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 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 study in an asbestos cement factory in Naples, Italy

The objective of this paper is to investigate mortality among 1247 male asbestos-cement workers employed in an asbestos-cement plant located in Naples. The cohort included 1247 men hired between 1950 and 1986. The follow-up began on January 1st 1965. The vital status and causes of death were ascertained up to December 31 2005. Cause-specific mortality rates of the Campania Region population were used as reference. Relative risks were estimated using Standardized Mortality Ratios (SMRs), and the confidence intervals were calculated at a 95% level (95% CI). A significant increase in mortality was observed for respiratory disease (81 deaths; SMR = 187; 95% CI = 149- 233), particularly for pneumoconiosis (42 deaths; SMR = 13 313; 95% CI = 9595-17 996) of which 41 deaths for asbestosis (SMR = 43 385; 95% CI = 31 134-58 857), for pleural cancer (24 deaths; SMR = 2617; 95% CI = 1677-3893), for lung cancer (84 deaths; SMR=153; 95% CI = 122-189) and for peritoneal cancer (9 deaths; SMR = 1985; 95% CI = 908-3769). Non-significant increases were also observed for rectum cancer (6 deaths; SMR = 157; 95% CI = 58-342). In conclusion, consistently with other mortality studies on asbestos-cement workers performed in different countries, an increased mortality from asbestosis, lung cancer, pleural and peritoneal mesothelioma was detected in the present cohort.     

Mortality among workers at a plastics manufacturing and research and development facility: 1946–1988

Mortality through 1988 was studied for 5,932 male employees who worked between January 1, 1946 and December 31, 1967 at a New Jersey plastics manufacturing and research and development facility. The cohort was followed for an average of 32 years and included 1,859 deaths. Potential exposures included asbestos, formaldehyde, and polyvinyl chloride (PVC). Mortality rates for the cohort were compared to both U.S. and state mortality rates, and analyses were also performed by lagging duration of employment. Based on U.S. rates, mortality among hourly males (n = 3,853) from all cancers was similar to expected [standardized mortality ratio (SMR), 102; 95% confidence interval (CI), 92-114]. Excess mortality among hourly workers was seen for pancreatic cancer (SMR, 146; 95% CI, 95–216) and “malignancies of other parts of the respiratory system” (SMR, 373; 95% CI, 121–870). The latter excess was due entirely to five deaths from pleural mesothelioma. There were no deaths identified due to nasal cavity or nasopharyngeal cancers, or angiosarcoma of the liver. Mortality from leukemia among research and development workers (n = 1,421) was significantly elevated (SMR, 265; 95% CI, 115–524) and related to assignment to process development. This study verifies the excess of pancreatic cancer among workers at the facility seen in earlier studies and observes excesses of mesothelioma due to asbestos exposure and leukemia in process development workers.     

Historical cohort study of a New Zealand foundry and heavy engineering plant

OBJECTIVES: To investigate the mortality of workers who had been exposed to asbestos, machining fluids and foundry work in a foundry and heavy engineering plant in the railway rolling stock manufacturing industry in New Zealand. METHODS: Historical cohort study design. RESULTS: For the total workforce of 3522 men employed between 1945 and 1991, follow up was 90% of person-years to 31 December 1991. Significantly increased standardised mortality ratios (SMRs) were found for all causes of death combined (SMR 1.07; 95% confidence interval (95% CI) 1.01 to 1.14), all malignancies (SMR 1.15; 95% CI 1.01 to 1.31), circulatory (SMR 1.16; 95% CI 1.07 to 1.27) and musculoskeletal diseases (SMR 3.06; 95% CI 1.39 to 5.84), all digestive cancers (SMR 1.29; 95% CI 1.04 to 1.59), all respiratory cancers (SMR 1.34; 95% CI 1.08 to 1.65), cancer of the oesophagus (SMR 1.97; 95% CI 1.01 to 3.45), and mesothelioma of the pleura (SMR 6.58; 95% CI 1.24 to 19.49). Three deaths from pleural mesothelioma were recorded, with latency times of 51, 53, and 57 years. There were no dose-response relations between exposure to asbestos, machining fluids or foundry work, or by duration of employment in the plant, and any cause of death. CONCLUSIONS: This study found small increases in risk for several causes of death among foundry and heavy engineering workers; however, these increases were small and the possible effects of smoking and other lifestyle factors could not be excluded. There was evidence of asbestos related disease in those involved in engineering work in the past.

