Influence of occupational risk factors for road traffic crashes among professional drivers: systematic review

Figures & data

Table 1. Overview of the PICOS framework used for the systematic literature review search regarding occupational risk factors for road traffic crashes among professional drivers.

P	Population	Adult individuals (≥18 years) who worked as a professional driver (e.g. driving cars, trucks, taxis or buses as the main part of their job)
I	Intervention/Exposures	Occupational risk factors for road traffic crashes
C	Comparator	Both with or without a comparison group
O	Outcome	Road crashes
S	Study design	All types of study designs were included

Figure 1. Flow of study selection.

Table 2. Systematic literature review of road traffic crashes among professional drivers – description of included studies.

Studies (N = 67)	Participants (type of occupation, N, Country)	Outcome measures (how were accidents measured?)	Risk factor measures (how was the risk factor measured?)	Quality of the study
Pokorny et al. (1987)	Bus accidents, N = 1251, Netherlands	Database (bus accidents from 1976 to 1980)	Database (company records)	Moderate
Feng et al. (2016)	Bus drivers, N = 1380, U.S.A.	Database (Buses Involved in Fatal Accidents (BIFA))	Database (BIFA)	High
Tasbakan et al. (2018)	Bus drivers, N = 1400, Turkey	Questionnaire (lifetime history)	Questionnaire	Moderate
Dorn and af Wahlberg (2008)	Bus drivers, N = 12,244, U.K.	Database (U.K. bus company crash database)	Questionnaire	High
Celikhisar and Ilkhan (2020)	Bus drivers, N = 162, Turkey	Database (official municipality records)	Clinical evaluation, polysomnography, questionnaire	Moderate
Wu et al. (2019)	Bus drivers, N = 200, China	Interview (one-month history)	Interview	Moderate
Miyama et al. (2020)	Bus drivers, N = 301, Japan	Questionnaire (one-month history)	Questionnaire	Moderate
La et al. (2013b)	Bus drivers, N = 365, Vietnam	Interview (three-year history)	Interview	Moderate
Hamed et al. (1998)	Bus drivers, N = 438, Jordan	Interview (lifetime history)	Interview	Moderate
Gomez-Ortiz et al. (2018)	Bus drivers, N = 524, Colombia	Questionnaire (three-year history)	Questionnaire	Moderate
Vennelle et al. (2010)	Bus drivers, N = 677, Scotland	Questionnaire (five-year history)	Questionnaire	Moderate
Wang et al. (2021)	Bus drivers, N = 725, China	Database (NA) and survey (one-year history)	Questionnaire	Moderate
Kim and Chung (2019)	MT (bus and taxi), N = 223, South Korea	Database (Korea Expressway Corporation database, crashes from 2009 to 2014)	Questionnaire	Moderate
Tzamalouka et al. (2005)	MT (bus and truck), N = 317, Greece	Interview (one-year history)	Interview	Moderate
Kwon et al. (2019)	MT (bus, construction, taxi and trucks), N = 161, South Korea	Questionnaire	Questionnaire	Moderate
Chen et al. (2014)	MT (delivery services drivers and truck drivers), N = 5568, U.S.A.	Database (BLS Census of Fatal Occupational Injuries)	Database	High
Mir et al. (2012)	MT (large passenger vehicles and trucks), N = 857, Pakistan	Questionnaire (five-year history)	Questionnaire	High
