Five-year trend of blood pressure among industrial workers in Haryana, India: A record-based analysis

Mitasha Singh; Pooja Goyal; Shweta Goswami; Kriti Yadav; Mithilesh Kumar; Sneha Kumari

doi:10.4103/AMJM.AMJM_2_23

ORIGINAL ARTICLE

Year : 2023 | Volume : 19 | Issue : 1 | Page : 9-13

Five-year trend of blood pressure among industrial workers in Haryana, India: A record-based analysis

Mitasha Singh, Pooja Goyal, Shweta Goswami, Kriti Yadav, Mithilesh Kumar, Sneha Kumari
Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India

Date of Submission	13-Feb-2023
Date of Acceptance	04-Mar-2023
Date of Web Publication	28-Mar-2023

Correspondence Address:
Kriti Yadav
Room No. 408, Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana 121001
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AMJM.AMJM_2_23

Abstract

Background: The burden of noncommunicable diseases (NCDs) has very swiftly seeped into all the classes of our society. It was a belief, a few decades back, that these diseases cannot affect the labor class or industrial workers. However, this has been proved wrong. Objective: To determine the trend of blood pressure among industrial workers at the same factory recorded between 2018 and 2022. Materials and Methods: A record-based analysis was conducted on the available records of health screening camps conducted at a steel dockyard located in Haryana, India. The blood pressure was measured using standard technique and was used as the outcome variable. Among all the records, data of 18 workers were available for all the five visits. Their trend was presented over the 5-year period. To account for regression to mean and effect of passage of time on blood pressure measurements of the industrial workers, repeated measures linear regression analysis was conducted on 18 observations at five points of time. Results: The prevalence of hypertension was 24.8% in the year 2018, it increased to 25.7% in 2020 and then drastically reduced to 16.8% in 2022. Among the 18 workers who were screened on all five visits, two were known hypertensives and taking treatment. Their mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) demonstrated a rising trend from baseline mean SBP of 126.61 ± 12.50 to 132.89 ± 16.19 mmHg and DBP of 81.72 ± 6.46 to 84.39 ± 12.31 mmHg. The estimated mean blood pressure in the repeated measures model was higher than the original means (although both followed the same trend over time). Although the blood pressure values of the industrial workers depicted a rising trend, the reported prevalence of hypertension was quite low. Therefore, the huge chunk of industrial population being constantly exposed to strenuous working conditions comprise of a highly vulnerable group warranting regular NCD screening and tracking.

Keywords: Camp based, factory workers, hypertension, screening

How to cite this article:
Singh M, Goyal P, Goswami S, Yadav K, Kumar M, Kumari S. Five-year trend of blood pressure among industrial workers in Haryana, India: A record-based analysis. Amrita J Med 2023;19:9-13

How to cite this URL:
Singh M, Goyal P, Goswami S, Yadav K, Kumar M, Kumari S. Five-year trend of blood pressure among industrial workers in Haryana, India: A record-based analysis. Amrita J Med [serial online] 2023 [cited 2023 Jun 4];19:9-13. Available from: https://ajmonline.org.in/text.asp?2023/19/1/9/372704

Introduction

Industrial workers are the major backbone of a country’s economy, and the health of this productive population is the responsibility of the nation. The workplace is a great opportunity to access a big proportion of the population and to track the patients, which is an important step in case of noncommunicable disease (NCD). India has entered the stage of manmade and degenerative disease stage of epidemiological transition where the cause of mortality has shifted from communicable to noncommunicable diseases.^[1] The disease burden profile of the northern state Haryana shows that the majority of deaths occurred in the age group 40–69 years old. The top causes of mortality are cardiovascular diseases, cancers, and diabetes. NCDs like HIV and tuberculosis have yet not been eliminated but their burden has decreased since 1990.^[2] Hence, the epidemiological transition of the nation is evident in this state too.