 

     

Cohort study on cancer mortality among workers in the pulp and paper industry in Catalonia,Spain

We examined mortality in a retrospective follow-up study of 3,241 workers employed between 1970–1992, in four pulp and paper mills in Catalonia, Spain. Vital status was determined for 95% of the cohort. Exposure was reconstructed using job histories and a company exposure questionnaire. Standardized mortality ratios (SMR) were derived using mortality rates of Spain as the reference. For all workers, mortality from all causes (SMR = 76; 95%; confidence intervals [CI] = 65–88; 189 deaths) and all malignant neoplasms (SMR = 93; CI = 72–119; 65 deaths) were less than the expected. Excess risk was observed for mortality from all neoplasms in females (SMR = 168; CI 84–303; 11 deaths), for large intestine cancer in both sexes (SMR = 250; CI = 115–525; 8 deaths), particularly after 10 years of employment and latency (SMR = 355; CI = 154–701; 8 deaths), and for breast cancer in females (SMR = 286; CI = 77–732; 4 deaths). These findings suggest that workers employed in the pulp and paper industry may have an excess risk of specific cancers. © 1996 Wiley-Liss, Inc.     

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.     

Mortality among a cohort of garment workers exposed to formaldehyde: an update

Aims: To evaluate the mortality experience of 11 039 workers exposed to formaldehyde for three months or more in three garment plants. The mean time weighted average formaldehyde exposure at the plants in the early 1980s was 0.15 ppm but past exposures may have been substantially higher.

Methods: Vital status was updated through 1998, and life table analyses were conducted.

Results: Mortality from all causes (2206 deaths, standardised mortality ratio (SMR) 0.92, 95% CI 0.88 to 0.96) and all cancers (SMR 0.89, 95% CI 0.82 to 0.97) was less than expected based on US mortality rates. A non-significant increase in mortality from myeloid leukaemia (15 deaths, SMR 1.44, 95% CI 0.80 to 2.37) was observed. Mortality from myeloid leukaemia was greatest among workers first exposed in the earliest years when exposures were presumably higher, among workers with 10 or more years of exposure, and among workers with 20 or more years since first exposure. No nasal or nasopharyngeal cancers were observed. Mortality from trachea, bronchus, and lung cancer (147 deaths, SMR 0.98, 95% CI 0.82 to 1.15) was not increased. Multiple cause mortality from leukaemia was increased almost twofold among workers with both 10 or more years of exposure and 20 years or more since first exposure (15 deaths, SMR 1.92, 95% CI 1.08 to 3.17). Multiple cause mortality from myeloid leukaemia among this group of workers was also significantly increased (8 deaths, SMR 2.55, 95% CI 1.10 to 5.03).

Conclusions: Results support a possible relation between formaldehyde exposure and myeloid leukaemia mortality. Previous epidemiological studies supporting a relation between formaldehyde exposure and leukaemia mortality have been primarily of formaldehyde exposed professional groups, not formaldehyde exposed industrial workers. Limitations include limited power to detect an excess for rare cancers such as nasal and nasopharyngeal cancers and lack of individual exposure estimates.

     

Workplace risk factors for cancer in the German rubber industry: Part 1. Mortality from respiratory cancers

OBJECTIVES: To determine the cancer specific mortality by work area among active and retired male workers in the German rubber industry. METHODS: A cohort of 11,663 male German workers was followed up for mortality from 1 January 1981 to 31 December 1991. Cohort members were classified as active (n = 7536) or retired (n = 4127) as of 1 January 1981 and had been employed for at least one year in one of five study plants producing tyres or technical rubber goods. Work histories were reconstructed with routinely documented "cost centre codes" which were classified into six categories: I preparation of materials; II production of technical rubber goods; III production of tyres; IV storage and dispatch; V maintenance; and VI others. Standardised mortality ratios (SMRs) adjusted for age and calendar year and 95% confidence intervals (95% CIs), stratified by work area (employment in respective work area for at least one year) and time related variables (year of hire, lagged years of employment in work area), were calculated from national reference rates. RESULTS: SMRs for laryngeal cancer were highest in work area I (SMR 253; 95% CI 93 to 551) and were significant among workers who were employed for > 10 years in this work area (SMR 330; 95% CI 107 to 779). Increased mortality rates from lung cancer were identified in work areas I (SMR 162; 95% CI 129 to 202), II (SMR 134; 95% CI 109 to 163), and V (SMR 131; 95% CI 102 to 167). Mortality from pleural cancer was increased in all six work areas, and significant excesses were found in work areas I (SMR 448; 95% CI 122 to 1146), II (SMR 505; 95% CI 202 to 1040), and V (SMR 554; 95% CI 179 to 1290). CONCLUSION: A causal relation between the excess of pleural cancer and exposure to asbestos among rubber workers is plausible and likely. In this study, the pattern of excess of lung cancer parallels the pattern of excess of pleural cancer. This points to asbestos as one risk factor for the excess deaths from lung cancer among rubber workers. The study provides further evidence for an increased mortality from laryngeal cancer among workers in the rubber industry, particularly in work area I.       

