A retrospective cohort study of mortality among New York State Farm Bureau members

A retrospective cohort study was conducted to examine mortality among 18,811 male farm owners and operators in New York State from 1973-1984. Farm Bureau membership lists were used to identify the study population, and vital status was determined through record linkage with death certificate and motor vehicle files. The comparison group consisted of the 1980 United States Census population of men who resided in the same towns as did the farmers. The results indicated that the study cohort experienced fewer than the expected numbers of deaths overall and for each major cause category except accidents. Specific causes with significant mortality deficits included cancer of the lung (standardized mortality ratio [SMR] = 47.0); diabetes mellitus (SMR = 57.5); ischemic heart disease (SMR = 65.3); bronchitis, emphysema, and asthma (SMR = 26.7); and cirrhosis of the liver (SMR = 29.7). The only specific cause with a significantly elevated mortality was accidents other than motor vehicle (SMR = 146.5). The investigation differs from previous research in method, setting, and population, but the pattern of findings is generally consistent with that of other studies.     

Environment/occupation: #49 Mortality among farmers and spouses in the agricultural health study

PURPOSE: In the Agricultural Health Study we evaluated the mortality experience of 52,395 farmers and 32,347 of their spouses in Iowa and North Carolina obtain information on cancer and other chronic disease risks from agricultural exposures and other factors associated with rural lifestyle.METHODS: Standardized mortality ratios (SMRs) adjusted for race, gender, age, and calendar time were computed for the prospective cohort, using the general population in each state as the referent.RESULTS: After an average follow-up of 3.7 years, the SMRs for most causes of death were significantly less than 1.0. Significant deficits were observed for all causes (SMR = 0.5), all cancers combined (SMR = 0.5), and for cancers of the lung (SMR = 0.3), female genital organs (SMR = 0.4), prostate (SMR = 0.6) and bladder (SMR = 0.6), as well as diabetes (SMR = 0.3), cardiovascular disease (SMR = 0.5), and chronic obstructive pulmonary disease (SMR = 0.2). Non-significant excesses involving at least 3 deaths occurred for liver cancer (SMR = 2.1), multiple myeloma (SMR = 1.6), leukemia (SMR = 1.4), and Parkinson's disease among spouses (SMR = 2.7. Among farmers elevated SMRs were noted for Hodgkin's disease (SMR = 2.9) and cancer of the thyroid gland (SMR = 2.9), and non-motor vehicle accidents (SMR = 1.1). Soft tissue sarcoma (SMR = 1.1 for spouses; SMR = 1.6 for applicators) was elevated in both groups. NHL had an SMR of 1.0 among applicators and spouses. Stratification by presence of livestock or corn on the farm, farm size, and duration of handling pesticides revealed no obvious mortality differences.CONCLUSION: Despite a very low initial mortality experience compared to the general population, Agricultural Health Study farmers and their spouses appear to have rates for some cancers and chronic diseases that deserve continued monitoring and further scrutiny.     

Mortality of a municipal worker cohort: III. Police officers

Very little is known about the long-term health risks associated with the high stress police officer occupation. We report here on a retrospective cohort of 2,376 ever-employed white male police officers employed between January 1950 and October 1979. Vital status was obtained for 96%, the officers accumulating a total of 39,462 person-years. Six-hundred sixty-one deaths were observed. Total mortality from all causes was comparable to that of the overall U.S. white male population (standardized mortality ratio [SMR] = 106). Significantly increased mortality was seen for all malignant neoplasms combined (SMR = 127), cancer of the esophagus (SMR = 286), and cancer of the colon (SMR = 180). Significantly lower than expected mortality was seen for infectious diseases (SMR = 26), respiratory diseases (SMR = 64), and accidents (SMR = 60). Internal cohort comparisons revealed that policeman exhibited significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9). Analysis of mortality by length of service as a police officer showed that those employed 10-19 years were at significantly increased risk of digestive cancers and cancers of the colon and lymphatic and hematopoietic tissues and decreased risk for all diseases of the circulatory system. Policeman employed more than 40 years had significantly elevated SMRs for all causes, all malignant neoplasms combined, digestive cancers, cancers of the bladder and lymphatic and hematopoietic tissues, and arteriosclerotic heart disease. Risk of mortality from arteriosclerotic heart disease tended to increase with increasing years employed. These findings are discussed in light of the police stress literature. The hypotheses generated in this study must be tested through study of the role of important confounders including reactions to stress on the job.     

