Alzheimer's disease mortality among taxi and ambulance drivers: population based cross sectional study.
Level 4 - case-series / case-control
Cross-sectional study of death certificate records
PubMed 39689964 · doi:10.1136/bmj-2024-082194
What was done
A population-based cross-sectional study analyzing US National Vital Statistics System death certificates from January 1, 2020, to December 31, 2022, for deceased adults aged 18 years and older with linked occupational data. The authors examined the proportion of deaths attributed to Alzheimer's disease across 443 occupations, comparing taxi and ambulance drivers against 441 other occupations after adjusting for age at death and sociodemographic factors.
What was found
Among 8,972,221 decedents with occupational records, 3.88% (348,328) had Alzheimer's disease listed as a cause of death. Unadjusted Alzheimer's mortality was 1.03% (171/16,658) in taxi drivers and 0.74% (10/1,348) in ambulance drivers. After adjustment, ambulance drivers (0.91%, 95% confidence interval 0.35% to 1.48%) and taxi drivers (1.03%, 95% CI 0.87% to 1.18%) demonstrated the lowest proportion of Alzheimer's deaths among all 443 occupations. This relationship was not present in other transportation roles requiring less real-time navigational processing, nor was it seen for other dementia types.
Why it matters
These findings provide large-scale population-level data indicating that lifetime involvement in occupations demanding high real-time spatial navigation is associated with lower proportionate Alzheimer's mortality.
Limits
The proportionate mortality cross-sectional design cannot measure absolute incidence or establish causality. Cause-of-death determinations relied entirely on death certificates without clinical or neuropathological confirmation. Occupational title at death does not capture lifetime work history, actual navigation practices (e.g., GPS reliance), or individual cognitive baseline.
Cited by
- contradicts Studies show that London taxi drivers do not get Alzheimer's disease.