Mir et al. (2013)	MT (large passenger vehicles and trucks), N = 857, Pakistan	Questionnaire (five-year history)	Questionnaire	High
Mehdizadeh et al. (2019)	MT (taxi and truck), N = 785, Iran	Questionnaire	Questionnaire	High
Boufous and Williamson (2009)	MT, N = 145,302, Australia	Database (Workers’ Compensation Scheme Statistics (WCSS) and The Traffic Accident Database System (TADS))	Database (TADS)	High
Howard et al. (2004)	MT, N = 2503, Australia	Questionnaire (three-year history)	Questionnaire	Moderate
Ebrahimi et al. (2015)	MT, N = 556, Iran	Questionnaire (five-year history)	Questionnaire	Moderate
Malka et al. (2018)	MT, N = 572, Israel	Interview	Interview	Moderate
Ezeibe et al. (2019)	MT, N = 720, Nigeria	Group interview	Field observation	Low
Amra et al. (2012)	MT, N = 931, Iran	Questionnaire (lifetime history)	Questionnaire	High
Zhang et al. (2017)	Other (farmers), N = 1422, China	Questionnaire	Questionnaire	Moderate
Barger et al. (2015)	Other (firefighters), N = 6933, U.S.	Questionnaire	Questionnaire	Moderate
Harland et al. (2016)	Other (fleet service drivers), N = 229, U.S.A.	Naturalistic driving videos	Naturalistic driving videos	High
Chu (2016)	Other (police drivers), N = 473, Taiwan	Database (national police accident reports, four-year history)	Database	High
Ozer et al. (2014)	Other (public transport drivers), N = 320, Turkey	Questionnaire (lifetime history)	Questionnaire	High
Sebastian and Vaghela (2021)	Other (public transport drivers), N = 4094, India	Questionnaire (three-year history)	Questionnaire	High
Sumer (2003)	Other, N = 295, Turkey	Questionnaire (three-year history)	Questionnaire	Moderate
Salminen et al. (2005)	Other, N = 720, Finland	Questionnaire (one-year history)	Questionnaire	Moderate
Zuzewicz et al. (2010)	Other, N = 30,491	Database (Central Statistical Office Accidents database, six-year history)	Database (Central Statistical Office Accidents database, six-year history)	Moderate
La et al. (2013a)	Taxi drivers, N = 1214, Vietnam	Interview (lifetime history)	Interview	Moderate
Baba et al. (2019)	Taxi drivers, N = 1739, Japan	Questionnaire	Questionnaire	Moderate
Allahyari et al. (2008)	Taxi drivers, N = 160, Iran	Questionnaire (three-year history)	Questionnaire	Moderate
Peng et al. (2020)	Taxi drivers, N = 2391, China	Interview and questionnaire (two-year history)	Interview and questionnaire	High
Wang et al. (2019)	Taxi drivers, N = 2391, China	Interview and questionnaire (two-year history)	Interview and questionnaire	Moderate
Dalziel and Job (1997)	Taxi drivers, N = 42, Australia	Questionnaire (two-year history)	Questionnaire	Low
Lam (2004)	Taxi drivers, N = 7923, Australia	Database (Traffic Accident Database System(TADS))	Database (TADS)	High
Asefa et al. (2015)	Taxi drivers, N = 712, Ethiopia	Questionnaire (three-year history)	Questionnaire	Moderate
Wang et al. (2015)	Taxi drivers, N = 726, China	Database (Xi’an Traffic Police Department official database)	Database (Xi’an Traffic Police Department official database)	Moderate
Chu (2012)	Truck drivers (gravel trucks), N = 1825, Taiwan	Data base (National police accident reports (four-year history))	Database (National police accident reports (four-year history))	High