Being a silent disease, screening is the only route to detect hypertension (HTN) at early stage. Hence, health camps conducted among industrial workers are used as an opportunistic screening tool for detecting HTN among industrial workers. Around 25% of the Indian population contributes to industrial workforce.^[3] Industrial sector now contributes around 25.92% of gross domestic product of India.^[4] Literature from camp-based approach for determining the prevalence of HTN reported 17% prevalent hypertensives among adult workers screened in 2019 from Faridabad, Palwal, Gurugram, and Kurukshetra.^[5] Prevalent studies are common, but there is scarcity of follow-up studies among workplaces that too among factory workers to track blood pressure. Hence, using the records of the health screening camps from the same setting, the study was conducted to determine the trend of blood pressure among industrial workers recorded between 2018 and 2022.

Materials and Methods

This is a record-based descriptive study. The tertiary care center at Faridabad, Haryana, has been organizing several health screenings camps in different factories for insured workers aged 18 years and above under the Employee’s State Insurance (ESI) act. Under this social security scheme, those employed in factories and earning 21,000 INR or less per month are eligible for medical and other benefits. The medical benefits are provided through ESI dispensaries and hospitals. The family members of the insured person are dependents of the person and liable for medical benefits too. There are around 15,528 industries registered under the ESI act in the Faridabad district with more than 10 lakh insured persons. Steel stockyard situated in Palwal subdistrict has been visited for the camps five times from 2018 to 2022. The unit catered only male workers as they are majorly employed in carrying heavy packages. At every visit, workers (minimum of 56 and maximum of 91) were screened for HTN using Omron Digital Blood pressure measuring instrument (Omron healthcare manufacturing Vietnam Co. Ltd, Vietnam). All workers present at each visit were screened, none of them refused as annual screening was a mandatory activity by the employer. From the available data of total workers screened on each visit, it was observed that 18 workers were available for screening on all five visits.

Before the measurement, 10-min rest was assured and the use of standard cuffs for adults minimized variation in measurement. Measurements were obtained from both arms, and two measurements were performed with a 1–2-min interval between them, with the participant in a sitting position. The mean of the two blood pressure measurements was considered the most accurate blood pressure and was used for statistical analyses. HTN was defined as a systolic blood pressure (SBP) of greater than or equal to 140 mmHg and/or diastolic blood pressure (DBP) of greater than or equal to 90 mmHg.

The ethical approval was sought from the institutional ethics committee vide letter number 134X/11/13/2022-IEC/73. Participants who were found to have a higher trend of blood pressure were counseled to seek medical advice and make lifestyle modifications on subsequent visits.

Data analysis was conducted using SPSS version 21 (IBM SPSS for Windows, Version 21.0. USA). SBP, DBP, and age were presented as mean and standard deviation. General linear repeated measures model was run with 18 workers’ readings for 5 years as dependent variable. The SBP and DBP variables were normally distributed. Age group (categorical variable; below and above 30 years old) and treatment for HTN (yes and no) were taken as factors and the latest weight of participants as covariate. Statistical significance was taken as P < 0.05.

Results

The health checkup at five different points of time at the same industrial unit did not reveal a linear trend of proportion of HTN among the workers. It was 24.8% in the year 2018, increased to 25.7% in 2020, and further reduced to 16.8% in 2022. The mean age was at its peak during 2020 coinciding with a higher proportion of HTN. All workers were males. The mean SBP was maximum during the year 2022 (125.28 ± 14.72) [Table 1].

Table 1: Trend of blood pressure during 5 years of visit at the steel stockyard

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Of all the workers screened, there were 18 of them who were present at all five visits. The majority (77.7%) of the workers reported a rise in SBP with a mean rise of 8 mmHg (SD, ±16 mmHg), whereas DBP was shown to have a mean rise of 3 mmHg (SD, ±13 mmHg) for 61% of the workers (2018–2022). Although mean age was higher among those who were hypertensive (32.9 ± 7.9 years) compared with nonhypertensive (25.9 ± 4.8 years), it was statistically nonsignificant. Similarly, mean weight was higher among those who were hypertensive (20.1 ± 6.4 kg) compared with nonhypertensive (17.1 ± 6.0 kg), but it was not statistically significant.