Standardized mortality ratios by region of residence, Israel, 1987-1994: a tool for public health policy

BACKGROUND: Standardized mortality ratios (SMRs) are used internationally to compare health status across regions and to identify high risk areas for investigation of specific diseases, for funding determination, and for planning purposes. OBJECTIVE: To ascertain regional differences in SMRs by sub-District in Israel for 1987-1994. METHOD: The indirect method of standardization of mortality rates with adjustment for age, gender, and continent of birth was used to calculate SMRs by major cause of death, by sub-District of residence for the Jewish population of Israel. RESULTS: SMRs for all causes of death ranged from regions with low rates (Petah Tikva, Sharon, Rehovot, Ashkelon, and Jerusalem) to those with high rates (Zefat/Golan, Hadera, Yizreel, Ramla, Haifa, Tel Aviv, and Be'er Sheva) (all p<0.0001). Zefat's SMRs are elevated for acute myocardial infarction, stroke, diabetes, and motor vehicle accidents (MVAs). Haifa's SMRs are high for all cardiovascular diseases, liver disease, MVAs, and lung cancer. Be'er Sheva residents had high SMRs for diabetes, liver disease, MVAs, some categories of cardiovascular disease, cervical cancer, and homicide. Yizreel had high SMRs for diabetes, hypertension, stroke, liver disease, and MVAs. Tel Aviv had elevated SMRs for septicemia, acute MI, perinatal causes, and colon, lung and breast cancer. Jerusalem (p<0.0001) and Kinneret residents (p<0.05) had low SMRs for everything except congenital anomalies. CONCLUSIONS: Regional SMR differences, adjusted for age, gender, and ethnicity, may be due to socioeconomic, nutritional, environmental, occupational, or health care factors. SMRs provide a tool to identify regions for epidemiological investigation and priorities for preventive interventions. Regional health monitoring should be undertaken routinely on mortality data, as well as other national databases, as part of national health monitoring.     

The mortality of Royal Naval submariners 1960-89.

OBJECTIVES: To examine the mortality pattern of submariners in the Royal Navy to assess the long term effects on health of serving in submarines. Any specific cause of death which was increased was considered in advance to be of interest, but attention focused particularly on cancer mortality. METHOD: A mortality follow up study: 15 138 submariners who had conducted their first submarine training between 1960 and 1979 were followed up through their time in the Navy and into civilian life, up to the end of 1989. The main outcome measures were the numbers of deaths and standardised mortality ratios (SMRs) which indicate whether the mortality from all causes and specific causes, particularly cancers, exceeds that in men in England and Wales. RESULTS: Mortality in submariners was lower than that for men in England and Wales with an all cause SMR of 86; this was comparable with that found in other studies of armed forces personnel. Cancer mortality was particularly low with an SMR of 69 and there was no particular cancer site which showed an excess. Increased mortality from digestive diseases was found, the excess being attributable to cirrhosis of the liver, which had an SMR of 221 based on 12 deaths, alcohol being a contributory factor in eight. Deaths from accidents and violence were also higher than expected with an SMR of 115, but this was due to high levels of accidents occurring after discharge from the Navy. There was no apparent trend in mortality with time since starting submarine work. Likewise there was no pattern by calendar period, although the excess of cirrhosis of the liver was confined to the period 1970-9. CONCLUSION: The submariners seemed to be a healthy group with low mortality overall. Working in submarines was not associated with any increased cancer mortality. Excess deaths from cirrhosis of the liver, and from accidents and violence after leaving the Navy, were of some concern but they cannot be attributed directly to the submarine environment.     

