Mortality among workers in an Italian cigarette factory

A cohort study was conducted to evaluate the mortality pattern among female and male workers in a cigarette factory. The study followed 972 female workers and 761 male workers with at least 6 months of cumulative employment from 1 January 1962 through 1 July 1996. Among women, mortality from all causes of death [standardized mortality ratio (SMR) = 0.9; 95% confidence interval (CI) = 0.8-1.1] and mortality from all malignant neoplasms (SMR = 1.1; CI = 0.9-1.3) were consistent with reference rates. Male workers had a significantly reduced overall mortality (SMR = 0.8; CI = 0.7-0.9), while mortality from all malignant neoplasms was as expected (SMR = 0.9; CI = 0.7-1.0). Among female workers the frequencies of deaths from diseases of nervous system (SMR = 2.0; CI = 1.1-3.4) and from non-Hodgkin's lymphoma (NHL) (SMR = 2.7; CI = 1.0-5.6) were elevated at a statistically significant level. No association between duration of employment and diseases of nervous system was observed. A higher risk for NHL, based on three deaths, was reported among female workers with 15 or more years of employment (SMR = 8.1; CI = 2.2-21.0). Although based on small numbers, the excess of NHL here reported suggests that potential exposure to foliar residues of pesticides should be thoroughly considered in tobacco manufacturing.     

Mortality among Catholic nuns certified as radiologic technologists

BACKGROUND: Several studies have shown that Catholic nuns have a different mortality experience than women of similar age in the general population. We had a unique opportunity to evaluate mortality patterns of nuns identified in an occupational study of nearly 145,000 radiologic technologists (73% female). METHODS: A total of 1,103 women were classified as nuns based on their titles of "Sister" or "SR". Their mortality experience was compared to other female radiologic technologists and to U.S. white females. RESULTS: Five hundred eighty-three nuns (53%) were deceased as of January 1, 1995. Compared to other technologists, nuns were at significantly increased risk of dying from all causes (Standardized mortality ratio (SMR)=1.1; 95% Confidence interval (CI)=1.0-1.2, stomach cancer (SMR=2.7; 95% CI=1.2-5.4), diabetes (SMR=2.2; 95% CI=1.0-4.1), ischemic heart disease (SMR=1.2; 95% CI=1.1-1.4), all digestive diseases (SMR=2.0; 95% CI=1.3-3.0), and gastric and duodenal ulcers (SMR=8.3; 95% CI=2.3-21.3). In contrast, we observed a significant deficit in lung cancer (SMR=0.5; 95% CI=0.2-0.9), no deaths from cervical cancer, and a breast cancer risk 10% lower than expected (SMR=0.9; 95% CI=0.6-1.3). When compared to U.S. females, nuns experienced significantly reduced mortality from all causes (SMR=0.8; 95% CI=0.7-0.9), cervical cancer (SMR=0.0; 95% CI=0.0-0.7), all endocrine, metabolic and nutritional diseases (SMR=0.5; 95% CI=0.3-0.9), all circulatory diseases (SMR=0.7; 95% CI=0.7-0.8) including ischemic heart disease and cerebrovascular disease, and all respiratory diseases (SMR=0.5; 95% CI=0.3-0.8), and a nearly significant deficit of diabetes (SMR=0.6; 95% CI=0.3-1.0). In contrast, nuns had an almost 3-fold greater risk of tuberculosis (SMR=2.9; 95% CI=1.4-5.3) and a 20% excess of breast cancer (SMR=1. 2; 95% CI=0.8-1.7). The breast cancer excess was concentrated among nuns first certified before 1940 (SMR=2.0; CI=1.3-3.0), when radiation doses were possibly the highest, but the risk did not increase with increasing length of certification. CONCLUSIONS: Compared with the general population, the mortality experience of nuns was favorable and reflected the "healthy worker effect" commonly seen in occupational studies. Patterns observed for breast and cervical cancer possibly indicate differences in reproductive and sexual activities associated with belonging to a religious order. The possibility of a radiation-related excess for breast cancer among nuns certified before 1940 cannot be completely discounted, although there was no dose-response relationship with a surrogate measure of exposure (number of years certified). When their mortality experience was compared with other radiologic technologists, the influence of lifestyle factors was not apparent. Am. J. Ind. Med. 37:339-348, 2000. Published 2000 Wiley-Liss, Inc. dagger     

Cancer risk for chemical workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin

Aims: To describe the long term mortality experience of a cohort of 2187 male chemical production workers previously exposed to substantial levels of dioxin.