Suicide risk among chernobyl cleanup workers in estonia still increased: an updated cohort study

PURPOSE: The aim of the study is to examine the mortality experience among Chernobyl cleanup workers. METHODS: A cohort study of 4786 men from Estonia who participated in the Chernobyl cleanup from 1986 to 1991 and were traced until December 31, 2002. Standardized mortality ratio (SMR) and adjusted mortality rate ratio (RR) derived through Poisson regression analysis were calculated. RESULTS: During follow-up, 550 deaths occurred, yielding an SMR of 1.01 (95% confidence interval [CI], 0.92-1.09). Increased risks were observed for suicide alone (SMR, 1.32; 95% CI, 1.03-1.67) and suicide combined with undetermined injury (SMR, 1.29; 95% CI, 1.03-1.60). One leukemia death occurred, and no thyroid cancer deaths were found. Elevated mortality also was observed for brain cancer (SMR, 2.78; 95% CI, 1.02-6.05). The adjusted RR for suicide remained stable over the time passed since return from the Chernobyl area, showing RRs of 1.09 (95% CI, 0.56-2.10) for 5 to 9 years and 1.00 (95% CI, 0.48-2.05) for 10 or more years compared with less than 5 years. CONCLUSIONS: During the 17 years after the accident, suicide risk in the cohort was greater than in the general male population. No elevated risk in overall mortality and radiation-related cancers was observed. The long-term nature of this elevated risk provides concrete evidence that psychological consequences represent the largest public health problem caused by the accident to date.     

Mortality patterns among workers exposed to styrene in the reinforced plastic boatbuilding industry: an update

BACKGROUND: Mortality was updated through 1998 for 5,204 workers exposed to styrene between 1959 and 1978 at two reinforced plastic boatbuilding plants. The a priori hypothesis: leukemia and lymphoma excesses would be found. METHODS: Standardized mortality ratios (SMR) and 95% confidence intervals (CI) used Washington State and U.S. rates. RESULTS: Overall, 860 deaths occurred (SMR 1.09, CI 1.02-1.17), with excess mortality for esophageal cancer (n = 12, SMR 2.30, CI 1.19-4.02), prostate cancer (n = 24, SMR 1.71, CI 1.09-2.54), and accidents (n = 99, SMR 1.26, CI 1.02-1.53). Among 2,062 highly exposed workers, urinary tract cancer (n = 6, SMR 3.44, CI 1.26-7.50) and respiratory disease (n = 12, SMR 2.54, CI 1.31-4.44) rates were elevated. Urinary tract cancer SMR increased with duration of employment. CONCLUSIONS: We found no excess leukemia or lymphoma mortality. Unanticipated excess urinary tract cancer and respiratory disease mortality, possibly associated with styrene exposure, are difficult to interpret and could be chance findings.     

Mortality among three refinery/petrochemical plant cohorts. I. 1970 to 1982 active/terminated workers

This study updates mortality rates for 19,075 active and terminated workers at three refinery/petrochemical plants. Mortality rates of the workers were compared with both national and state rates. The results indicated deficits of deaths for all causes, all malignant neoplasms, and respiratory and prostate cancer. The noteworthy finding was a statistically significant increase in leukemia among Louisiana male subjects (standardized mortality ratio [SMR], 181; 95% confidence interval [CI], 122 to 259), which showed suggestive trends of increasing SMRs with increasing tenure. This excess was largely due to increased chronic lymphocytic leukemia (SMR, 351; 95% CI, 168 to 645). The rate of kidney cancer remained elevated among Louisiana male subjects, but this finding was no longer significant, and there were no patterns in SMRs by tenure and latency. Mesothelioma was increased at the Louisiana (SMR, 198; 95% CI, 72 to 430) and Texas (SMR, 246; 95% CI, 99 to 507) locations. The leukemia findings have prompted a study of leukemia incidence at the Louisiana location.     