A comparative analysis of rural and urban mortality in Georgia, 1979

This paper examines the relationship between mortality and ruralness in the state of Georgia. In 1979, the rural Standardized Mortality Ratio (SMR) for deaths from all causes was significantly higher than expected when compared to statewide levels, while the urban SMR was significantly lower (p less than 0.01). Of the 13 leading causes of death, 9 had rural SMRs significantly higher than expected, while only homicide had a significantly greater urban SMR (p less than 0.01). Although much of the rural/urban difference in overall mortality is attributed to the fact that the rural population is older, figures adjusted for age and race still reveal that the rural death rate is significantly higher than the urban rate (p less than 0.01). Furthermore, there are several specific differences when analyzed by cause of death, age, and race that remain unexplained. Specific rural health problems include congenital anomalies, motor vehicle and other accidents, heart disease, and cerebrovascular disease. Specific urban health problems include homicides and cancer. In addition to metropolitan status, a second indicator of ruralness, county population size, was used to analyze the data and produced similar results. As county population size increases, the total mortality decreases.     

Mortality in the agricultural health study, 1993-2007

Comparing agricultural cohorts with the general population is challenging because the general healthiness of farmers may mask potential adverse health effects of farming. Using data from the Agricultural Health Study, a cohort of 89,656 pesticide applicators and their spouses (N = 89, 656) in North Carolina and Iowa, the authors computed standardized mortality ratios (SMRs) comparing deaths from time of the enrollment (1993-1997) through 2007 to state-specific rates. To compensate for the cohort's overall healthiness, relative SMRs were estimated by calculating the SMR for each cause relative to the SMR for all other causes. In 1,198,129 person-years of follow-up, 6,419 deaths were observed. The all-cause mortality rate was less than expected (SMR(applicators) = 0.54, 95% confidence interval (CI): 0.52, 0.55; SMR(spouses) = 0.52, 95% CI: 0.50, 0.55). SMRs for all cancers, heart disease, and diabetes were significantly below 1.0. In contrast, applicators experienced elevated numbers of machine-related deaths (SMR = 4.15, 95% CI: 3.18, 5.31), motor vehicle nontraffic accidents (SMR = 2.80, 95% CI: 1.81, 4.14), and collisions with objects (SMR = 2.12, 95% CI: 1.25, 3.34). In the relative SMR analysis for applicators, the relative mortality ratio was elevated for lymphohematopoietic cancers, melanoma, and digestive system, prostate, kidney, and brain cancers. Among spouses, relative SMRs exceeded 1.0 for lymphohematopoietic cancers and malignancies of the digestive system, brain, breast, and ovary. Unintentional fatal injuries remain an important risk for farmers; mortality ratios from several cancers were elevated relative to other causes.     

Mortality among Army Chemical Corps Vietnam veterans

Army Chemical Corps personnel who served in Vietnam were among those service personnel with the greatest potential for exposure to herbicides. An earlier evaluation of the mortality experience of 894 Army Chemical Corps Vietnam veterans found a statistically significant excess risk of dying from digestive disease, primarily due to cirrhosis of the liver, and from motor vehicle accidents. That study was expanded to include 2,872 Vietnam veterans who served with the Army Chemical Corps and a comparison cohort of 2,737 veterans who never served in Southeast Asia but who did serve in the same occupational category. The results of the analysis comparing the Vietnam cohort to the non-Vietnam cohort support the earlier finding of a significant excess of deaths from digestive diseases (adjusted relative risk (RR) = 3.88, 95% C.I. = 1.12–13.45) primarily due to liver cirrhosis. Non-significant elevated relative risks were observed for all cancers combined, digestive and respiratory systems cancers, skin cancer, lymphopoietic cancers, and respiratory system diseases. Compared to the mortality rates in the general population, the non-Vietnam Army Chemical Corps veterans had a statistically significant deficit in mortality from all causes combined, which is consistent with a ‘healthy selection bias’ seen among military populations (SMR = 0.79, 95% C.I. = 0.66–0.94). For the Vietnam veterans, patterns of elevated but nonsignificant SMRs persisted for diseases of the digestive and respiratory systems and for selected cancer sites. Am. J. Ind. Med. 31:719–726, 1997. © 1997 Wiley-Liss, Inc.     

Mortality and cause of death among first-generation Japanese in S?o Paulo, Brazil

The death certificates of first-generation Japanese in the city of S?o Paulo, Brazil, were analysed for underlying causes of death, and standardized mortality ratio (SMR) values were calculated using the age-specific mortality rates for Japan and S?o Paulo. Mortality rates for all causes were lower than those of the general population in S?o Paulo for all age groups and both sexes, and were almost equal to those in Japan. Compared with the mortality in Japan, significantly higher SMR values were obtained for diabetes mellitus, ischaemic heart disease, respiratory diseases (females), motor vehicle accidents, and homicide (males), whereas SMR values were low for all causes (males), other heart diseases, cerebrovascular disease, chronic liver diseases (males), suicide, and malignant neoplasms (males). On the other hand, compared with the mortality for S?o Paulo, SMR values were significantly low for most causes of death. The potential cultural and social factors contributing to these changes in mortality pattern are discussed.     