Methods: Vital status for a previously identified cohort was determined for an additional 10 years, to 1995. Dioxin exposures took place before 1983 and were sufficient to result in chloracne in 245 individuals. Mortality rates were compared with national figures and with a large pool of co-workers in unrelated production jobs.

Results: All cancers combined (standardised mortality ratio (SMR) = 1.0, 95% CI 0.8 to 1.1) and lung cancer (SMR = 0.8, 95% CI 0.6 to 1.1) were at or below expected levels. Rates for soft tissue sarcoma (SMR = 2.4, 95% CI 0.3 to 8.6) and non-Hodgkin's lymphoma (SMR = 1.4, 95% CI 0.6 to 2.7) were greater than expected overall, but below expectation in the update period. No trend of increasing risk with increasing exposure was observed for these cancers. Workers who developed chloracne had very low all-cancer rates (SMR = 0.5, 95% CI 0.3 to 1.0), and lung cancer rates (SMR = 0.3, 95% CI 0.0 to 1.1).

Conclusions: We found no coherent evidence of increased cancer risk from dioxin exposure in this cohort. Our study highlights the wide range of cancer rates and the lack of consistency across dioxin studies.

     

Cancer mortality among women in the Russian printing industry.

BACKGROUND: This study evaluates cancer mortality among women employed in two large printing plants in Moscow. METHODS: A total of 3,473 women who were actively employed as of December 31, 1978, with a minimum of 2 years employment were followed from 1 January 1979 to 31 December 1993. There were 47,791 person-years observed, with only 51 women lost to follow-up (1.5%). Standardized mortality ratios (SMRs) were calculated using the population of Moscow to generate expected numbers. Analyses by job (compositors, press operators, and bookbinders), age hired, latency, and duration of employment were conducted. RESULTS: Among women employed in the two printing plants, there was a significant excess of esophageal cancer, based on seven deaths (expected = 2.7, SMR = 2.7, 95% CI = 1.1-5.4). Four of the seven esophageal cancer deaths occurred among bookbinders (expected = 1.0, SMR = 4.1, 95% CI = 1.1-10.4), all among workers hired before 1957 (expected = 0.6, SMR = 7.1, 95% CI = 1.9-18.3), the last year benzene was used in bookbinding. Ovarian cancer was also significantly elevated among bookbinders (12 observed, 4.2 expected, SMR = 2.9, 95% CI = 1.5-5.0), which, along with one death from mesothelioma of the abdomen, might be related to the use of asbestos-contaminated talc fillers in paper. Press operators had significantly elevated mortality from stomach cancer (observed = 9, expected = 4.1, SMR = 2.2, 95% CI = 1.0-4.2) and, based on two deaths each, melanoma and bladder cancer. CONCLUSIONS: Women in this printing industry cohort experienced excess mortality of cancer of the esophagus and stomach, with suggested increases of melanoma and bladder cancer. Further follow-up of this cohort, which would allow more in-depth analysis of rare cancer sites, latency, and duration of employment, is warranted. Gender comparisons within the cohort should also be conducted to clarify the role of occupational and lifestyle factors in the etiology of cancer among workers in the printing industry.     

