, at a minimum.
There was a sizable second group of hypertension‐aware drivers, whose BP values were in the hypertensive range. It is not unusual for hypertensive patients to be unaware of or to misunderstand their BP values or goals following provider visits; only 20% of patients with uncontrolled hypertension describe their BP as “high” and 38% as "borderline high" following a hypertension diagnosis. 30 Additional research needs to be conducted with hypertension‐aware drivers to elucidate the reasons behind their persistently elevated BP. For those with a usual care source, provider‐ and patient‐related factors must be investigated and addressed. For example, are the providers aware of current BP guidelines? Are there communication gaps between providers and drivers? Are drivers attending all suggested appointments? Are they adherent with their medications? If not, why not, and do these reasons include health beliefs, costs, and/or side effects?
Among the 226 hypertension‐aware drivers, just 69% reported currently taking medications. Furthermore, 104 drivers had hypertensive‐range readings despite their hypertension awareness and medication use, indicating a need for further investigation, including into potential medication non‐adherence and into provider counseling and prescribing practices. Among immigrant populations, medication non‐adherence has been associated with factors such as longer length of stay in the United States, lower perceived susceptibility, lower perceived benefit of Western medication, 31 adverse side effects due to higher sensitivity to certain medication, poor health literacy, language barriers, 32 and financial concerns. 33 Successful interventions for managing BP include linking medication adherence to daily habits, providing adherence feedback, motivational interviewing, and multi‐modular designs. 34 , 35 Randomized controlled trials have supported the use of BP telemonitoring and emphasized its potential for BP management among high‐risk patients. 36 The BP Control Model stipulates that focusing on systemic changes, including increasing physician access frequency and improving physicians' prescribing behavior, rather than patient medication adherence is necessary to improve BP. 37 Further, BP self‐monitoring has been found to be effective in lowering BP only when combined with other interventions, including self‐management, systematic medication titration, or lifestyle counseling. 38 Non‐adherence to BP measurement guidelines occurs frequently in physicians' offices by both physicians and nurses/technicians and at home, with many patients also reporting a lack of measurement instructions. 39
A major study caveat is that a hypertensive‐range reading does not mean that a driver is hypertensive. A hypertension diagnosis requires, in a health care office setting, an average of two or more readings on two or more separate occasions. 2 , 3 , 4 Our study was conducted from 2010 to 2017 and used the hypertensive‐range values that were in place at the time 2 ; using the updated 2017 guidelines, 68% of drivers would have been considered to have hypertensive‐range readings. 3 , 4 This study was cross‐sectional, which allowed the estimation of BP awareness and prevalence in this understudied population. We were unable to account for important risk factors, such as family history, lack of physical activity, and poor nutrition due to a lack of standardized data collection reporting across the sample period. Additionally, self‐reported health conditions are subject to recall bias. BP readings were also collected in high‐stress work environments, which may have led to higher BP readings. That said, these are the usual conditions among which drivers live.
5. CONCLUSIONS
In summary, we compared objectively measured BP readings with drivers' self‐reported BP history at health fairs. We found that 30% of all participants were hypertension‐unaware with hypertensive‐range readings and 16% of all participants were hypertension‐aware yet had hypertensive‐range readings. Hypertension‐unaware drivers with hypertensive‐range readings were less likely to have a usual care source than hypertension‐aware drivers, indicating that interventions to link drivers with insurance and a usual care source may improve diagnosis and treatment in this population. Drivers with seemingly unmanaged hypertension despite awareness, and even treatment, may benefit from tailored multimodal interventions to address the lifestyle and socioeconomic barriers to hypertension control. Community and worksite health fairs have been successfully implemented to enable health screening and promotion services for the vulnerable taxi/FHV driver population. 8 , 40 This approach should be employed to navigate hypertensive and prehypertensive drivers into health care and programs addressing the complex causes of unmanaged BP. The taxi/FHV driver population is growing exponentially in the United States, largely driven by the advent of app‐based services; the population more than doubled to 689 000 drivers from 2016 to 2018. 41 , 42 Our study demonstrates the need for targeted lifestyle and access‐to‐care interventions aimed at this group and potentially interventions with their providers. These findings also have implications for the management of hypertension among other populations with similar occupationally related risk factors, barriers to care, and socioeconomic characteristics as well as largely immigrant, male, and difficult to reach populations.
CONFLICT OF INTEREST
To the best of our knowledge, no conflict of interest, financial, or other exists.
AUTHOR CONTRIBUTIONS
B. Narang, F. Gany, S. Mirpuri, S. Y. Kim, and D. R. Jutagir provided substantial contributions to the conception and design of the work, acquisition, analysis, and interpretation of data for the work. B. Narang, F. Gany, and S. Mirpuri drafted and revised the work, critically for important intellectual content. B. Narang, F. Gany, and S. Mirpuri approved the final version to be published. B. Narang and F. Gany agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
DISCLAIMER
The research presented in this paper is that of the authors and does not reflect the official policy of the NIH.
Narang B, Mirpuri S, Kim SY, Jutagir DR, Gany F. Lurking in plain sight: Hypertension awareness and treatment among New York City taxi/for‐hire vehicle drivers. J Clin Hypertens. 2020;22:962–969. 10.1111/jch.13869
Funding information
All authors were supported by National Cancer Institute (P30 CA008748); National Institute of Nursing Research (R01 NR015265); and National Institute on Minority Health and Health Disparities (U01 MD010648 and R24 MD008058). Study sponsors did not have any role in the study design, collection, analysis, and interpretation of data, writing, or decision to submit this manuscript.
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