Cohort mortality study of Philadelphia firefighters

BACKGROUND: Fire fighters are exposed to a wide variety of toxic chemicals. Previous studies have reported excess risk of some cancers but have been limited by small numbers or little information on employment characteristics. METHODS: We conducted a retrospective cohort mortality study among 7,789 Philadelphia firefighters employed between 1925 and 1986. For each cause of death, the standardized mortality ratios (SMRs) and 95% confidence intervals were estimated. We also compared mortality among groups of firefighters defined by the estimated number of career runs and potential for diesel exposure. RESULTS: In comparison with U.S. white men, the firefighters had similar mortality from all causes of death combined (SMR = 0.96) and all cancers (SMR = 1.10). There were statistically significant deficits of deaths from nervous system diseases (SMR = 0.47), cerebrovascular diseases (SMR = 0.83), respiratory diseases (SMR = 0.67), genitourinary diseases (SMR = 0.54), all accidents (SMR = 0.72), and suicide (SMR = 0.66). Statistically significant excess risks were observed for colon cancer (SMR = 1.51) and ischemic heart disease (SMR = 1.09). The risks of mortality from colon cancer (SMR = 1.68), kidney cancer (SMR = 2.20), non-Hodgkin's lymphoma (SMR = 1.72), multiple myeloma (SMR = 2.31), and benign neoplasms (SMR = 2.54) were increased among firefighters with at least 20 years of service. CONCLUSIONS: Our study found no significant increase in overall mortality among Philadelphia firefighters. However, we observed increased mortality for cancers of the colon and kidney, non-Hodgkin's lymphoma and multiple myeloma. There was insufficient follow-up since the introduction of diesel equipment to adequately assess risk.     

Health related selection and death rates in the United Kingdom Atomic Energy Authority workforce

Follow up data on 37,355 employees of the United Kingdom Atomic Energy Authority (UKAEA) for the period 1946-79 were analysed to investigate the extent to which selection for work on the basis of health affected subsequent death rates. Causes of death were grouped into two broad categories for analysis: all cancers and all other causes of death. Evidence for an effect of selection of healthy individuals into the workforce was sought primarily by examining standardised mortality ratios (SMRs) by period since recruitment. SMRs for both categories were particularly low during the first two years after recruitment (SMR = 69, 95% confidence interval (CI) 48-97 for all cancers; SMR = 55, 95% CI 44-69 for all other causes of death). SMRs for all cancers did not increase significantly with period since recruitment (chi 2 for trend = 0.4, p = 0.53) but did increase for causes of death other than cancer (chi 2 for trend = 11.1, p = 0.001). Although adjustment for social class strengthened the association between death from causes other than cancer and period since recruitment (chi 2 for trend = 18.8, p less than 0.001), simultaneous adjustment for all confounding factors considered (age at death, sex, calendar period of death, geographical location of the workforce, and social class) produced results broadly similar to those obtained from the unadjusted analyses for both cause of death categories. SMRs remained low even after 25 years of follow up (SMR = 84, 95% CI 69-101 for all cancers; SMR = 81, 95% CI 72-91 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR = 149, 95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers, SMR = 99, 95% CI 85-115 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR 149,95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers SMR = 99, 95% CI 85-115 for all other causes of death). Apart from this initial fall, there was little evidence of a systematic increase or decrease in mortality with increasing period was not significantly associated with durationof employment for either cause of death category either before or after adjustment for confounding factors. Whereas selection of individuals into or out of the workforce on the basis of health affects the way in which death rates change with time, other factors such as sociodemographic characteristics or health related behaviour determine the general level of mortality in the longer run. The persistently low SMRs observed in this workforce throughout the follow up period suggest that selection on the latter factors are likely to have had a considerable effect on death rates in the UKAEA workforce.     

Health related selection and death rates in the United Kingdom Atomic Energy Authority workforce.