Suicide among Indigenous Sami in Arctic Norway, 1970–1998

Suicide mortality was examined between 1970 and 1998 in a cohort of 19,801 persons categorized as indigenous Sami in Arctic Norway. Standardized mortality ratios (SMR) were calculated using the suicide rates of the rural population of Arctic Norway as reference. There was a significant moderate increased risk for suicide among indigenous Sami (SMR = 1.27, 95% Confidence interval (CI): 1.02–1.56). In the study period, 89 suicides occurred in the cohort (70 men and 19 women) with increased suicide mortality both for indigenous Sami males (SMR = 1.27; 95% CI: 0.99–1.61) and females (SMR = 1.27; 95% CI: 0.77–1.99). Significant increased suicide mortality was found for young Sami aged 15–24 for both males (SMR = 1.82; 95% CI: 1.13–2.78) and females (SMR = 3.17; 95% CI: 1.17–6.91). Significant increased suicide mortality was found for indigenous Sami males residing in Sami core area (SMR = 1.54; 95% CI: 1.04–2.20) and for indigenous Sami males not belonging to semi-nomadic reindeer herding (SMR = 1.30; 95% CI: 1.00–1.65). Clusters of suicides in Sami core area may explain the increased suicide mortality found in subgroups among indigenous Sami.     

Mortality among workers exposed to polychlorinated biphenyls (PCBs) in an electrical capacitor manufacturing plant in Indiana: an update

An Indiana capacitor-manufacturing cohort (n=3,569) was exposed to polychlorinated biphenyls (PCBs) from 1957 to 1977. The original study of mortality through 1984 found excess melanoma and brain cancer; other studies of PCB-exposed individuals have found excess non-Hodgkin lymphoma and rectal, liver, biliary tract, and gallbladder cancer. Mortality was updated through 1998. Analyses have included standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) using rates for Indiana and the United States, standardized rate ratios (SRRs), and Poisson regression rate ratios (RRs). Estimated cumulative exposure calculations used a new job-exposure matrix. Mortality overall was reduced (547 deaths; SMR, 0.81; 95% CI, 0.7-0.9). Non-Hodgkin lymphoma mortality was elevated (9 deaths; SMR, 1.23; 95% CI, 0.6-2.3). Melanoma remained in excess (9 deaths; SMR, 2.43; 95% CI, 1.1-4.6), especially in the lowest tertile of estimated cumulative exposure (5 deaths; SMR, 3.72; 95% CI, 1.2-8.7). Seven of the 12 brain cancer deaths (SMR, 1.91; 95% CI, 1.0-3.3) occurred after the original study. Brain cancer mortality increased with exposure (in the highest tertile, 5 deaths; SMR, 2.71; 95% CI, 0.9-6.3); the SRR dose-response trend was significant (p=0.016). Among those working >or= 90 days, both melanoma (8 deaths; SMR, 2.66; 95% CI, 1.1-5.2) and brain cancer (11 deaths; SMR, 2.12; 95% CI, 1.1-3.8) were elevated, especially for women: melanoma, 3 deaths (SMR, 5.99; 95% CI, 1.2-17.5); brain cancer, 3 deaths (SMR, 2.87; 95% CI, 0.6-8.4). These findings of excess melanoma and brain cancer mortality confirm results of the original study. Melanoma mortality was not associated with estimated cumulative exposure. Brain cancer mortality did not demonstrate a clear dose-response relationship with estimated cumulative exposure.     

Evaluation of mortality and cancer incidence among alachlor manufacturing workers.

Alachlor is the active ingredient in a family of preemergence herbicides. We assessed mortality rates from 1968 to 1993 and cancer incidence rates from 1969 to 1993 for manufacturing workers with potential alachlor exposure. For workers judged to have high alachlor exposure, mortality from all causes combined was lower than expected [23 observed, standardized mortality ratio (SMR) = 0.7, 95% CI, 0.4-1.0], cancer mortality was similar to expected (6 observed, SMR = 0.7, 95% CI, 0.3-1.6), and there were no cancer deaths among workers with 5 or more years high exposure and 15 or more years since first exposure (2.3 expected, SMR = 0, 95% CI, 0-1.6). Cancer incidence for workers with high exposure potential was similar to the state rate [18 observed, standardized incidence ratio (SIR) = 1.2, 95% CI, 0.7-2.0], especially for workers exposed for 5 or more years and with at least 15 years since first exposure (4 observed, SIR = 1.0, 95% CI, 0.3-2.7). The most common cancer for these latter workers was colorectal cancer (2 observed, SIR 3.9, 95% CI, 0.5-14.2 among workers). Despite the limitations of this study with respect to small size and exposure estimating, the findings are useful for evaluating potential alachlor-related health risks because past manufacturing exposures greatly exceeded those characteristic of agricultural operations. These findings suggest no appreciable effect of alachlor exposure on worker mortality or cancer incidence rates during the study period.     

