Assessment of mortality in the construction industry in the United States, 1984-1986

Our plain-English summary of Assessment of mortality in the construction industry in the United States, 1984-1986, by C. Robinson, F. Stern, W. Halperin, et al (American Journal of Industrial Medicine, 1995).

The study

• Authors: C. Robinson, F. Stern, W. Halperin, H. Venable, M. Petersen, T. Frazier, C. Burnett, N. Lalich, J. Salg, J. Sestito
• Journal: American Journal of Industrial Medicine
• Published: 1995;28(1):49-70
• Cited by: 75 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Construction, one of the larger industries in the United States, employs 7.6 million workers, many in skilled trades occupations. Previously published data about potential worksite exposures and mortality of construction site workers are limited. We analyzed occupation and industry codes on death certificates from 19 U.S. states to evaluate mortality risks among men and women usually employed in construction occupations. Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986. Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides. Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction. In addition, women experienced excess cancer of the connective tissue and suicide mortality. Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers. Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers. Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers.

In plain English

This study analyzed 1984-1986 death certificates from 19 U.S. states coded for usual occupation and industry, using proportionate mortality ratios (PMRs). A PMR compares a cause's share of deaths in one group with its share among all decedents, and 100 means average. Decedents usually employed in construction included 61,682 white men, 9,379 black men, 1,225 white women and 68 black women. White men dying before 65 had an asbestosis PMR of 393 (95% CI 196-703, 11 deaths) and a silicosis PMR of 327 (95% CI 149-620, 9 deaths). The authors reported significantly elevated asbestosis PMRs for plumbers, insulators, roofers and boilermakers. Significantly elevated PMRs for cancer of the pleura were reported for plumbers, insulators and electricians, and for peritoneal cancer in insulators, mostly from few deaths. The tables note these categories may include mesotheliomas. Asbestos exposure was not measured. The authors concluded that construction workers dying before 65 (analyzed only for white men) had significant excess asbestosis and silicosis mortality. They noted that death certificates can misstate occupation and cause of death, that smoking was not adjusted for, and that asbestosis was probably undercounted.

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: Proportionate mortality ratio (PMR) analysis of death certificates coded for usual occupation and industry
• Who was studied: Decedents usually employed in the construction industry who died 1984-1986 in 19 U.S. states: 61,682 white men, 9,379 black men, 1,225 white women and 68 black women. They were compared with all workers and, in a second analysis, with blue-collar workers.
• Exposure: Usual employment in the construction industry or in specific construction trades (e.g. plumbers, insulation workers, electricians, roofers, boilermakers, laborers), as recorded on the death certificate. No fiber types or exposure measurements were studied.
• Main results:
  • White male construction workers who died before age 65: asbestosis PMR 393 (p less than 0.01, 95% CI 196-703, 11 deaths)
  • White male construction workers who died before age 65: silicosis PMR 327 (p less than 0.01, 95% CI 149-620, 9 deaths)
  • White male construction workers of all ages: asbestosis PMR 295 (24 deaths, 95% CI 189-439), from Table III
  • White male construction workers of all ages: cancer of pleura or peritoneum PMR 141 (33 deaths, 95% CI 97-198), not marked statistically significant. The table notes this category may include mesotheliomas.
  • Plumbers: significantly elevated PMRs for cancer of the pleura (PMR 327, 5 deaths, 95% CI 106-763), a category the table notes may include mesotheliomas, and for asbestosis (PMR 1097, 8 deaths, 95% CI 474-2162), per Table IV
  • Insulation workers (267 deaths): significantly elevated PMRs for lung cancer, nonmalignant respiratory disease, asbestosis (9 asbestosis deaths), and cancer of the peritoneum and of the pleura. The table notes the peritoneum and pleura categories may include mesotheliomas.
  • Electricians: significantly elevated PMR for cancer of the pleura, a row Table IV labels 'Cancer of pleura (mesothelioma)' (PMR 331, 6 deaths, 95% CI 122-719). Their asbestosis PMR of 349 (3 deaths, 95% CI 72-1019) was not marked significant.
  • Roofers: significantly elevated asbestosis PMR (PMR 1873, 2 deaths, 95% CI 227-6766)
  • Boilermakers: significantly elevated asbestosis PMR (PMR 3238, 3 deaths, 95% CI 668-9462)
  • Using blue-collar workers as the comparison group gave very similar results. Some PMRs fell and became non-significant, including lung cancer among plumbers and electricians.
• The authors' conclusion: The authors concluded that significant excess mortality from asbestosis and silicosis was observed in U.S. construction industry workers who died before age 65. The under-65 analysis was done only for white men.
• Limitations the authors state:
  • Cause of death and usual occupation on death certificates can be misclassified. The authors say this would tend to lower risk estimates toward the null.
  • The authors could not adjust for smoking or alcohol
  • Asbestosis PMRs are probably underestimated because of a 1982 change in how occupational lung disease deaths were coded
  • Many statistical comparisons were made, so significant results should be treated as generating hypotheses
  • The PMR method itself may bias risk estimates

Topics

Medical terms in this study, explained in our Lexicon: Death Certificate, Stomach Cancer, Lung Cancer.

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• Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94 — A. Jemal, D. Grauman, et al. (2000)
• Cancer mortality among women in the Russian printing industry — M.A. Bulbulyan, S.A. Ilychova, et al. (1999)

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