A mortality study among workers in a French aluminium reduction plant

Objective: A mortality study on the association between lung cancer and occupational exposure to polycyclic aromatic hydrocarbons (PAHs) was carried out in a French aluminium reduction plant. This study updated a previous mortality study. Method: The historical cohort included every male worker who had been employed in the plant for at least 1 year between 1950 and 1994. Workers were followed-up for mortality from 1968 to 1994. Causes of death were obtained from death certificates. Standardised mortality ratios (SMRs) and 95% confidence intervals (CI) were computed using regional mortality rates as external reference to compare observed and expected numbers of deaths, adjusted for gender, age and calendar time. Results: The cohort comprised 2,133 men, of whom 335 died during the follow-up period. The observed mortality was lower than expected for all causes of death (SMR=0.81, CI 0.72–0.90) and for lung cancer (observed=19, SMR=0.63, CI 0.38–0.98). No lung cancer excess was observed in workshops where PAH exposure was likely to have occurred, and no trend was observed according to duration of exposure and time since first exposure. This low lung cancer mortality could be partly explained by a marked healthy worker effect and a possible negative confounding by smoking. An excess was observed for bladder cancer (observed=7, SMR=1.77, CI 0.71–3.64) in the whole cohort, that was higher among workers employed in workshops where PAH exposure was likely to have occurred (observed=6, SMR=2.15, CI 0.79–4.68). In addition, an SMR higher than unity was observed for “psychoses and neuro-degenerative diseases” (observed=6, SMR=2.39, CI 0.88–5.21), that could not be related to occupational aluminium exposure. Conclusion: No lung cancer risk was detected. Non-significant excesses were observed for bladder cancer and for psychoses and neuro-degenerative diseases. Received: 11 June 1999 / Accepted: 22 January 2000     

Mortality in a cohort of asbestos cement workers in Carrara, Italy

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the mortality of 262 workers (200 men and 62 women) employed in an asbestos cement plant located in Carrara, Italy, exposed to a mixture of chrysotile and crocidolite asbestos in a ratio of 2:5. METHODS: Follow-up started on 1 January, 1963. The vital status and causes of death were ascertained on 31 December, 2003. The Tuscany population mortality was used as reference. The relative risk was estimated by Standardized Mortality Ratio (SMR) and the confidence intervals were calculated at 95% level [95%CI]. RESULTS: Among men, a significant increase in mortality was observed for respiratory disease (14 deaths; SMR = 244.1; IC95% = 133.4-409.5), particularly for pneumoconiosis (10 deaths; SMR= 1,800; IC95% = 856.9-3,300.0; of which 5 deaths due to asbestosis; SMR = 120,000; IC95% = 37,000-270,000), and for pleural cancer (4 deaths; SMR = 2,500; IC95% = 676.8-6,400.0). Non-significant increases were also observed for lung cancer (10 deaths; SMR = 114.2; IC95% = 54.8-209.9), and gastric cancer (7 deaths; SMR= 167.1; IC95% = 67.2-344.3). Among women, significant increases were observed for pneumoconiosis (1 death; SMR = 17,000; 95%CI = 425-93,000), and for liver cancer (3 deaths; SMR = 765.0; IC95% = 157.8-2,200.0). CONCLUSIONS: For males our results were consistent with other mortality studies on asbestos-cement workers. No other cohort studies on asbestos cement workers have dealt with mortality of female workers.     

Mortality and cancer incidence among alachlor manufacturing workers 1968-99

Background: Alachlor is the active ingredient in pre-emergent herbicide formulations that have been used widely on corn, soybeans, and other crops. It has been found to cause nasal, stomach, and thyroid tumours in rodent feeding studies at levels that are much higher than likely human exposures.

Aims: To evaluate mortality rates from 1968 to 1999 and cancer incidence rates from 1969 to 1999 for alachlor manufacturing workers at a plant in Muscatine, Iowa.

Methods: Worker mortality and cancer incidence rates were compared to corresponding rates for the Iowa state general population. Analyses addressed potential intensity and duration of exposure.

Results: For workers with any period of high alachlor exposure, mortality from all causes combined was lower than expected (42 observed deaths, SMR 64, 95% CI 46 to 86) and cancer mortality was slightly lower than expected (13 observed deaths, SMR 79, 95% CI 42 to 136). Cancer incidence for workers with potential high exposure was similar to that for Iowa residents, both overall (29 observed cases, SIR 123, 95% CI 82 to 177) and for workers exposed for five or more years and with at least 15 years since first exposure (eight observed cases, SIR 113, 95% CI 49 to 224). There were no cases of nasal, stomach, or thyroid cancer.