Retrospective cohort mortality study of cancer among sewage plant workers

There is little known about the incidence of cancer among sewage workers. In this paper we examine findings from a retrospective cohort study of 487 white male sewer authority workers employed between January 1950 and October 1979. Vital status was ascertained for 93% of the cohort yielding a total of 6,886 person years. Total mortality from all causes was comparable to that of the general white male U.S. population (Standardized Mortality Ratio [SMR] = 0.91, 95% Confidence Interval [CI] = 0.77-1.07). The cohort was subdivided into those not exposed, and sewer workers who were exposed to sewage effluent, sludge, or wastewater containing chemicals including potential carcinogens. Among the nonexposed group, mortality from all causes was significantly low (SMR = 0.55, 95% CI = 0.33-0.88). Among the exposed sewer workers, mortality from all causes was not significantly different from that of the general white male U.S. population (SMR = 1.00, 95% CI = 0.84-1.19). Mortality from all cancers among exposed sewer workers was slightly higher than that of the general population (SMR = 1.19, 95% CI = 0.79-1.7). Statistically significant elevated mortality ratios were seen for cancer of the larynx (SMR = 7.93, 95% CI = 1.59-23.96), and cancer of the liver (SMR = 5.4, 95% CI = 1.10-16.05). Careful study of the medical and occupational histories of these cases suggested that larynx cancer was possibly work-related, while liver cancer was not. A group estimated to be the highest exposed, composed predominantly of operatives, had a higher directly adjusted death rate from all malignant neoplasms combined compared to all other workers (rate ratio = 1.64). These findings of increased risk of cancer among exposed sewage workers, especially operators, are based on small number of cases and should be interpreted with caution. Studies of larger cohorts are needed to clarify the risk of these cancers among sewage workers.     

Extended mortality follow-up of a cohort of dry cleaners

PURPOSE: The mortality follow-up of a cohort of dry cleaners was extended to further evaluate cancers risks associated with organic solvents. METHODS: The underlying and contributing causes of death among 5,369 members of a dry cleaning union in St. Louis were determined through December 31, 1993. The mortality experience of the cohort was compared to that of the US population adjusted for age at entry, year of death, race and gender. RESULTS: The total mortality was about as expected (SMR = 1.0, N = 2351, 95% CI = 1.0-1.1). Excesses were observed for emphysema (SMR = 1.7, N = 21, 95% CI = 1.0-2.5), Hodgkin's disease (SMR = 2.0, N = 5, 95% CI = 0.6-4.6) and cancers of the esophagus (SMR = 2.2, N = 26, 95% CI = 1.5-3.3), larynx (SMR = 1.7, N = 6, 95% CI = 0.6-3.7), lung (SMR = 1.4, N = 125), 95% CI = 1.1-1.6), and cervix (SMR = 1.6, N = 27, 95% CI = 1.0-2.3). These excesses occurred among men and women and blacks and whites. Bladder cancer was elevated among white men and women and kidney cancer among black men and women, but not significantly so. None of these causes of death showed strong relationships with duration or estimated level of exposure to dry cleaning solvents, although relative risks for cancers of the larynx, lung and kidney were larger among subjects estimated to have higher levels of exposure and risks from bladder cancer and chronic nephritis were greater among persons who entered the union after 1960. CONCLUSION: The excesses observed are unlikely to be due to chance because most occurred in earlier as well as the recent follow-up. The specific factors contributing the excesses, however, are not clear. Socioeconomic, lifestyle, and occupational exposures are all possibilities. Lack of information on socioeconomic and lifestyle factors hampers evaluation.     

Mortality and cancer incidence among Lithuanian cement producing workers

Aims: To investigate mortality and cancer incidence of cement producing workers.