Mauchly’s test of sphericity indicated that assumption of sphericity had been violated, showing that variances of the differences of SBP (W = 0.24, χ² (9) = 17.65, P = 0.04) and DBP (W = 0.08, χ² (9) = 30.82, P < 0.001) are not equal. Therefore, a Greenhouse-Geisser correction was applied (η² = 0.12 for SBP and 0.07 for DBP). Repeated measures analyses using correction found statistically nonsignificant change in SBP (P = 0.92) and DBP (P = 0.41) over 5-year period [Table 2] and [Table 3]. The estimated SBP and DBP means in the repeated measures model [Figure 1] and [Figure 2] were higher than the original means (although both followed the same trend over time). The increase in estimated mean blood pressure (BP) from baseline to fifth follow-up was statistically nonsignificant both when accounted for treatment of HTN and age group of participants.

Table 2: Within subjects’ effects for SBP (ANCOVA-repeated measures model)

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Table 3: Within subjects’ effects for DBP (ANCOVA-repeated measures model)

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Figure 1: Original SBP versus estimated SBP after subjecting to general repeated measures model for 18 workers

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Figure 2: Original DBP versus estimated DBP after subjecting to general repeated measures model for 18 workers

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Discussion

Utilizing the opportunity to screen the apparently healthy workforce in their own industrial workplace for NCDs can emerge as a feasible tool for calculating the correct burden of HTN or other such diseases. The house-to-house surveys usually have a drawback of missing the male workforce of the family. At the time of interview, they are mostly at their workplaces. Through the series of health checkup camps at the same steel stockyard, where only male workers were employed the trend of mean blood pressure, was analyzed at different visits. There was no linear trend observed; however, the overall mean SBP and DBP increased at the setting. The overall prevalence of HTN was highest in 2020 (prepandemic phase) (25.7%) and lowest in 2019 (12.4%). The prevalence, however, decreased in postpandemic phase. Mean age and weight were higher among hypertensives. In a study on factory workers of Bangladesh by Bhowmik et al.,^[6] with a mean age of 38.9 years, the prevalence of HTN was reported as 27.9%. Fatema et al.^[7] reported a prevalence of HTN as 14.5% among garment factory workers, the majority between 26 and 35 years old. Although, there is not much evidence of similar research done among industrial workers in the state, the national family health survey-V^[8] data for Haryana report quite higher prevalence (25.1%) of elevated blood pressure among adult men aged 15 years and above. The low prevalence of HTN in the present study could be attributed to its small sample size.

Among the 18 participants, the mean BP increased in postpandemic phase. In a study by Akpek^[9] to evaluate the effect of coronavirus disease 2019 (COVID-19) on HTN in the short-term post-COVID-19 period, a significant increase in SBP and DBP was reported. Angiotensin-converting enzyme 2 in severe acute respiratory syndrome coronavirus 2 infection has been suggested to play a role in the pathogenesis of HTN in COVID-19.^[10]

Since repeated measurements were made on the same subject, values of blood pressure could have been subjected to random error. The possibility of observing relatively low BP followed by high BP near the subject’s true mean could arise due to repeated measurements in the same subject. This phenomenon of regression to mean (RTM) occurs in any variable that is subject to random error. To rule out RTM as a cause of observed change in BP of each subject’s follow-up, measurement was adjusted according to their baseline measurement using general linear model. The estimated SBP and DBP were higher than observed (when age, weight, and treatment for HTN were accounted for), although not statistically significant. Hence, the clustering of observations may not be proved.

As the expected values from the model are higher than the observed values, the regression equation does not completely predict the change in blood pressure values over time as a function of age, weight, and treatment history. A lot of variation remains unexplained, which could have been better explained by inclusion of other factors (modifiable and nonmodifiable viz family history, smoking, alcohol, physical inactivity, unhealthy diet, comorbidities, impact of COVID-19 pandemic, etc).

Small sample size, failure to track all the study participants throughout the study period of 5 years due to migration/unavailability of workers, and noninclusion of all the variables that could have explained the variation in blood pressure values are some of the limitations of the study.

Conclusion

The present study reflects upon the dire need for intensified screening of NCDs among the underserved industrial population so as to obtain accurate data on the prevalence of NCDs in this highly vulnerable section of population exposed to difficult working conditions. This could help formulate the policies and pave the future course of actions directed towards this highly vulnerable working population of the country.

Acknowledgments

The authors are grateful to the employer and employees of the steel dockyard who are forthcoming and participate in annual checkup. The authors extend their gratitude to the Dean and Academic Registrar of the institute whose constant motivation helps them in contributing for evidence generation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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