Mortality among United Kingdom servicemen who served abroad in the 1950s and 1960s

Our plain-English summary of Mortality among United Kingdom servicemen who served abroad in the 1950s and 1960s, by S.C. Darby, C.R. Muirhead, R. Doll, et al (British Journal of Industrial Medicine, 1990).

The study

• Authors: S.C. Darby, C.R. Muirhead, R. Doll, G.M. Kendall, B. Thakrar
• Journal: British Journal of Industrial Medicine
• Published: 1990;47(12):793-804
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The Registrar General's decennial supplements on occupational mortality provide only limited information on mortality in the armed forces in the United Kingdom. Mortality has therefore been studied among a group of 30,619 United Kingdom servicemen who served abroad in tropical or desert areas in the 1950s and 1960s, and who remained in the services for a total of at least five years. Mortality from all causes of death, all neoplasms, and all other known non-violent causes was lower than that expected from rates for all men in England and Wales, whereas mortality from accidents and violence was raised. These differences remained after adjustment for social class, affected both officers and other ranks, and had not disappeared even after the men had been followed up for at least 20 years. When mortality from 20 specific cancers and 10 other disease groups was examined there were significant excesses for cancers of the oesophagus (standardised mortality ratio (SMR) = 146; p = 0.03) and prostate (SMR = 156; p = 0.03), and significant deficits for cancers of the lung (SMR = 73; p less than 0.001), stomach (SMR = 66; p = 0.002), bladder (SMR = 53; p = 0.02), other specified neoplasms (SMR = 48; p = 0.001), coronary heart disease (SMR = 76; p less than 0.001), bronchitis, emphysema, and chronic obstructive lung disease (SMR = 42; p less than 0.001), and for five further groups of diseases unrelated to smoking or alcohol. Examination of mortality in each of the three services separately identified two specific hazards in the Royal Navy; seven deaths from mesothelioma occurred compared with less than 2.06 expected (p less than 0.005), and there was also an excess of neoplasms and of other diseases associated with alcohol (SMRs of 181 and 229; p = 0.002 and less than 0.001). Mortality from smoking related diseases other than those associated with alcohol was low in all three services, particularly among officers.

In plain English

The authors followed 30,619 United Kingdom servicemen who served abroad in tropical or desert areas in the 1950s and 1960s and stayed in the services at least five years. Deaths up to 1 January 1984 were compared with death rates for men in England and Wales (for mesothelioma, men in Britain). The men had lower death rates from all causes, all cancers and other non-violent diseases. Their death rates from accidents and violence were higher (standardised mortality ratio 137). Seven death certificates mentioned mesothelioma, all for Royal Navy men. Two were officers, where less than 0.29 were expected, and five were other ranks, where less than 1.77 were expected. There were none in the Army and Royal Air Force, where 3.16 were expected. These deaths occurred 27 to 41 years after enlistment. The authors stated they had no direct evidence this excess came from asbestos in ships. They also stated that expected numbers were overstated because 1968 rates were used for earlier years. They described it as a small absolute excess pointing to a specific Royal Navy hazard.

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: Retrospective cohort (mortality follow-up) study comparing observed deaths with numbers expected from national rates for men in England and Wales
• Who was studied: 30,619 United Kingdom servicemen who served abroad in tropical or desert areas in the 1950s and 1960s and served at least five years in total. They included participants in the UK atmospheric nuclear weapon tests and a control group. 42% were in the Royal Navy, 17% in the Army and 41% in the Royal Air Force. Follow-up ran to 1 January 1984.
• Exposure: Military service abroad, compared across the Royal Navy, Army and Royal Air Force and between officers and other ranks. Asbestos exposure was not measured. The authors considered asbestos in ships as a possible explanation for the mesothelioma deaths but stated they had no direct evidence for it.
• Main results:
  • Compared with all men in England and Wales, the servicemen had lower mortality from all causes, all neoplasms and all other non-violent causes.
  • For all servicemen combined, mortality from accidents and violence was higher than expected from national rates (SMR 137, p less than 0.001).
  • Expected numbers of deaths with mesothelioma mentioned on the death certificate were calculated from counts for men in Britain for 1968 to 1983, not from England and Wales rates.
  • Of 14 Royal Navy death certificates coded to neoplasms of unspecified site, four mentioned mesothelioma. None of the 10 such certificates for the other two services mentioned it.
  • A search of all death certificates found three more deaths attributed to mesothelioma of the pleura. These had been grouped with lung cancer, and all three were also Royal Navy men.
  • In the Royal Navy, 2 mesothelioma deaths occurred among officers, where less than 0.29 were expected. Five occurred among other ranks, where less than 1.77 were expected. The increase was statistically significant in both groups (p less than 0.03).
  • In the Army and Royal Air Force combined, there were 0 deaths mentioning mesothelioma against 3.16 expected (p = 0.08). For all services and ranks combined, there were 7 observed against 5.22 expected (SMR 134, p = 0.51).
  • The deaths mentioning mesothelioma occurred 27, 30, 34, 35, 40, 41 and 41 years after enlistment.
  • For all ranks combined, there were significant excesses of cancer of the oesophagus (SMR 146, p = 0.03) and cancer of the prostate (SMR 156, p = 0.03).
  • Mortality from the category 'cancer of trachea, bronchus, lung and pleura' was lower than expected (230 deaths, SMR 73, p less than 0.001).
  • In the Royal Navy, mortality from cancers associated with alcohol was raised (SMR 181, p = 0.002).
• The authors' conclusion: The authors concluded that two findings pointed to specific hazards in the Royal Navy, neither of which they found unexpected: a small absolute excess of deaths from mesothelioma, and an excess of deaths from cancers and other diseases associated with alcohol.
• Limitations the authors state:
  • Mesothelioma counts for years before 1968 were not available, so 1968 rates were used for earlier years. The authors state this exaggerates the expected number of mesothelioma deaths.
  • The authors had no direct evidence that the mesothelioma excess was due to asbestos exposure in ships.
  • The healthy worker effect was expected to be especially strong in this population, because men were selected as fit for enlistment and again for service overseas.
  • Social class adjustment rested on the conventional assumption that officers belong to social class I and other ranks mainly to social class III.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Emphysema, Obstructive Lung Disease, Mesothelioma.

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