Adams-Guppy et al. (2003)	Truck drivers (heavy goods vehicles), N = 640, U.K.	Questionnaire (lifetime history)	Questionnaire	High
Campbell (1991)	Truck drivers (large trucks), N ≤ 25,000, U.S.	Database (University of Michigan Transportation Research Institute (UMTRI))	Database (University of Michigan Transportation Research Institute (UMTRI))	Moderate
Adejugbagbe et al. (2015)	Truck drivers (long-distance), N = 592, Nigeria	Interview (lifetime and one-year history)	Interview	Moderate
Lemke et al. (2016)	Truck drivers (long-haul truckers), N = 260, U.S.A.	Survey data	Survey	Moderate
Stoohs et al. (1994)	Truck drivers (long-haul truckers), N = 90, U.S.A.	Database (NA) and questionnaire (five-year history)	Questionnaire	Moderate
Pérez-Chada et al. (2005)	Truck drivers (long-haul), N = 738, Argentina	Questionnaire (lifetime history)	Questionnaire	Moderate
Swedler et al. (2015)	Truck drivers (multiple types), N = 446, U.S.A.	Questionnaire	Questionnaire	Moderate
Sabbagh-Ehrlich et al. (2005)	Truck drivers (Port trucks), N = 160, Israel	Interview (lifetime history)	Interview	Moderate
Laberge-Nadeau et al. (2000)	Truck drivers, N = 3593 (driver years), Canada	Database (four-year history, public insurer for automobile injuries) # Cohort	Database and Questionnaire	High
Morrow et al. (2004)	Truck drivers, N = 116, U.S.A.	Database (Motor Carrier Safety Status Measurement System Database: Safestat)	Database (Safestat)	Moderate
Gander et al. (2006)	Truck drivers, N = 130, New Zealand	Questionnaire (lifetime history)	Questionnaire	Moderate
Hong et al. (2019)	Truck drivers, N = 15,011, South Korea	Database (Korea Expressway Corporation (KEC) crash database, 2012–2016)	Database (Korea Expressway Corporation (KEC) crash database, 2012–2016)	Moderate
Staplin and Gish (2005)	Truck drivers, N = 25,609, U.S.A.	Database (Motor Carrier Management Information System: MCMIS)	Database (MCMIS)	Moderate
Souza et al. (2005)	Truck drivers, N = 260, Brazil	Questionnaire (five-year history)	Questionnaire	Low
Garbarino et al. (2016a)	Truck drivers, N = 283, Italy	Questionnaire	Clinical evaluation, interview, questionnaire, polysomnography	Moderate
Alahmari et al. (2019)	Truck drivers, N = 338, Saudi Arabia	Questionnaire (six-month history)	Questionnaire	Moderate
Oliveira et al. (2016)	Truck drivers, N = 535, Brazil	Interview (lifetime history)	Interview	Moderate
Hamido et al. (2021)	Truck drivers, N = 554, Japan	Database (drivers records, three-year history)	Database (drivers records)	Moderate
Catarino et al. (2014)	Truck drivers, N = 714, Portugal	Interview and questionnaire (five-year history)	Interview and Questionnaire	Moderate
Ronna et al. (2016)	Truck drivers, N = 797, U.S.A.	Questionnaire	Questionnaire	High
Thiese et al. (2015)	Truck drivers, N = 797, U.S.A.	Questionnaire (lifetime history)	Questionnaire	Moderate
Garbarino et al. (2016b)	Truck Drivers, N = 949, Italy	Questionnaire	Clinical evaluation, interview and questionnaire	Moderate
Garbarino et al. (2017)	Truck Drivers, N = 949, Italy	Questionnaire	Clinical evaluation, interview and questionnaire	Moderate