Follow up data on 37,355 employees of the United Kingdom Atomic Energy Authority (UKAEA) for the period 1946-79 were analysed to investigate the extent to which selection for work on the basis of health affected subsequent death rates. Causes of death were grouped into two broad categories for analysis: all cancers and all other causes of death. Evidence for an effect of selection of healthy individuals into the workforce was sought primarily by examining standardised mortality ratios (SMRs) by period since recruitment. SMRs for both categories were particularly low during the first two years after recruitment (SMR = 69, 95% confidence interval (CI) 48-97 for all cancers; SMR = 55, 95% CI 44-69 for all other causes of death). SMRs for all cancers did not increase significantly with period since recruitment (chi 2 for trend = 0.4, p = 0.53) but did increase for causes of death other than cancer (chi 2 for trend = 11.1, p = 0.001). Although adjustment for social class strengthened the association between death from causes other than cancer and period since recruitment (chi 2 for trend = 18.8, p less than 0.001), simultaneous adjustment for all confounding factors considered (age at death, sex, calendar period of death, geographical location of the workforce, and social class) produced results broadly similar to those obtained from the unadjusted analyses for both cause of death categories. SMRs remained low even after 25 years of follow up (SMR = 84, 95% CI 69-101 for all cancers; SMR = 81, 95% CI 72-91 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR = 149, 95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers, SMR = 99, 95% CI 85-115 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR 149,95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers SMR = 99, 95% CI 85-115 for all other causes of death). Apart from this initial fall, there was little evidence of a systematic increase or decrease in mortality with increasing period was not significantly associated with durationof employment for either cause of death category either before or after adjustment for confounding factors. Whereas selection of individuals into or out of the workforce on the basis of health affects the way in which death rates change with time, other factors such as sociodemographic characteristics or health related behaviour determine the general level of mortality in the longer run. The persistently low SMRs observed in this workforce throughout the follow up period suggest that selection on the latter factors are likely to have had a considerable effect on death rates in the UKAEA workforce.     

Cohort mortality study of capacitor manufacturing workers, 1944-2000

A mortality study of workers employed between 1944 and 1977 at an electrical capacitor manufacturing plant where polychlorinated biphenyls (PCBs), chlorinated naphthalenes, and other chemicals were used was undertaken. Age, gender, and calendar year-adjusted standardized mortality ratios (SMRs) were calculated for 2885 white workers. Total mortality and all-cancer mortality were similar to expected in both males and females. Females employed 10 or more years had a significantly elevated SMR of 6.2 for liver/biliary cancer. Intestinal cancer was significantly elevated in females employed 5 or more years after PCBs were introduced (SMR = 2.2). In males, stomach cancer (SMR = 2.2) and thyroid cancer (SMR = 15.2) were significantly elevated. Although individual exposure assessment was limited, PCBs alone or in combination with other chemicals could be associated with increased risks for liver/biliary, stomach, intestinal, and thyroid cancer.     

汽车铸造作业工人队列死因研究

目的 分析危害汽车铸造作业工人健康的主要疾病,探讨铸造作业有害因素对工人寿命的影响.方法 采用流行病学队列研究方法,以某汽车铸造厂1980年在册的3529名职工为研究对象,从1980年随访至2005年底,以全国城市居民年龄别死亡率均值为参照,用标化死亡比(SMR)作为统计指标,并计算95%可信区间.结果 随访至2005年底,共计84 999人年,共死亡265人,死亡率3.12‰,累积死亡率为7.51%.铸工队列全死因SMR为0.96(95%CI:0.85～1.08)与全国平均水平持平,随着年龄增长,全死因SMR呈现升高趋势,50岁以上组工人的SMR均大于1.影响铸造工人寿命的主要疾病按累积死亡率从高到低排序分别是:恶性肿瘤(3.43%)、意外伤害(1.16%)、脑血管疾病(1.08%)、心血管疾病(0.79%).恶性肿瘤占总死亡原因的45.7%.铸造工人中死亡率明显升高的疾病有恶性肿瘤(SMR=7.87)、意外伤害(SMR=2.70)、心血管疾病(SMR=2.68)、消化系统疾病(SMR=2.79).一线作业工人恶性肿瘤死亡是辅助丁人的1.95倍(RR=1.95,P<0.05).结论 铸造作业中粉尘等职业危害因素明显影响工人的健康,恶性肿瘤死亡明显增加,应加强防护.     