Methods: A total of 2498 cement workers who have been employed at Portland cement producing departments for at least one year from 1956 to 2000 were followed up from 1 January 1978 to 31 December 2000. The cohort contributed 43 490 person-years to the study. Standardised incidence ratios (SIR) and standardised mortality ratios (SMR) were calculated as ratios between observed and expected numbers of cancers and deaths. The expected numbers were based on sex specific incidence and mortality rates for the total Lithuanian population.

Results: Significantly increased SMRs were found for all malignant neoplasms (SMR 1.3, 95% CI 1.0 to 1.5) and for lung cancer (SMR 1.4, 95% CI 1.0 to 1.9) among male cement workers. SIR for all cancer sites was 1.2 (95% CI 1.0 to 1.4). Excess risk was found for cancer of the lung (SIR 1.5, 95% CI 1.1 to 2.1). The SIR for urinary bladder cancer was also increased (SIR 1.8, 95% CI 0.9 to 3.5). The overall cancer incidence was not increased among females (SIR 0.8, 95% CI 0.6 to 1.1). With increasing cumulated exposure to cement dust, there were indications of an increasing risk of lung and stomach cancers among males.

Conclusions: This study supported the hypothesis that exposure to cement dust may increase the lung and bladder cancer risk. A dose related risk was found for stomach cancer, but no support was found for an increased risk of colorectal cancer.

     

Occupational risk factors for mortality from stomach and lung cancer among rubber workers: an analysis using internal controls and refined exposure assessment

OBJECTIVES: To determine occupational risk factors for stomach and lung cancer among workers in the German rubber industry. METHODS: A cohort of all male German rubber workers (n = 11,633) who had been employed for at least one year in one of five study plants and who were alive and actively employed or retired on 1 January 1981 was followed for mortality from 1 January 1981 through December 1991. A subcohort of n = 8,933 workers who were hired after 1 January 1950 was defined to focus on working conditions in the more recent rubber industry. Work histories were reconstructed using routinely documented 'cost centre codes' and classified into six work areas as well as subgroups of some work areas. The work areas are: 1. preparation of materials, 2. production of technical rubber goods, 3. production of tyres, 4. storage and dispatch, 5. maintenance, 6. others. Standardized mortality ratios (SMR) and Cox proportional hazards models were calculated for each of the work areas (>1 year of employment in the respective work area). Hazard rate ratios were adjusted for age (time marker) and stratified for year of hire (1950-1959, > or =1960) and years of employment in the respective work area (1-9 years, > or =10 years); years of employment were lagged 10 years to account for latency. RESULTS: Compared to the national reference population mortality from cancer of stomach (observed 44, SMR = 117; 95% CI: 85-157) and lung (observed 154, SMR = 123; 95% CI: 104-144) was slightly increased. Using internal controls we observed excess deaths from stomach cancer in work area 1 (relative risk [RR] = 2.3; 95% CI: 1.2-4.2) and from lung cancer in work areas 1 (RR = 1.7; 95% CI: 1.2-2.3), 2 (RR = 1.5; 95% CI: 1.1-2.1), and 3 (RR = 1.3; 95% CI: 0.9-1.8). On the basis of cumulative years of employment an exposure response relationship was observed for mortality from both cancer sites among a subcategory of work area 1: weighing and mixing. Increased risks were also seen for lung cancer among workers employed in production of technical rubber goods. CONCLUSION: Our results support an association between an excess mortality from stomach and lung cancer and employment in early production stages of rubber manufacturing, especially weighing and mixing. This may point to an aetiologic role of asbestos or carbon black. For stomach cancer additional risk factors, e.g. exposure to dust and talc, deserve further investigation. The results of the present study do not support a causal role of nitrosamines for stomach or lung cancer.     