Note: Sorted by occupational type. MT = multiple types of drivers (truck, taxi, bus and/or other).

Figure 2. Framework for categorising risk factors for road crashes among professional drivers. n = number of studies.

Table 3. Risk factors for road traffic crashes among professional drivers in the organisational domain.

Participants (author) (n = 31)	Rest (n = 6)	Shift work (n = 6)	Working time (n = 14)	Support and income (n = 8)	Other (n = 14)
Bus drivers (Gomez-Ortiz et al., 2018)				Lack of supervisor support ↑
Bus drivers (Hamed et al., 1998)	No effect (regular rest times)				No effect (time of day)
Bus drivers (La et al., 2013b)				Perceived sufficiency of income ↓
Bus drivers (Miyama et al., 2020)			Long working hours, inadequate time spent with family ↑		Difficulty reporting poor health ↑
Bus drivers (Pokorny et al. 1987)		No effect
Bus drivers (Wang et al., 2021)					Low safety climate level ↑
Bus drivers (Wu et al., 2019)			Working ≥14 hours/day ↑	Performance-based salary ↑	Restrictive work requirements ↑
MT (bus and taxi drivers) (Kim & Chung, 2019)					Low organisational justice ↑
MT (bus and truck drivers) (Tzamalouka et al., 2005)			Non-driving working hours ↑
MT (Ebrahimi et al., 2015)		No effect (rotational work)	No effect (hours/day)		No effect (driving route)
MT (Howard et al. 2004)		Night shift ↓	No effect (hours/week)
MT (Malka et al., 2018)					Dual priority work task ↑
MT (taxi and truck drivers) (Mehdizadeh et al., 2019)				Higher income ↓
Other (farmers) (Zhang et al., 2017)				Dissatisfaction with income ↑
Other (police drivers) (Chu 2016)		No effect
Other (Salminen et al., 2005)	Freedom to choose timing of breaks ↓
Other (Zuzewicz et al., 2010)					Night time (23.00–6.59 o’clock) ↑
Taxi drivers (Asefa et al., 2015)				No effect (salary)
Taxi drivers (Baba et al., 2019)	Irregular breaks ↑		Insufficient vacation ↑		No effect (company size) Difficulty reporting poor health ↑
Taxi drivers (La et al., 2013a)		Part time ↑		Perceived sufficiency of income ↓
Taxi drivers (Peng et al., 2020)			More working hours ↑	Financial burden, dissatisfaction with income ↑
Truck drivers (Catarino et al. 2014)			Supplementary hours ↑
Truck drivers (Garbarino et al. 2016b)	Rest breaks ↓
Truck drivers (Laberge-Nadeau et al., 2000)					Higher working radius and distance driven ↑
Truck drivers (Lemke et al. 2016)			No effect (working > daily hour limit)
Truck drivers (Morrow et al. 2004)	No effect (difficulty finding rest places)		Increased time spent loading ↑		No effect (schedule regularity)
Truck drivers (Oliveira et al., 2016)			Working >12 hours/day ↑		No effect (hired/self-employed)
Truck drivers (Sabbagh-Ehrlich et al. 2005)	Difficulty finding parking when tired ↑		No effect (workday < legal hours)
Truck drivers (Souza et al. 2005)			No effect (hours/day)
Truck drivers (Staplin & Gish, 2005)					Job change ↑
Truck drivers (Thiese et al., 2015)		Night shift ↓	No effect (long vs. short haul)		No effect (Unloading/loading)
Summary	[4/6] Rest breaks (1) and freedom to choose timing of breaks (1) ↓ Irregular breaks (1), difficulty finding parking when tired (1) ↑	[3/6] Night shift (2) ↓ Part time (1) ↑	[8/14] Long working hours (5), increased time spent loading (1), non-driving working hours (1), insufficient vacation (1) or time spent with family (1) ↑	[7/8] Higher income (1), sufficient income (2) ↓ Financial burden (1), dissatisfaction with income (2), performance-based salary (1), lack of supervisor support (1) ↑	[10/14] Difficulty reporting poor health (2), night time (1), low safety climate level (1), restrictive work requirements (1), low organisational justice (1), higher working radius and distance driven (1), dual priority work tasks (1), job change (1) ↑

Note: ↑ and ↓ means increased and decreased risk, respectively. Sorted by occupational type. MT = multiple types of drivers (truck, taxi, bus and/or other).

Table 4. Risk factors for road traffic crashes among professional drivers in the individual driver characteristics domain.