Mortality among women Vietnam veterans, 1973-1987

A retrospective cohort mortality study was conducted to examine health effects of US military service in Vietnam on women veterans who served there between July 4, 1965 and March 28, 1973. About 4,600 women Vietnam veterans and 5,300 women veterans who had never served in Vietnam were identified from military records and followed for vital status on December 31, 1987. Mortality rates for all causes of death combined and for all cancers among Vietnam veterans were similar to those among non-Vietnam veterans (relative risk (RR) = 0.93). There was a slight excess of mortality from external causes among women Vietnam veterans compared with non-Vietnam veterans (RR = 1.33), primarily due to an excess of motor vehicle accidents (RR = 3.19). Suicide rates were nearly the same in both cohorts (RR = 0.96). Vietnam veterans had twofold increases in mortality from cancers of the pancreas and uterine corpus compared with non-Vietnam veterans. Women Vietnam veterans and non-Vietnam veterans had lower-than-expected mortality from all causes of death combined (standardized mortality ratio (SMR) = 0.82 and 0.88, respectively), based on rates for US women, due to significant deficits of deaths from circulatory diseases. Compared with rates for US women, mortality from cancers of the pancreas (five deaths, SMR = 3.27) and uterine corpus (four deaths, SMR = 4.05) was significantly elevated among Vietnam veteran nurses.     

Mortality and incidence of cancer among a cohort of self employed butchers from Geneva and their wives.

To investigate whether specific cancers are associated with the occupation of butcher, as has been reported from other countries, a historical prospective cohort study was undertaken. The cohort consisted of all self employed butchers (n = 552) and pork butchers (n = 310) born since 1880 who set up a shop in the canton of Geneva from 1901 to 1969, and of their wives (n = 887). The study group was followed up from 1901 to 1990 for general mortality, from 1942 to 1990 for cause specific mortality, and from 1970 to 1989 for incidence of cancer. There was no trace of 45 men (5%) and 52 women (6%). Compared with the general population of the canton of Geneva, butchers and pork butchers experienced a significant increase, taking into account 15 years of latency, in mortality from all causes (observed deaths (Obs) 540, expected deaths (Exp) 445.5, standardised mortality ratio (SMR) 121, 90% confidence interval (90% Cl) 113-130). There were significant excesses in incidence and mortality from colorectal cancer, cancer of the prostate, and all malignant neoplasms, and in incidence of cancer of the liver. The risk of lung cancer was significantly increased among pork butchers (SMR 176, 90% Cl 114-262; standardised incidence ratio (SIR) 231, 90% Cl 137-368) but not among butchers (SMR 92, 90% Cl 59-138; SIR 113, 90% Cl 67-179). There was also a significant increase in mortality from cancer of the larynx among butchers. For non-malignant causes of death significant excesses were found among all men for ischaemic heart disease, motor vehicle accidents, and cirrhosis of the liver. Analysis of subgroups showed a cluster of deaths from leukaemia among older butchers born between 1880 and 1899 (Obs 5, Exp 0.6, p < 0.0001). Exposure of pork butchers to polycyclic aromatic hydrocarbons during meat smoking, which was assessed in a contemporary study, might have contributed to their increased risk of lung cancer. The possible role of other factors, especially cigarette smoking, nitrosamines, and oncogenic viruses was discussed. Moreover, there was evidence from another contemporary study that butchers and pork butchers ate more animal fat, and probably more animal protein, than the average male population of Geneva. These results suggest that dietary factors could be implicated in the excesses of colorectal cancer, cancer of the prostate, and ischaemic heart disease. An increased risk for alcohol abuse might explain the excesses of liver cirrhosis, cancer of the liver, cancer of the larynx and motor vehicle accidents. Among all wives overall mortality was similar to that expected (SMR 100, 90% Cl 93-108) and there was no significant excess risk for any specific cancer nor for any non-malignant cause of death. Results for cancer of the cervix uteri, especially among subgroups, suggest an increased risk consistent with previous findings from other countries.     

Mortality among aerial pesticide applicators and flight instructors: follow-up from 1965-1988.

