Vol 75, No 1 (2024)
Original article
Published online: 2024-03-29
Self-reported diabetes mellitus among seafarers: occupational and sociodemographic predictors
12
, 13, 1, 4, 13
, 13, 1, 4, 13
Abstract
Background: Seafarers are at increased risk of diabetes due to their lifestyle and working conditions on
board ships. There is, however, limited evidence regarding the magnitude of diabetes and its risk factors.
In this study, we aimed to assess the prevalence of self-reported diabetes among seafarers on board ships
and identify risk factors associated with it.
Materials and methods: A cross-sectional epidemiological survey was conducted among seafarers aboard
ships between November and December 2022. The study enrolled a total of 4,500 seafarers aged 18
and older. Data were collected using anonymous, standardized questionnaires. The association between
the outcome variable and the independent variables was assessed using binary logistic regression models.
Results: In total, 2,986 participants were included in the study. The prevalence of self-reported diabetes
among seafarers was found to be 8.2% (95% CI: 7.2–9.2). Self-reported diabetes prevalence among officers
and non-officers was 7% and 9%, respectively. The mean age of study participants was 37.96 ± 10.22, while
the mean age of participants with diabetes was 47.5 ± 9.46. Independent predictors of self-reported diabetes
mellitus were age (51+ years) [adjusted odds ratio (AOR): 3.52, 95% confidence interval (CI): 1.46–8.95],
rank (non-officer) [AOR: 1.65; 95% CI: 1.14–2.40], worksites (engine) (AOR: 2.08, 95% CI: 1.19–3.77),
work experience (10–20 years) (AOR: 4.66, 95% CI: 2.33–10.05), work experience (21+ years) (AOR: 5.01,
95% CI: 2.32–11.55), working hours per week (57–70 hours) (AOR: 1.57, 95% CI: 1.08–2.31), working
hours per week (71+ hours) (AOR: 1.80, 95% CI: 1.17–2.80), self-reported hypertension (AOR: 1.44, 95%
CI: 1.03–1.99), overweight (AOR: 1.74; 95% CI: 1.24–2.47), and obesity (AOR: 2.93; 95% CI: 1.84–4.65).
Conclusions: This study revealed that one in twelve seafarers between the ages of 19 and 70 have self-reported
diabetes. The present study identified significant risk factors associated with diabetes. Risk factor
mitigation strategies aimed at high-risk groups should be implemented on board ships.
Keywords: diabeteshypertensionoverweightobesitysmokingseafarersworking hours
References
- World Health Organization. Diabetes, https://www.who.int/health-topics/diabetes#tab=tab_1 (accessed 26 March 2023).
- Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022; 183: 109119.
- Lin X, Xu Y, Pan X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020; 10(1): 14790.
- Bloor M, Thomas M, Lane T. Health risks in the global shipping industry: An overview. Health, Risk & Society. 2000; 2(3): 329–340.
- Oldenburg M, Harth V, Jensen HJ. Overview and prospect: food and nutrition of seafarers on merchant ships. Int Marit Health. 2013; 64(4): 191–194.
- Guide to understandinG diabetes a seafarer’s, https://www.ifsma.org/resources/Good-Health-for-Seafarers-Guide-MtS.pdf (accessed 3 April 2023).
- Kirkutis A, Norkiene S, Griciene P, et al. Prevalence of hypertension in Lithuanian mariners. Proc West Pharmacol Soc. 2004; 47: 71–75.
- Hansen, Henrik Lyngbeck Lifestyle, nutritional status and working conditions of Danish sailors. Travel Medicine International. 1994; 12: 139–143.
- Kivimäki M, Kawachi I. Work Stress as a Risk Factor for Cardiovascular Disease. Curr Cardiol Rep. 2015; 17(9): 630.
- Mulić, Rosanda, Pero Vidan and RB. Comparative analysis of medical assistance to seafarers in the world and the republic of Croatia. in 15Th International Conference on Transport Science. ; 2012: 1–8.
- Oldenburg M, Jensen HJ, Latza U, et al. Coronary risks among seafarers aboard German-flagged ships. Int Arch Occup Environ Health. 2008; 81(6): 735–741.
- Purnawarma I, Jensen OC, Canals ML, et al. Prevalence of cardiovascular risks factors and 10 year predictions of coronary heart disease in seafarers of Pertamina shipping (Indonesia). Medicina Maritima. 2011; 11: 49–60.
- Scovill SM, Roberts TK, McCarty DJ. Health characteristics of inland waterway merchant marine captains and pilots. Occup Med (Lond). 2012; 62(8): 638–641.
- Møller Pedersen SF, Jepsen JR. The metabolic syndrome among Danish seafarers. Int Marit Health. 2013; 64(4): 183–190.
- Baygi F, Jensen OC, Qorbani M, et al. Prevalence and associated factors of cardio-metabolic risk factors in Iranian seafarers. Int Marit Health. 2016; 67(2): 59–65.
- Nittari G, Tomassoni D, Di Canio M, et al. Overweight among seafarers working on board merchant ships. BMC Public Health. 2019; 19(1): 45.
- Amenta F, Capone L, Sibilio F. Telemedical Assistance of Patients on Board Ships Activity of Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service. (TMAS).
- Szafran-Dobrowolska J, Renke M, Wołyniec W. Telemedical Maritime Assistance Service at the University Center of Maritime and Tropical Medicine in Gdynia. The analysis of 6 years of activity. Med Pr. 2020; 71(2): 121–125.
- Mahdi SS, Amenta F. Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance. Int Marit Health. 2016; 67(4): 187–195.
- Westlund K, Attvall S, Nilsson R, et al. Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012. Int Marit Health. 2016; 67(1): 24–30.