Participants (author) (n = 32)	Age (n = 30)	Anthropometrics (n = 5)	BMI (n = 9)	Ethnicity (n = 2)	Gender (n = 9)	Marital status (n = 7)
Bus drivers (Celikhisar & Ilkhan, 2020)	No effect	Higher neck circumference ↑	No effect
Bus drivers (Dorn & af Wahlberg 2008)	U-shaped effect of age
Bus drivers (Feng et al. 2016)	U-shaped effect of age				Male ↑
Bus drivers (Hamed et al., 1998)	Old age ↑
Bus drivers (La et al., 2013b)	No effect					No effect
Bus drivers (Miyama et al., 2020)	No effect				No effect	No effect
Bus drivers (Tasbakan et al. 2018)	Old age ↑
Bus drivers (Wang et al., 2021)					No effect	Unmarried ↑ (univariate)
MT (Amra et al. 2012)	No effect	Higher neck circumference ↑	No effect
MT (Boufous & Williamson 2009)	Old age ↑				Male ↑
MT (bus and truck drivers) (Tzamalouka et al., 2005)	No effect
MT (Ebrahimi et al., 2015)	No effect		No effect
MT (Howard et al. 2004)	Old age ↓				No effect
MT (taxi and truck drivers) (Mehdizadeh et al., 2019)	No effect
MT (truck drivers, delivery services drivers) (Chen et al. 2014)	Old age ↑			No effect	Male ↑
Other (police drivers) (Chu 2016)	Young age ↑
Other (public transport drivers) (Sebastian & Vaghela 2021)	No effect	No effect	No effect
Other (Salminen et al., 2005)	Young age ↑
Taxi drivers (Baba et al., 2019)	Old age ↓		No effect		No effect	No effect
Taxi drivers (La et al., 2013a)	Old age ↓					No effect
Taxi drivers (Lam 2004)	No effect				Female ↑
Taxi drivers (Wang et al., 2019)	Old age ↑
Truck drivers (Alahmari et al., 2019)	Young/Old ↓
Truck drivers (Campbell 1991)	No effect
Truck drivers (Catarino et al. 2014)	No effect	No effect	BMI ≤35 ↑
Truck drivers (Garbarino et al. 2016b)	No effect
Truck drivers (Hamido et al., 2021)	No effect
Truck drivers (long-distance) (Adejugbagbe et al., 2015)	Young age ↑			No effect		No effect
Truck drivers (Oliveira et al., 2016)	No effect					No effect
Truck drivers (Souza et al. 2005)	Young age ↑		No effect
Truck drivers (Stoohs et al. 1994)			Higher BMI ↑
Truck drivers (Thiese et al., 2015)	Old age ↑	No effect	No effect		Male ↑
Summary	[16/30] Old age (4), Young (1) ↓ Old (6), young (4) ↑ U-shaped effect (2)	[2/5] Higher neck circumference (2) ↑	[2/9] Higher BMI (2) ↑	[0/2] No effect	[5/9] Male (4), female (1) ↑	[1/7] Unmarried (1) ↑

Note: Sorted by occupational type. MT = multiple types of drivers (truck, taxi, bus and/or other).

^Stated significant in the text but p-values not reported. ↑ = Increase risk, ↓ = Decrease risk.

Table 5. Risk factors for road traffic crashes among professional drivers in the qualification factor domain.

Participants (author) (n = 15)	Education (n = 6)	Experience (n = 14)	License (n = 2)
Bus drivers (Dorn & af Wahlberg 2008)		More experience ↓ (effect weakens with time)
Bus drivers (Hamed et al., 1998)		More experience ↓
Bus drivers (La et al., 2013b)	No effect
Bus drivers (Wang et al., 2021)	No effect
MT (Amra et al. 2012)	No effect
MT (Boufous & Williamson 2009)			No effect
MT (Ebrahimi et al., 2015)		More experience ↑
MT (taxi and truck drivers) (Mehdizadeh et al., 2019)		More experience (only taxi drivers) ↑
Other (Salminen et al., 2005)		Less experience ↑
Other (truck and bus drivers) (Tzamalouka et al., 2005)		No effect
Taxi drivers (Asefa et al., 2015)	No effect (first aid training)
Taxi drivers (Baba et al., 2019)		No effect
Taxi drivers (La et al., 2013a)	No effect	No effect	Higher license level ↑
Taxi drivers (Wang et al., 2015)		More experience ↓^
Truck drivers (Alahmari et al., 2019)		6–10 years’ experience ↑
Truck drivers (long-distance) (Adejugbagbe et al., 2015)	No education ↑	No effect
Truck drivers (Oliveira et al., 2016)		More experience ↓
Truck drivers (Swedler et al. 2015)		No effect
Truck drivers (Thiese et al., 2015)		No effect (in adjusted model)
Summary	[1/6] No education (1) ↑	[8/14] More experience (4) ↓ More experience (2), less experience (1), 6–10 years’ experience (1) ↑	[1/2] Higher license level ↑

