Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011

Our plain-English summary of Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites: follow-up through 2011, by K. Ringen, J. Dement, L. Welch, et al (American Journal of Industrial Medicine, 2015).

The study

• Authors: K. Ringen, J. Dement, L. Welch, E. Bingham, P. Quinn, A. Chen, S. Haas
• Journal: American Journal of Industrial Medicine
• Published: 2015;58(2):152-67
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The Building Trades National Medical Screening Program (BTMed) was established in 1996 to provide occupational medicine screening examinations for construction workers who have worked at US Department of Energy nuclear sites. Workers participating in BTMed between 1998 and 2011 were followed to determine their vital status and mortality experience through December 31, 2011.

Methods: The cohort includes 18,803 BTMed participants and 2,801 deaths. Cause-specific Standardized Mortality Ratios (SMRs) were calculated based on US death rates.

Results: Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, and lung and lymphatic and hematopoietic system, mesothelioma, COPD, and asbestosis.

Conclusions: Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Risks are associated with employment during all time periods covered including after 1980. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. Continued medical surveillance is important.

© 2014 Wiley Periodicals, Inc.

In plain English

This study followed 18,803 construction and craft workers from 20 US Department of Energy (DOE) nuclear sites who had completed a screening program work history interview between 1998 and 2011, tracking deaths through December 31, 2011. They compared the 2,801 deaths with US death rates using standardized mortality ratios (SMRs). Deaths from all causes were slightly higher than expected (SMR 1.06, 95% CI 1.02–1.10). Deaths were also higher for mesothelioma (36 deaths, SMR 6.86, 95% CI 4.80–9.49), asbestosis (37 deaths, SMR 27.04, 95% CI 19.04–37.28), lung cancer (SMR 1.43, 95% CI 1.28–1.60), COPD (SMR 1.40, 95% CI 1.22–1.60), and lymphatic and hematopoietic cancers (SMR 1.31, 95% CI 1.06–1.61). There were no mesothelioma or asbestosis deaths among Amchitka workers. Mesothelioma and asbestosis risk was highest in workers first employed before 1960. Lung cancer risk rose with the profusion of lung-tissue changes on chest x-ray. Pleural abnormalities showed no significant link to lung cancer after adjustment. The authors concluded that the excess mesothelioma, lung cancer and asbestosis reflected significant past asbestos exposure. They noted possible self-selection, and that exposures were not limited to DOE work.

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 mortality study of medical screening program participants, comparing their deaths with US national death rates (standardized mortality ratios), with Cox models for lung cancer and chest x-ray findings
• Who was studied: 18,803 former construction trades workers (94.1% male) from 20 DOE sites covered by the Building Trades National Medical Screening Program (BTMed). They completed a work history interview between 1/1/1998 and 12/31/2011 and were followed for deaths through December 31, 2011. The cohort had 115,286 person-years and 2,801 deaths.
• Exposure: Work at DOE nuclear weapons sites in construction, maintenance, renovation, demolition and cleanup. Exposures included external and internal radiation, asbestos, silica, solvents, metals, and welding/cutting gases and fumes. Asbestos fiber types were not specified. Trades analyzed separately were carpenters, electricians, laborers and pipe trades.
• Main results:
  • All causes, whole cohort: 2,801 deaths observed vs 2,647.75 expected, SMR 1.06 (95% CI 1.02–1.10)
  • Mesothelioma, whole cohort: 36 deaths observed vs 5.25 expected, SMR 6.86 (95% CI 4.80–9.49)
  • Asbestosis, whole cohort: 37 deaths observed vs 1.37 expected, SMR 27.04 (95% CI 19.04–37.28)
  • Cancer of the trachea, bronchus and lung, whole cohort: 327 deaths observed vs 228.11 expected, SMR 1.43 (95% CI 1.28–1.60)
  • COPD, whole cohort: 219 deaths observed vs 156.21 expected, SMR 1.40 (95% CI 1.22–1.60)
  • Lymphatic and hematopoietic cancers, whole cohort: 95 deaths observed vs 72.33 expected, SMR 1.31 (95% CI 1.06–1.61)
  • All cancers, whole cohort: 919 deaths observed vs 713.90 expected, SMR 1.29 (95% CI 1.21–1.37)
  • Amchitka workers had no deaths from asbestosis or mesothelioma. Significant excess risks for these causes were seen at all the other sites.
  • Mesothelioma and asbestosis deaths were significantly elevated in all trade groups (carpenters, electricians, laborers, pipe trades, all other trades)
  • Mesothelioma and asbestosis risk was highest among workers first employed at DOE sites before 1960, with a decreasing trend for later entry years
  • Workers first employed at DOE sites after 1980 still had significantly elevated risks for all cancers, lung cancer and asbestosis
  • Among 15,881 workers with ILO chest x-ray readings, 695 (4.4%) had parenchymal changes with a profusion of 1/0 or greater and 2,228 (14.0%) had pleural changes
  • In Cox models adjusted for smoking and other factors (13,373 workers), the lung cancer hazard ratio rose significantly as chest x-ray profusion category increased, and also rose with age and smoking
  • After adjustment for parenchymal changes, smoking, age, gender and race, pleural abnormalities were not significantly related to lung cancer death
  • Smoking history was available for 15,391 workers: 20.3% current, 36.6% past and 43.1% never smokers. The authors judged that smoking alone was not a likely explanation for the excess lung cancer or COPD.
• The authors' conclusion: The authors concluded that the excess risk for mesothelioma, lung cancer and asbestosis in the cohort reflected significant past exposure to asbestos. They also concluded that excess risks were associated with DOE work that began after 1980, and that continued medical surveillance is important.
• Limitations the authors state:
  • Despite including workers who did not take the medical exam, self-selection into the program remains possible
  • Follow-up was short for sites added recently, giving few deaths and reduced statistical power
  • Most workers were employed at DOE sites only intermittently, so the deaths reflect exposures not limited to DOE work
  • Years of DOE site work and years of trade work are not good stand-ins for cumulative exposure
  • Mesothelioma and asbestosis deaths among workers with under 30 years of trade work were too few for meaningful duration analyses
  • Pleural changes were strongly linked with age and profusion category, making their independent effect on lung cancer hard to separate
  • Race was missing for about 11% of workers, who were assumed to be white

Topics

The National Library of Medicine indexes this study under subjects our site covers: Construction, Power plants and utilities.

Medical terms in this study, explained in our Lexicon: standardized mortality ratio (SMR), Bronchus, Mesothelioma, COPD.

Related studies

• Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016 — K. Ringen, J. Dement, et al. (2019)
• Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites — J.M. Dement, K. Ringen, et al. (2009)
• Airways obstruction among older construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2010)
• Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2003)
• French cohort of the uranium processing workers: mortality pattern after 30-year follow-up — I. Guseva Canu, E. Cardis, et al. (2010)
• Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987 — C.F. Robinson, M. Petersen, et al. (1999)

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