Mortality in a cohort of sugar refinery workers in Arezzo Province, Italy

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate mortality of a cohort of 1,767 male workers employed in a sugar refinery plant located in the Province of Arezzo, Italy, where asbestos had been used from the 1960's for the insulation of thermohydraulic systems and for furnaces. In 1987-88 workers removed the asbestos-cement insulation from the plant. METHODS: The cohort was composed by male workers who were employed in the plant between 1 March 1962 and 1 February 1996, and had worked for at least 2 months. Follow-up started on 1 March 1962, and ended on 31 May, 2003. The population mortality for Tuscany Region was used as the reference. The relative risk was estimated by Standardized Mortality Ratio (SMR) and the confidence intervals were calculated at a 95% level (95% CI). RESULTS: The majority of workers were employed during the summer only. Significant decreases in mortality were observed for overall mortality (SMR = 78; 95% CI = 69-88), all cancers (SMR = 80; 95% CI = 65-97), cardiovascular diseases (SMR = 64; 95% CI = 50-81), lung cancer (SMR = 66; 95% CI = 43-98), and gastrointestinal diseases (SMR = 53; 95% CI = 26-98). Non-significant increases were observed for kidney cancer (SMR = 229; 95% CI = 92-472), and diseases of the nervous system (SMR = 155; 95% CI = 71-294). Kidney cancer mortality for workers employed for > = 5 years was significantly higher (SMR = 508; 95% CI = 105-1485). CONCLUSIONS: Mortality for asbestos-related diseases did not show any increase. The higher kidney cancer mortality for workers employed for > = 5 years could be due to exposures to various carcinogens, that occurred not only in the sugar refinery plant, given that the workers were seasonal and did other jobs during the rest of the year. Asbestos-related deaths could occur in the future among some workers who in 1987-88 were employed on the removal of asbestos-cement insulation from the plant.     

Mortality from bladder cancer in dyestuff workers exposed to aromatic amines: A 73-year follow-up

Objective:To update the analysis of mortality of a cohort of dyestuff workers, in northern Italy, heavily exposed to carcinogenic aromatic amines.Methods:We updated to 2018 overall and cause-specific mortality in a cohort of 590 male workers heavily exposed to carcinogenic aromatic amines in a dyestuff factory from 1922 to 1972. Workers were censored at age 85. Expected cases for the period 1946-2018 were computed using Piedmont mortality rates and standardized mortality ratios (SMR) were computed.Results:Between 1946 and 2018, 470 deaths were reported. The overall SMR from all causes was 1.59 (95% confidence interval [CI] 1.45-1.74) and the SMR from all cancers was 2.05 (95% CI = 1.77-2.37); compared to a previous report, there were 4 additional deaths from bladder cancer, for a total of 60 deaths compared with 4.0 expected (SMR 14.86, 95% CI 11.34-19.12). The SMR for bladder cancer increased with younger age at first exposure and longer duration of exposure, while it decreased with time since last exposure, albeit it was still 3.5, 30, or more years since last exposure. An increased risk was observed among workers exposed to fuchsine or ortho-toluidine (SMR=16.3; 95% CI = 6.0-35.5).Conclusions:This 73-year follow-up confirms the results from previous analyses, with increased overall mortality, and increased mortality from all cancers and especially for bladder cancer. The excess risk of bladder cancer persisted several decades after stopping exposure.     

Mortality in male and female capacitor workers exposed to polychlorinated biphenyls

A mortality study was conducted in workers with at least 90 days' exposure to polychlorinated biphenyls (PCBs) between 1946 and 1977. Vital status was established for 98.7% of the 7075 workers studied. In hourly male workers, the mortality from all cancers was significantly below expected (standardized mortality ratio [SMR] = 81; 95% confidence interval [CI], = 68 to 97) and comparable to expected (SMR = 110; 95% CI, 93 to 129) in hourly female workers. No significant elevations in mortality for any site-specific cause were found in the hourly cohort. All-cancer mortality was significantly below expected in salaried males (SMR = 69; 95% CI, 52 to 90) and comparable to expected in salaried females (SMR = 75; 95% CI, 45 to 118). No significant elevations were seen in the most highly exposed workers, nor did SMRs increase with length of cumulative employment and latency. None of the previously reported specific excesses in cancer mortality were seen. This is the largest cohort of male and female workers exposed to PCBs. The lack of any significant elevations in the site-specific cancer mortality of the production workers adds important information about human health effects of PCBs.     

Cancer mortality among workers in the meat department of supermarkets.