Note: Sorted by occupational type. MT = multiple types of drivers.

^Stated significant in the text but p-values not reported. ↑ = Increase risk, ↓ = Decrease risk.

Table 6. Risk factors for road traffic crashes among professional drivers in the driver condition domain.

Participants (author) (n = 46)	Sleep (n = 25)	Fatigue (n = 15)	Substance use (n = 21)	Health parameters (n = 22)
Bus drivers (Celikhisar & Ilkhan, 2020)			No effect (alcohol, smoking)	Obstructive sleep apnea (OSA) severity ↑
Bus drivers (Gomez-Ortiz et al., 2018)				Hypertension ↑
Bus drivers (La et al., 2013b)	No effect	No effect	No effect (alcohol, smoking)
Bus drivers (Miyama et al., 2020)	Inadequate sleep ↑		No effect (smoking)	Driving when feeling sick ↑
Bus drivers (Tasbakan et al. 2018)	Sleepiness ↑
Bus drivers (Vennelle et al. 2010)	Sleepiness ↑
Bus drivers (Wang et al., 2021)				Insomnia ↑
MT (Amra et al. 2012)	Sleepiness ↑		No effect (smoking)	High-risk Berlin Questionnaire ↑
MT (bus and truck drivers) (Tzamalouka et al., 2005)	Decreased sleep duration ↑	No effect	No effect (alcohol, smoking)
MT (bus, construction, taxi and truck drivers) (Kwon et al., 2019)	Sleepiness, bad sleep quality ↑	Fatigue ↑		Poor mental health ↑
MT (Ebrahimi et al., 2015)	Sleepiness ↑		No effect (smoking)
MT (Howard et al. 2004)	Sleepiness ↑		Narcotic analgesic, antihistamines ↑	No effect (Multivariable Apnea Prediction)
MT (large passenger vehicle and truck drivers) (Mir et al. 2012)			Alcohol, marijuana ↑
MT (large passenger vehicle and truck drivers) (Mir et al. 2013)			Alcohol ↑
Other (farmers) (Zhang et al., 2017)		Fatigue ↑	Drunk driving ↑	Sleep disorder, illness, chronic disease, stress, poor vision or hearing ↑
Other (firefighters) (Barger et al. 2015)				Sleeping disorder ↑
Other (fleet service drivers) (Harland et al., 2016)			No effect (smoking)
Other (public transport drivers) (Ozer et al. 2014)	Sleepiness ↑
Other (public transport drivers) (Sebastian & Vaghela 2021)	Sleepiness, snoring ↑		No effect (smoking) Alcoholism ↑	No effect (diabetes, hypertension) OSA severity ↑
Taxi drivers (Allahyari et al. 2008)				No effect (Cognitive Failure Questionnaire)
Taxi drivers (Asefa et al., 2015)			Alcohol ↑
Taxi drivers (Baba et al., 2019)				Chronic disease ↑
Taxi drivers (Dalziel & Job 1997)		No effect
Taxi drivers (La et al., 2013a)	No effect	No effect	No effect (alcohol, smoking)
Taxi drivers (Peng et al., 2020)	Sleep problems ↑	Fatigue ↑
Taxi drivers (Wang et al., 2015)		No effect
Taxi drivers (Wang et al., 2019)	Sleep problems ↑	Fatigue ↑