Conclusions: There were no cancers of the types found in toxicology studies and no discernible relation between cancer incidence for any site and years of alachlor exposure or time since first exposure. Despite the small size of this population, the findings are important because these workers had chronic exposure potential during extended manufacturing campaigns, while use in agriculture is typically limited to a few days or weeks each year.

     

A mortality cohort study among workers in a graphite electrode production plant in Italy

Aims: To investigate mortality from cancer and other diseases among workers in a graphite electrode production plant in Italy.

Methods: A total of 1291 males actively employed between 1 January 1950 and 31 December 1989 who had worked at the plant for at least one year were studied. The follow up extended from 1950 to 1997. Standardised mortality ratios (SMR) and their 95% confidence intervals (CI) were computed using mortality rates for the Italian and regional male population.

Results: Excess mortality was observed for all causes (SMR 1.44, CI 1.32 to 1.56), all cancers (SMR 1.27, CI 1.07 to 1.50), liver cancer (SMR 4.19, CI 2.68 to 6.23), silicosis (SMR 66.39, CI 52.56 to 82.7), and cirrhosis and other chronic diseases of the liver (SMR 1.87, CI 1.31 to 2.59) in comparison with the national male population. When regional rates were used to calculate the number of expected deaths, SMRs remained higher for silicosis (SMR 57.32, 42.11 to 76.22), and liver cancer (SMR 2.57, 1.57 to 3.97). Mortality from silicosis was increased in workers hired at young ages (<25 years, SMR 81.79; 25–34 years, SMR 82.73), and in workers aged <45 at death (SMR 333.3, CI 159.8 to 613). Mortality from liver cancer increased threefold (SMR 3.11, CI 1.78 to 5.05) in workers with more than 10 years of employment at the plant during the manufacture of Karbate products.

Conclusions: Results support the association between excess mortality from silicosis and occupational exposure to siliceous sands experienced during graphite electrode manufacturing. The observed excess mortality from liver cancer is compatible, to some extent, with exposures that may have occurred during the manufacture of phenolic and furfuryl resins treated products, although a role of lifestyle factors and viral infections cannot be excluded.

     

Mortality among urban policemen in Rome

A total of 3,868 urban policemen in Rome were investigated through a historical cohort study with emphasis on mortality from cardiovascular disease and cancer. Overall mortality from cardiovascular disease, respiratory conditions, digestive and genitourinary diseases, and accidents was lower than expected. An excess risk of ischemic heart disease was observed among subjects aged less than 50 years [14 deaths, standardized mortality ratio (SMR = 1.63), 95% CI = 0.89–2.73], corresponding to workers with a short duration of employment and a short latency since first employment. Overall cancer mortality was as expected and no excess was found for lung cancer (82 deaths, SMR = 1.05). Increased mortality was observed from colon cancer (16 deaths, SMR = 1.47), melanoma (four deaths, SMR = 2.34), bladder cancer (13 deaths, SMR = 1.27), renal cancer (seven deaths, SMR = 1.39), and non-Hodgkin's lymphoma (six deaths, SMR = 1.51), although none of the excesses were statistically significant. Two deaths from male breast cancer (SMR = 14.36) and three from cancer of endocrine glands were found (SMR = 3.44). Nested case-control studies were conducted to evaluate cancer mortality risk by job category. Bladder cancer was significantly increased among car drivers (OR = 4.17); for kidney cancer, an increased odds ratio (OR = 2.27) was found among motorcyclists; non-Hodgkin's lymphoma clustered among motorcyclists (OR = 5.14). In summary, excess risk for specific cancer sites (colon, male breast, and endocrine glands) might be linked to occupational exposures; professional drivers seem to be at higher risk of bladder cancer, kidney cancer, and non-Hodgkin's lymphoma.     

Cancer mortality among magazine printing workers.

OBJECTIVE: After an inquiry from the employees of an offset printing plant, a historical cohort study was conducted to investigate cancer mortality among these workers. METHODS: The cohort comprised 262 men, who contributed 2771 person-years of observation. 16 deaths were identified during the follow up period (1980-91). Expected numbers of deaths were derived from age specific regional rates. Standardised mortality ratios (SMR) and 95% confidence intervals (95% CIs) were calculated. RESULTS: An increased cancer mortality was found after 10 years of employment (SMR 213, 95% CI 98 to 405, based on nine deaths), mainly due to a high mortality from lung cancer (SMR 381, 95% CI 104 to 975, four deaths), and from oesophageal cancer (SMR 1049, 95% CI 216 to 3065, three deaths). For workers with at least 20 years since the start of employment, the SMR was 262 (95% CI 105 to 540) for all cancer sites, 447 (95% CI 92 to 1306) for lung cancer, and 1094 (95% CI 132 to 3952) for oesophageal cancer. The increased cancer mortality was concentrated among pressmen. CONCLUSION: Although based on small numbers, the findings suggest an increased risk of cancer among these workers, which should be further investigated.     