OBJECTIVES--The aim was to study the risk of dying from cancer among workers in the meat department of supermarkets potentially exposed to oncogenic retroviruses and fumes during the wrapping and labelling of meat. METHODS--Cancer mortality for the period 1949 to 1989 was compared in a previously studied cohort of 10,841 members of a local meatcutters' union in Baltimore, Maryland who worked in the meat department of supermarkets, after an extended follow up of nine years (1981-9). Person-years and deaths were apportioned in five-year intervals by sex, age, and calendar year, and standardised mortality ratio (SMR) and proportional mortality ratio (PMR) analyses were conducted. The United States general population was used as the comparison group. Analyses of SMR and PMR were also conducted for a control group of workers from the same union who worked exclusively in non-meat companies. RESULTS AND DISCUSSION--Among women, an SMR of 1.6 (95% confidence interval (95% CI) 1.1-2.2) and a PMR of 1.5 (95% CI 1.0-2.0) for lung cancer were found. For men, the SMR for cancer of the buccal cavity and pharynx was 1.8 (95% CI 1.0-3.0), and for colon cancer it was 1.5 (95% CI 1.1-2.1). The respective PMRs were 1.9 (95% CI 1.1-3.1) and 1.5 (95% CI 1.1-2.1). Whereas the role of non-occupational factors needs to be taken into account before occupational factors can be implicated in the occurrence of the excess of cancer of the buccal cavity and pharynx, and colon cancer in men, there is reason to suspect that occupational factors may be responsible for the lung cancer excess in women. Thus exposures that occur predominantly in women, such as exposure to fumes during wrapping and labelling, should be investigated as to their role in this excess.     

Mortality among augmentation mammoplasty patients

Much attention has focused on disease risks among women receiving silicone breast implants, but there has been little evaluation of their mortality experience. We undertook a retrospective cohort study of 13,488 women receiving cosmetic implants and 3,936 patients with other types of plastic surgery at 18 plastic surgery practices. After an average of 13 years of follow-up, deficits in overall mortality were found as compared with the general population (U.S. rates) for both implant [255 deaths; standardized mortality ratio (SMR) = 0.69, 95% confidence interval (CI) = 0.6-0.8] and comparison subjects (125 deaths; SMR = 0.58, 95% CI = 0.5-0.7). These findings indicate that patients seeking plastic surgery are in general healthier than their peers. Implant patients, however, experienced excess risks of death compared with the general population for brain cancer (SMR = 2.45) and suicide (SMR = 1.54). Internal analyses showed a higher overall mortality among the implant than among the comparison patients (relative risk = 1.27, 95% CI = 1.0-1.6). This overall excess reflected increases for respiratory tract (SMR = 3.03) and brain (SMR = 2.25) cancers and for suicide (SMR = 4.24).     

Serum cholesterol--risk factor for coronary disease mortality in younger and older blacks and whites. The Charleston Heart Study, 1960-1988.

Serum total cholesterol (> or = 6.7 mmol/L) measured in 1960 in the Charleston Heart Study cohort was found to be a risk for mortality from coronary heart disease during the period of 1960 to 1988 in white men (relative risk [RR] 1.5; 95% confidence interval [CI]: 1.1, 2.2), white women (RR 1.7; 95% CI: 1.1, 2.7), and black women (RR 1.6; 95% CI: .9, 2.9) after age, systolic blood pressure, smoking status, education level, obesity, and diabetes were considered. For black men, the relative risk was .96 (95% CI, .39, 2.39). Only among white women was the relative risk (RR 2.4; 95% CI, 1.2, 4.5) increased among those in the older ages (55 to 74) in 1960. The evidence for cholesterol as a risk factor for coronary disease mortality in black men is inconclusive and requires further study.     