Truck drivers (Adams-Guppy et al. 2003)		No effect
Truck drivers (Alahmari et al., 2019)	Bad sleep quality ↑
Truck drivers (Catarino et al. 2014)	Sleepiness ↑	Fatigue, “feeling not up to par” ↑	Alcohol, antidepressants ↑	Depression, hypertension, gastroesophageal reflux disease (GERD) symptoms ↑
Truck drivers (Chu 2012)			No effect (drunk driving)
Truck drivers (Gander et al. 2006)		No effect
Truck drivers (Garbarino et al. 2016a)				Sleeping disorder severity ↑
Truck drivers (Garbarino et al. 2016b)	Sleepiness ↑		No effect (smoking)	Sleep disorder ↑
Truck drivers (Garbarino et al. 2017)				Sleep disorder ↑
Truck drivers (Laberge-Nadeau et al., 2000)				Uncomplicated diabetes (no insulin) ↑
Truck drivers (Lemke et al. 2016)	Decreased sleep duration ↑
Truck drivers (long-distance) (Adejugbagbe et al., 2015)			Alcohol ↑
Truck drivers (Morrow et al. 2004)	No effect	No effect
Truck drivers (Oliveira et al., 2016)	No effect		No effect (alcohol, illicit drugs)	No effect (stress, psychiatric diagnosis)
Truck drivers (Pérez-Chada et al. 2005)	Sleepiness ↑			No effect (insufficient sleep syndrome)
Truck drivers (Ronna et al. 2016)				Risk for cardiovascular disease (CVD) ↑
Truck drivers (Sabbagh-Ehrlich et al. 2005)	Sleepiness ↑	No effect
Truck drivers (Souza et al. 2005)	No effect		No effect (alcohol, psychostimulants)	Excessive Daytime Sleepiness (EDS) ↑
Truck drivers (Stoohs et al. 1994)	Sleepiness ↑
Truck drivers (Thiese et al., 2015)	No effect	Feeling exhausted after work ↑	No effect (alcohol use)	Increased pulse pressure ↑ No effect (heart disease, low-back pain)
Summary	[19/25] Sleepiness (13), bad sleep quality (2), inadequate sleep (1), decreased sleep duration (2), sleep problems (2), snoring (1) ↑	[6/15] Fatigue (6), “feeling not up to par” (1), exhausted after work (1) ↑	[8/21] Alcohol (6), drunk driving (1), marijuana (1), antidepressants (1), narcotic analgesic (1), antihistamines (1) ↑	[18/22] Sleep disorder (5), sleep disorder severity (3), risk for OSA (1), excessive daytime sleepiness (1), chronic disease (2), illness (2), hypertension (2), increased pulse pressure (1) GERD (1), depression (1), poor mental health (1), uncomplicated diabetes (1), risk for CVD (1), poor vision and/or hearing (1) ↑

Note: Sorted by occupational type. MT = multiple types of drivers.

^Stated significant in the text but p-values not reported. ↑ = Increase risk, ↓ = Decrease risk.

Table 7. Risk factors for road traffic crashes among professional drivers in the driving behaviour domain.