- Gonçalves VSS, Andrade KRC, Carvalho KMB, et al. Accuracy of self-reported hypertension: a systematic review and meta-analysis. J Hypertens. 2018; 36(5): 970–978.
- Najafi F, Pasdar Y, Shakiba E, et al. Validity of self-reported hypertension and factors related to discordance between self-reported and objectively measured hypertension: evidence from a cohort study in iran. J Prev Med Public Health. 2019; 52(2): 131–139.
- Samanic C, Barbour K, Liu Y, et al. Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use by County and Rural-Urban Classification — United States, 2017. MMWR. Morbidity and Mortality Weekly Report. 2020; 69(18): 533–539.
- Lee AJ, Sanchez D, Reyes-Dumeyer D, et al. Reliability and validity of self-reported vascular risk factors: hypertension, diabetes, and heart disease, in a multi-ethnic community based study of aging and dementia. J Alzheimers Dis. 2023; 95(1): 275–285.
- World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization - Technical Report Series. 2000; 894: 252.
- Urbanek S, Bibiko H-J, Stefano ML. R: a language and environment for statistical computing. The R Foundation for Statistical Computing, https://www.r-project.org (2014).
- Yan Z, Cai M, Han Xu, et al. The interaction between age and risk factors for diabetes and prediabetes: a community-based cross-sectional study. Diabetes Metab Syndr Obes. 2023; 16: 85–93.
- Maedler K, Schumann DM, Schulthess F, et al. American Diabetes Association, American Diabetes Association. Aging correlates with decreased beta-cell proliferative capacity and enhanced sensitivity to apoptosis: a potential role for Fas and pancreatic duodenal homeobox-1. Diabetes. 2006; 55(9): 2455–2462.
- Sagaro GG, Dicanio M, Battineni G, et al. Incidence of occupational injuries and diseases among seafarers: a descriptive epidemiological study based on contacts from onboard ships to the Italian Telemedical Maritime Assistance Service in Rome, Italy. BMJ Open. 2021; 11(3): e044633.
- Siegrist J, Rödel A. Work stress and health risk behavior. Scand J Work Environ Health. 2006; 32(6): 473–481.
- Oldenburg M, Jensen HJ, Oldenburg M, et al. Seafaring stressors aboard merchant and passenger ships. Int J Public Health. 2009; 54(2): 96–105.
- Oldenburg M, Jensen HJ. Stress and strain among seafarers related to the occupational groups. Int J Environ Res Public Health. 2019; 16(7).
- Dzhambov AM. Long-term noise exposure and the risk for type 2 diabetes: a meta-analysis. Noise Health. 2015; 17(74): 23–33.
- Zare Sakhvidi MJ, Zare Sakhvidi F, Mehrparvar AH, et al. Association between noise exposure and diabetes: A systematic review and meta-analysis. Environ Res. 2018; 166: 647–657.
- Huth C, Thorand B, Baumert J, et al. Job strain as a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study. Psychosom Med. 2014; 76(7): 562–568.
- Nyberg S, Fransson E, Heikkilä K, et al. Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women. PLoS ONE. 2013; 8(6): e67323.
- Salyga J, Juozulynas A. Association between environment and psycho-emotional stress experienced at sea by Lithuanian and Latvian seamen. Medicina (Kaunas). 2006; 42(9): 759–769.
- Comperatore C A, Rivera PK, Kingsley L. Enduring the shipboard stressor complex: a systems approach - PubMed. Aviat Space Environ Med 2005; 76: B108–B118.
- Carter T. Working at sea and psychosocial health problems Report of an International Maritime Health Association Workshop. Travel Med Infect Dis. 2005; 3(2): 61–65.
- Sagaro GG, Battineni G, Di Canio M, et al. Self-reported modifiable risk factors of cardiovascular disease among seafarers: a cross-sectional study of prevalence and clustering. J Pers Med. 2021; 11(6).
- Siddiqui A, Madhu SV, Sharma SB, et al. Endocrine stress responses and risk of type 2 diabetes mellitus. Stress. 2015; 18(5): 498–506.
- Lupien SJ, McEwen BS, Gunnar MR, et al. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009; 10(6): 434–445.
- McEwen BS, Bowles NP, Gray JD, et al. Mechanisms of stress in the brain. Nat Neurosci. 2015; 18(10): 1353–1363.
- Oldenburg M, Jensen HJ, Latza U, et al. Coronary risks among seafarers aboard German-flagged ships. Int Arch Occup Environ Health. 2008; 81(6): 735–741.
- Salvetti A, Brogi G, Di Legge V, et al. The inter-relationship between insulin resistance and hypertension. Drugs. 1993; 46 Suppl 2: 149–159.
- Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol. 2018; 34(5): 575–584.
- Muscelli E, Mari A, Casolaro A, et al. Separate impact of obesity and glucose tolerance on the incretin effect in normal subjects and type 2 diabetic patients. Diabetes. 2008; 57(5): 1340–1348.
- Faerch K, Borch-Johnsen K, Holst JJ, et al. Pathophysiology and aetiology of impaired fasting glycaemia and impaired glucose tolerance: does it matter for prevention and treatment of type 2 diabetes? Diabetologia. 2009; 52(9): 1714–1723.
- Hansen HL, Hjarnoe L, Jepsen JR. Obesity continues to be a major health risk for Danish seafarers and fishermen. Int Marit Health. 2011; 62: 98–103.
- Sagaro GG, Angeloni U, Marotta C, et al. The magnitude of cardiovascular disease risk factors in seafarers from 1994 to 2021: a systematic review and meta-analysis. J Pers Med. 2023; 13(5).
- Hoeyer JL, Hansen HL. Obesity among Danish seafarers. Int Marit Health. 2005; 56(1-4): 48–55.
