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

Our plain-English summary of All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up, by V. Arndt, D. Rothenbacher, U. Daniel, et al (Occupational and Environmental Medicine, 2004).

The study

• Authors: V. Arndt, D. Rothenbacher, U. Daniel, B. Zschenderlein, S. Schuberth, H. Brenner
• Journal: Occupational and Environmental Medicine
• Published: 2004;61(5):419-25
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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 further follow up of the cohort.

In plain English

This cohort study followed 19,827 male construction workers in Baden-Württemberg, Germany, examined 1986–1992, comparing their deaths through 1998–2000 with the regional population. At baseline, 7.5% reported asbestos exposure and 2.4% silica exposure. There were 818 deaths, fewer than expected (SMR 0.71; 95% CI 0.66 to 0.76), including 299 from cancer (SMR 0.89; 95% CI 0.79 to 1.00). Respiratory system cancer deaths were close to expected (SMR 1.01; 95% CI 0.82 to 1.22). Pneumoconiosis deaths were raised but not statistically significant (three cases; SMR 2.30; 95% CI 0.48 to 6.74). Non-transport accident deaths were raised (SMR 1.61; 95% CI 1.15 to 2.27), mainly falls (SMR 1.87; 95% CI 1.18 to 2.92); deaths from being struck by falling objects were not significantly raised overall (SMR 1.90; 95% CI 0.88 to 3.64). Labourers and non-German workers had the highest falling-object risk. The authors concluded that falls and falling objects pose particular hazards, and that lower than expected cancer mortality needs careful interpretation and further follow-up. They noted follow-up may be too short for cancer to develop and that 15% of causes of death were missing.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cohort study comparing deaths with the general population (standardised mortality ratios), with about 10 years of follow-up
• Who was studied: 19,943 male construction workers aged 25–64 in six job groups (plumbers, carpenters, painters, plasterers, bricklayers, labourers). All had a health examination in Baden-Württemberg, Germany, between 1 August 1986 and 31 December 1992. After excluding 116 with no follow-up information, the final study population was 19,827 men. Vital status was traced between October 1998 and February 2000. Deaths were compared with the Baden-Württemberg general population.
• Exposure: Work in the German construction industry. At baseline, 7.5% of workers reported asbestos exposure and 2.4% reported silica exposure. Asbestos fiber types and doses were not given.
• Main results:
  • Whole cohort: 818 deaths, with all-cause SMR 0.71 (95% CI 0.66 to 0.76), meaning lower mortality than the general male population.
  • Whole cohort: 299 cancer deaths, SMR 0.89 (95% CI 0.79 to 1.00).
  • Whole cohort: deaths from diseases of the circulatory system were lower than expected (185 observed, 312 expected; SMR 0.59, 95% CI 0.51 to 0.68).
  • Whole cohort: deaths from cancer of the respiratory system were close to expected (100 observed, 99 expected; SMR 1.01, 95% CI 0.82 to 1.22), despite high smoking prevalence and potential asbestos and silica exposure.
  • Whole cohort: non-significant excess of deaths from pneumoconiosis and other lung diseases related to external agents (3 observed, 1.3 expected; SMR 2.30, 95% CI 0.48 to 6.74). The number of cases was very small.
  • Whole cohort: excess deaths from non-transport accidents (36 deaths; SMR 1.61, 95% CI 1.15 to 2.27). These were mainly falls (21 deaths; SMR 1.87, 95% CI 1.18 to 2.92) and being struck by falling objects (9 deaths; SMR 1.90, 95% CI 0.88 to 3.64; not statistically significant). Transport accidents (SMR 0.73) and suicides (SMR 0.59) were not increased.
  • Risk of death from being struck 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).
  • Workers aged 25–44 during follow-up had increased cancer mortality: SMR 1.51 (95% CI 1.00 to 2.30), based on 23 deaths.
  • Analysis allowing 20, 30 and 40 years of lag time showed no evidence of increased risk for cancer or for all-cause mortality.
• The authors' conclusion: The authors concluded that fatal injuries from falls and being struck by falling objects pose particular health hazards among construction workers. They said further efforts to reduce fatal accidents should target young and middle-aged, semi-skilled and foreign workers. They also said the lower than expected cancer mortality deserves careful interpretation and further follow-up of the cohort.
• Limitations the authors state:
  • Participation was voluntary, so study members may not be representative. Observed mortality may underestimate the true mortality of the source population.
  • Workers who left the construction industry for health reasons before the baseline examination were not captured.
  • The follow-up period may be too short for cancer or other chronic health effects to develop.
  • Broad, non-specific disease categories may dilute effects.
  • Cause of death was missing for 15% of those who died. The statistical adjustment for this may be less accurate for rare causes of death, such as site-specific cancers.
  • Numbers of fatal falls within each job category were very small, and the findings need confirmation in larger samples.

Related studies

• A cohort mortality study of construction workers — J. Sun, E. Shibata, et al. (1997)
• Cause-specific mortality in a Chinese chrysotile textile worker cohort — X. Wang, S. Lin, et al. (2013)
• Assessment of mortality in the construction industry in the United States, 1984-1986 — C. Robinson, F. Stern, et al. (1995)
• Proportionate mortality among construction laborers — F. Stern, P. Schulte, et al. (1995)
• Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011 — K. Ringen, J. Dement, et al. (2015)
• Lung function predicts mortality: 10-year follow-up after lung cancer screening among asbestos-exposed workers — T. Vehmas, P. Pallasaho, et al. (2013)

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