Participants (author) (n = 17)	Seat belt use (n = 6)	Traffic violations and risky driving behaviour (n = 12)	Speeding (n = 8)	Distracting activities (n = 8)
Bus drivers (La et al., 2013b)	No effect	No effect		No effect (phone use)
Bus drivers (Wang et al., 2021)		Previous traffic violation ↑	Speeding ↑
MT (Boufous & Williamson 2009)			Speedy driving ↑
MT (large passenger vehicles and truck drivers) (Mir et al. 2013)	Seat belt use ↓
MT (taxi and truck drivers) (Mehdizadeh et al., 2019)		Previous traffic violation, aggressive driving ↑
Other (farmers) (Zhang et al., 2017)		Driving while ill or drunk ↑		Phone use ↑
Other (police drivers) (Chu 2016)		No effect	Lower speed limit during emergency response ↑	No effect (distracted driving)
Other (Sumer 2003)		No effect
Other drivers (fleet service drivers) Harland et al., 2016				Phone use ↑
Taxi drivers (Asefa et al., 2015)	No effect	Previous traffic violation ↑	Speedy driving ↑	Phone use ↑ Listening to mass media ↓
Taxi drivers (La et al., 2013a)	Seat belt use ↓	Previous traffic violation ↑		No effect (phone use)
Taxi drivers (Peng et al., 2020)		Reckless driving ↑	Speeding ↑
Taxi drivers (Wang et al., 2015)	No effect	No effect	No effect	No effect (phone use)
Taxi drivers (Wang et al., 2019)			Speeding ↑
Truck drivers (Oliveira et al., 2016)	No effect	Previous traffic violation/ticket ↑	No effect
Truck drivers (Swedler et al. 2015)		No effect
Truck drivers (Thiese et al., 2015)				Phone use ↑
Summary	[2/6] Seat belt use (2) ↓	[7/12] Previous traffic violation (5), reckless and aggressive driving (2), driving while ill or drunk (1) ↑	[6/8] Speedy driving (2), speeding (3), lower speed limit during emergency response (1) ↑	[4/8] Listening to mass media (1) ↓ Phone use (4) ↑

Note: Sorted by occupational type. MT = multiple types of drivers.

^Stated significant in the text but p-values not reported. ↑ = Increase risk, ↓ = Decrease risk.

Table 8. Risk factors for road traffic crashes among professional drivers in the external factors domain.

Participants (author) (n = 13)	Area and road condition (n = 10)	Freight type (n = 3)	Season/weather (n = 6)	Vehicle factors (n = 2)	Other (n = 2)
Bus drivers (Hamed et al., 1998)	No effect (suburb, rural, urban area)^		No effect (weather)
Bus drivers (La et al., 2013b)					Migrate from other province ↑
MT (bus and truck drivers) (Tzamalouka et al., 2005)		Fruit/vegetables and livestock ↑			No effect (church attendance)
MT (Ezeibe et al., 2019)	Traffic sign deficit ↑
MT (Howard et al. 2004)	Interstate/country driving ↓
MT (large passenger vehicles and truck drivers) (Mir et al. 2013)	Poor road conditions ↑			Brake/tire failures ↑
Taxi drivers (Asefa et al., 2015)	Wet roadway ↑			Faulty taxi ↑
Taxi drivers (Lam 2004)	No effect (special road feature)		No effect (weather)
Taxi drivers (Wang et al., 2015)	Wet pavement ↑		Adverse weather and bad visibility ↑
Truck drivers (Chu 2012)	Signalised rural area ↓	No effect (overload/improper load)	No effect (weather)
Truck drivers (Hong et al., 2019)	High traffic volume ↑		Snow, rain ↑
Truck drivers (long-distance) (Adejugbagbe et al., 2015)	Narrow roads, bad portions of tarred roads ↑		First quarter of year ↑		Saturday ↑
Truck drivers (Thiese et al., 2015)		No effect (loading/unloading of trucks)
Summary	[8/10] Interstate/country driving (1), signalised rural area (1) ↓ Poor road conditions (2), wet roads (2), high traffic volume (1), narrow roads (1) traffic sign deficit (1) ↑	[1/3] Fruit, vegetables and livestock (1) ↑	[3/6] First quarter of year (1), adverse weather (1), bad visibility (1), snow (1), rain (1) ↑	[2/2] Faulty vehicle (2) ↑	[1/2] Migrate from other province (1), Saturday (1) ↑

Note: Sorted by occupational type. MT = multiple types of drivers.

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