The Syndemic Attrition Crisis of European Truck Drivers: A Systems-AI Framework to Transform Research and Policy.

Truck drivers sustain the movement of goods across Europe, yet the sector faces a concurrent health and workforce retention crisis-mirroring trends observed in North America. Approximately 426,000 driver positions remain unfilled across Europe, while rates of fatigue, sleep disruption, obesity, depression, musculoskeletal pain, and cardiometabolic disease are markedly higher among drivers than in the general working population. These challenges are often framed as isolated hazards or lifestyle-related outcomes. However, growing evidence indicates that they emerge from cumulative, interacting exposures shaped by working conditions, employment structures, mobility regimes, and related nonwork factors rather than drivers' behaviors alone. This paper introduces the working-life-exposome of European truck driving (WLE-ETD)-a systems-science paradigm for understanding how biological, behavioral, psychosocial, occupational, environmental, and sociostructural domains interact across the working lifecourse to shape health and workforce participation. The WLE-ETD conceptualizes driver health deterioration and labor shortages as co-produced outcomes of a shared exposure ecosystem rather than separate problems. It further outlines how longitudinal, multimodal data streams-integrating surveys, administrative records, biomarkers, wearables, environmental sensors, audits, and psychosocial assessments-can be linked with network epidemiology and interpretable AI to identify syndemic "nodes" that disproportionately drive both chronic disease and premature workforce withdrawal. By reframing this crisis as a systems-level outcome, the WLE-ETD provides a foundation for anticipatory prevention, cross-sector intervention design, and coordinated European policy action. Addressing the syndemic attrition crisis requires alignment across labor regulation, rest infrastructure, employment protections, and population health services. The WLE-ETD offers a conceptual and operational roadmap for such integrated approaches.