Mortality among North Carolina construction workers, 1988-1994

Our plain-English summary of Mortality among North Carolina construction workers, 1988-1994, by E. Wang, J.M. Dement, H. Lipscomb (Applied Occupational and Environmental Hygiene, 1999).

The study

• Authors: E. Wang, J.M. Dement, H. Lipscomb
• Journal: Applied Occupational and Environmental Hygiene
• Published: 1999;14(1):45-58
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study evaluated proportionate mortality patterns among all male construction workers in North Carolina who resided and died in North Carolina during the period 1988-1994. Proportionate Mortality Ratios (PMRs) and Proportionate Cancer Mortality Ratios (PCMRs) compared the number of deaths among male construction workers with the number of deaths expected based on the gender, race, and cause-specific mortality experience of the entire North Carolina population by five-year age groups for the same years of study. PMRs based on United States death rates also were calculated. Among all male construction workers, significantly elevated mortality was observed for several causes possibly related to work including malignant neoplasms of buccal cavity (PMR = 143), pharynx (PMR = 134), and lung (PMR = 113), pneumoconiosis (PMR = 111), transportation accidents (PMR = 106), and accidental falls (PMR = 132). Elevated mortality also was observed for causes more related to lifestyle and non-occupational factors including alcoholism (PMR = 145), cirrhosis of the liver (PMR = 129), accidental poisoning (PMR = 136), and homicide (PMR = 141). Patterns of elevated mortality for Whites and Black men were similar and PCMR mortality patterns for Blacks and Whites combined were similar to PMRs. Construction workers were at significantly increased risk for deaths resulting from falls from ladders or scaffolds, falls from or out of buildings or structures, and electrocutions. Construction trades found to have statistically elevated cancer risks include laborers and roofers (buccal cavity), painters (pharynx), laborers (peritoneum), and carpenters, painters, brick masons, and operating engineers (lung). These data are consistent with other reports demonstrating excess mortality from asbestos-related diseases (pneumoconiosis, lung cancer, and mesothelioma) among construction workers. Dry-wall workers and laborers were found to have a statistically elevated risk of death as a result of respiratory tuberculosis.

In plain English

This proportionate mortality study used death certificates of men whose usual industry was construction and who lived and died in North Carolina from 1988 to 1994: 21,617 White, 7,483 Black and 454 of other races. The authors compared each cause's share of deaths with the share expected from all North Carolina deaths by sex, race and five-year age group in the same years; a PMR above 100 means a larger share than expected. Among all the men, significantly elevated PMRs were found for lung cancer (113, 3,023 deaths), 'pneumonoconiosis and other respiratory diseases' (111), falls from ladders, scaffolds and buildings, electrocutions, alcoholism and homicide. Sixteen deaths were assigned ICD-9 code 163, which the authors described as mesotheliomas of the pleura; nine were assigned codes generally used for peritoneal mesothelioma. Laborers had a significant PMR of 239 for cancer of the peritoneum and unspecified digestive organs. Insulators had a PMR of 218 for pneumonoconiosis and other respiratory diseases. The authors concluded that cancer mortality was excessive at sites with established occupational risk factors, including lung, pleura and peritoneum. They noted the data lacked exposure and smoking histories.

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 study (death certificate surveillance), with PMR and PCMR analyses
• Who was studied: All deaths in 1988 to 1994 among males whose usual industry on the death certificate was construction and who both resided and died in North Carolina: 21,617 White males, 7,483 Black males and 454 males of other races (29,554 in total). Expected deaths were based on the gender, race and cause-specific mortality of the entire North Carolina population by five-year age groups for the same years; a separate analysis used U.S. death proportions.
• Exposure: Usual industry of construction, as recorded on the death certificate, grouped into trades (for example carpenters, laborers, painters, insulators, plumbers and pipe fitters, drywall installers). Asbestos and other exposures were not measured.
• Main results:
  • All male construction workers: significantly elevated PMR for malignant neoplasm of trachea, bronchus and lung (PMR = 113; 3,023 deaths).
  • All male construction workers: significantly elevated PMR for the category 'pneumonoconiosis and other respiratory diseases' (ICD-9 470 to 478 and 494 to 519; PMR = 111; 1,355 deaths).
  • When U.S. death rates were used for comparison, the PMRs for all male construction workers were 125 for lung cancer and 122 for pneumonoconiosis and other respiratory diseases.
  • Among all the construction worker deaths, 16 were assigned ICD-9 code 163, which the authors described as mesotheliomas of the pleura.
  • A further nine deaths were assigned ICD-9 categories generally used for peritoneal mesotheliomas (158.8 and 159.9).
  • Construction laborers had a significantly elevated PMR of 239 for malignant neoplasm of the peritoneum and unspecified digestive organs. Two of these laborer deaths were coded specifically to 158.8 or 159.9.
  • Lung cancer PMRs were above 100 in every construction trade. They were statistically significant for carpenters (119); painters, paperhangers and plasterers (118); brick masons, stonemasons and tile setters (118); operating engineers and equipment operators (116); and construction supervisors (119).
  • Insulators had a significantly elevated PMR of 218 for pneumonoconiosis and other respiratory diseases. Their lung cancer PMR was 153, which was not marked as statistically significant.
  • All male construction workers: significantly elevated PMRs for cancer of other parts of the buccal cavity (PMR = 143) and of the pharynx (PMR = 134).
  • All male construction workers had significantly increased deaths from falls from ladders or scaffolding (PMR = 224, 24 deaths), falls from or out of buildings or structures (PMR = 266, 36 deaths), and electric current (PMR = 229, 55 deaths).
  • All male construction workers: significantly elevated PMR for alcoholism (PMR = 145).
  • All male construction workers: 1,007 homicides, a statistically significant excess (PMR = 141).
• The authors' conclusion: The authors concluded that cancer mortality was excessive for several sites with well-established occupational risk factors, including cancers of the buccal cavity, pharynx, lung, pleura and peritoneum. They also concluded that deaths from falls from elevations and from electrocutions were clearly elevated in this workforce.
• Limitations the authors state:
  • Death certificate data lack exposure histories and information on non-occupational risk factors such as smoking and diet.
  • Usual occupation recorded on death certificates may be inaccurate. The authors cited another study that reported 30 to 50 percent misclassification, which may lead to underestimated risks for specific groups.
  • Only statistically significant results based on at least five deaths were reported, which limited reporting on less common causes of death. The authors stated that the absence of a significant excess by trade does not negate associations found in other studies.
  • In proportionate mortality studies, an excess in one cause must be offset by a deficit in another, so each PMR depends on the others.
  • Many statistical tests were performed by trade and cause, so some significant findings would be expected by chance.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Pneumoconiosis, Peritoneum, Lung Cancer, Mesothelioma.

Related studies

• Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987 — C.F. Robinson, M. Petersen, et al. (1999)
• Lung cancer mortality and fibre exposures among North Carolina asbestos textile workers — D. Loomis, J.M. Dement, et al. (2009)
• Protest and survive, the U.K. Construction Safety Campaign: a case study of workers' and victims' family action and legal and regulatory inaction on construction health and safety — M. Holder, T. O'Brien (2007)
• Cancer and noncancer mortality among aluminum smelting workers in Badin, North Carolina — E.S. McClure, P. Vasudevan, et al. (2020)
• Lung cancer mortality in North Carolina and South Carolina chrysotile asbestos textile workers — L. Elliott, D. Loomis, et al. (2012)
• A cohort mortality study of construction workers — J. Sun, E. Shibata, et al. (1997)

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