An updated mortality study of workers at a petroleum refinery in Beaumont, Texas, 1945 to 1996

The present investigation represents an update of a previous cohort mortality study of 7543 workers who were employed at a petroleum refinery in Beaumont, Texas, for at least 1 year between 1945 and 1996. The updated study covered an observation period of 51 years, from 1946 to 1996, with a total of 208,627 person-years of observation. A total of 3020 (40.0%) cohort members were known to have died. The mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs). The overall mortality of the cohort was significantly lower than expected when compared with that of the general US population (SMR, 95.7; 95% CI, 92.3 to 99.2). Overall cancer mortality was also lower than expected (SMR, 85.8; 95% CI, 79.4 to 92.5). For specific cancer sites, significant mortality deficits were observed for the following: buccal cavity and pharynx, esophagus, large intestine, rectum, larynx, lung, and bladder and other urinary organs. No significant increase was reported for any site-specific cancer. A non-significant increase in acute myeloid leukemia was observed among male employees (SMR, 147.2; 95% CI, 76.1 to 257.2). Detailed analyses indicated that the excess was restricted to workers hired before 1950. No increase was detected for other leukemia cell-types, non-Hodgkin's lymphoma, or multiple myeloma. For non-malignant diseases, the majority of SMRs were below 100, and no significant increase was observed for any cause. In particular, significant mortality deficits were reported for ischemic heart disease (SMR, 91.0; 95% CI, 85.4 to 96.9), non-malignant respiratory disease (SMR, 61.5; 95% CI, 52.2 to 72.0), pulmonary fibrosis (SMR, 51.0; 95% CI, 22.0 to 100.4), cirrhosis of the liver (SMR, 47.2; 95% CI, 30.6 to 69.7), and accidents (SMR, 81.7; 95% CI, 66.3 to 99.6). Separate analyses of male workers by job classification (process and maintenance) were conducted. Mortality from acute myeloid leukemia was elevated among employees in maintenance jobs (8 observed deaths vs 4.31 expected; SMR, 185.5; 95% CI, 80.1 to 365.6). However, no upward trend by length of service was found. A detailed analysis indicated that the acute myeloid leukemia mortality excess was limited to maintenance workers who were hired before 1950. No other significant excess was detected for any cause among maintenance or process workers. These findings from the present study were discussed in conjunction with results from previous investigations of employees at the Beaumont refinery and with results from other refinery studies. Potential limitations of the study were also discussed.     

All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up

Background: Construction workers are potentially exposed to many health hazards, including human carcinogens such as asbestos, silica, and other so-called "bystander" exposures from shared work places. The construction industry is also a high risk trade with respect to accidents.

Methods: A total of 19 943 male employees from the German construction industry who underwent occupational health examinations between 1986 and 1992 were followed up until 1999/2000.

Results: A total of 818 deaths occurred during the 10 year follow up (SMR 0.71; 95% CI 0.66 to 0.76). Among those were 299 deaths due to cancer (SMR 0.89; 95% CI 0.79 to 1.00) and 312 deaths due to cardiovascular diseases (SMR 0.59; 95% CI 0.51 to 0.68). Increased risk of mortality was found for non-transport accidents (SMR 1.61; 95% CI 1.15 to 2.27), especially due to falls (SMR 1.87; 95% CI 1.18 to 2.92) and being struck by falling objects (SMR 1.90; 95% CI 0.88 to 3.64). Excess mortality due to non-transport accidents was highest among labourers and young and middle-aged workers. Risk of getting killed by falling objects was especially high for foreign workers (SMR 4.28; 95% CI 1.17 to 11.01) and labourers (SMR 6.01; 95% CI 1.63 to 15.29).

Conclusion: Fatal injuries due to falls and being struck by falling objects pose particular health hazards among construction workers. Further efforts are necessary to reduce the number of fatal accidents and should address young and middle-aged, semi-skilled and foreign workers, in particular. The lower than expected cancer mortality deserves careful interpretation and futher follow up of the cohort.