Prevalence of hepatitis A virus infection among sewage workers in Georgia

BACKGROUND: Wastewater (WW) workers could have opportunity for direct contact with raw sewage, which might contain hepatitis A virus (HAV). METHODS: A serologic survey of WW workers and a comparison population of roads and drainage workers (RD). Factors potentially associated with anti-HAV positivity were evaluated in univariate and multivariate analyses. RESULTS: Among the 365 WW workers, overall anti-HAV prevalence was 38%, similar to that (35%) of the 166 RD workers (P = 0.5). Prevalence varied by wastewater job type from 45% among the 164 field crew workers to 32% among the 201 treatment plant workers. In multivariate modeling, factors associated with anti-HAV positivity included age > or = 40 years (odds ratio [OR] = 2.4; 95% CI = 1.6-3.7), black compared to other races (OR = 2.4; 95% CI = 1.5-3.8), birth outside the United States (OR = 7.5; 95% CI = 3.0-18.6), a high school education or less (OR 2.1; 95% CI = 1.4-3.2) and work on the field crew compared to RD work (OR 1.6; 95% CI = 1.1-2.4). CONCLUSIONS: These results are consistent with no or a small increased risk of hepatitis A among WW workers, and do not provide a clear mandate for hepatitis A vaccination of these workers. Am. J. Ind. Med. 43: 172-178, 2003.     

Mortality among taxi drivers in Rome: A cohort study

The mortality pattern of taxi drivers in Rome as possibly exposed mainly to gasoline engine exhausts was evaluated by means of a historical cohort study. A total of 2,311 male subjects registered as taxi drivers between 1950 and 1975 was followed from 1965 through 1988. The overall mortality was lower than expected on the basis of regional (Latium) reference rates (692 deaths, standardized mortality ratio [SMR] = 0.89, 95% confidence interval [CI] 0.82–0.96), whereas the number of recorded deaths for malignant neoplasms was about the expected (205 deaths, SMR = 0.99, 95% CI 0.86–1.13). Mortality from circulatory and respiratory diseases was lower than expected. Diabetes was significantly increased (42 deaths, SMR = 1.73, 95% CI = 1.25–2.34). An increased SMR appeared for respiratory cancer (SMR = 1.23, 95% CI = 0.98–1.50), mainly due to lung cancer (observed [O] = 76, SMR = 1.23, 95% CI = 0.97–1.54); two pleural cancers were also recorded. The excess of lung cancer deaths was present only among those enrolled in the most recent period (1965–1975) (45 deaths, SMR = 1.40, 95% CI = 1.02–1.87), especially among those of younger age (<65 years) (SMR = 1.86); there was no relation between lung cancer mortality and latency since first enrollment in the cooperatives or duration of membership. There are difficulties in interpreting the excess of lung cancer on the basis of occupational exposures; however, the increased risk observed among workers employed in more recent calendar periods may be due to heavier exposure in the last decades; further follow-up of the cohort may elucidate whether there is an increasing lung cancer risk among taxi drivers. © 1994 Wiley-Liss, Inc.     

Mortality rates among augmentation mammoplasty patients: an update

BACKGROUND: A large follow-up study of cosmetic breast implant patients previously suggested an overall decrease in mortality but increased risks of brain and respiratory cancers and of suicides. METHODS: This cohort of 12,144 implant patients and 3614 patients with other types of plastic surgeries was followed for 5 additional years, enabling derivations of standardized mortality ratios (SMRs) based on population rates and relative risks (RRs) based on comparisons with the other patients. RESULTS: A total of 443 implant and 221 other plastic surgery patients were identified as deceased (SMR = 0.65 [95% confidence interval (CI) = 0.6-0.7] and 0.56 [0.5-0.6], respectively). Despite evidence that implants can interfere with mammographic visualization, there was no evidence that implant patients had a higher risk of death from breast cancer as compared with either the general population or other plastic surgery patients. The previous excess risk of brain cancer deaths among implant patients was attenuated by follow-up (as the result of no additional deaths; SMR = 1.43, 0.8-2.5; RR = 2.07, 0.5-8.9). A previously observed excess risk of respiratory cancer deaths persisted in comparisons with other plastic surgery patients (RR = 1.63; 1.0-2.7), but there was no evidence of a trend of risk with follow-up time. Implant patients also showed an elevated risk of suicide (SMR = 1.63, 1.1-2.3; RR = 2.58, 0.9-7.8) and of deaths caused by motor vehicle accidents (RR = 1.73; 0.6-5.4). CONCLUSIONS: Although several elevations in cause-specific mortality were attenuated by additional follow-up, the excess risk of suicide among the implant patients remains of concern.