BACKGROUND: Vital status followup for a retrospective cohort mortality study of 9,961 male aerial pesticide applicators was extended beyond a previous study (1965-1979) (Cantor et al. 1991), through December 31, 1988. METHODS: Rate ratios (RR) were used to compare directly adjusted mortality rates between applicators and a comparison cohort of 9,969 flight instructors. Standardized mortality ratios (SMR) were calculated for comparisons with the U.S. white male population. RESULTS: Among applicator pilots, there were 1,441 deaths, and among instructors, 1,045. In both groups, aircraft accidents were the major cause of death (446 applicators; 234 instructors). Compared with flight instructors, aerial applicator pilots were at significantly elevated risk for all causes of death (risk ratio = 1.34) and for malignant neoplasms (1.18), non-motor vehicle accidents (1.71), motor vehicle accidents (1.69), and stroke (1.91). Pancreatic cancer (2.71) and leukemia (3.35) were significantly elevated. Applicators were at lower risk of colon cancer (0.51) and multiple myeloma (0.23) mortality. Based on U.S. rates, the SMR for all causes of death among applicators was 111 (95% confidence interval (CI) = 105-117) and among instructors, 81 (CI = 76-85). CONCLUSIONS: Aircraft accidents were a major cause of mortality in both applicator and flight instructor cohorts. Several other causes of death, some possibly related to pesticide exposure, were also elevated among pesticide applicator pilots. Published 1999 Wiley-Liss, Inc.     

Prisoner survival inside and outside of the institution: implications for health-care planning

The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients.     

Cohort mortality study of employees at the Celanese plant in Pampa,Texas

BACKGROUND: The mortality experience of chemical workers from the Pampa, Texas Celanese Ltd. plant through 1991 has been previously reported. This study updates that effort and presents an additional seven years of data and follow-up that provided 268 additional cohort members and 71 new deaths. METHODS: Mortality was determined through December 31, 1998, the period for which the National Death Index could provide information on deaths. The mortality experience of Celanese Ltd. employees was compared to that of the general population of the United States. All cause and cause-specific standardized mortality ratios (SMRs) were calculated. RESULTS: For the entire cohort, several causes of death including all causes (SMR = 65.9; 95% confidence interval (CI) = 56.9-76.0), heart disease (SMR = 69.1; 95% CI = 53.6-87.8), and all malignant neoplasms (SMR = 74.2; 95% CI = 56.3-95.9) were significantly less than expected. SMRs were also calculated separately for white men, non-white men, and women. Unlike the initial study, the SMR for prostate cancer among white males was not significantly elevated (SMR=176.1; 95% CI = 76.0-347.0) and was much lower than the prior SMR of 330.4. This suggests that the initial findings, which were based on a small number of deaths, were likely due to chance. CONCLUSIONS: Overall, Celanese Ltd. employees from the Pampa plant have significantly lower than expected SMRs for several causes of death, and no causes of death that are significantly elevated.     

Mortality from external causes among ethnic German immigrants from former Soviet Union countries, in Germany

BACKGROUND: Diaspora migration flows from the former Soviet Union to Western Europe and Israel have increased since the late 1980s. Risk factors responsible for the East-West mortality gap and post-migration factors may lead to higher mortality from external causes of death like suicide amongst such Diaspora immigrants. We investigated whether ethnic German immigrants from the former Soviet Union had increased mortality from external causes compared to native Germans. METHODS: We conducted a retrospective cohort study of 34 393 adults, so-called Aussiedler who arrived in Germany's largest federal state between 1990 and 2001. We ascertained vital status and causes of death from registry data. Standardized mortality ratios (SMRs) were calculated using the native German population as comparison. Multivariate effects were assessed using Poisson regression. RESULTS: 1 657 members (4.8%) died, 88 from external causes. Overall SMR was 1.29 (95% confidence intervals 1.05-1.61). Males had a 39% higher mortality from all external causes and accidents, and a 30% higher mortality from suicide than German males. Females had slightly higher mortality from accidents but comparable mortality from all external causes. Aussiedler aged <65 years had rate ratios above one for external causes and accidents in multivariate models. SMRs for suicide and all external causes decreased with length of stay. CONCLUSION: While ethnic German immigrants have a mortality disadvantage compared to the NRW population, it is on a much lower scale than expected if they were representative of their source populations in former Soviet Union countries.