Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016

Our plain-English summary of Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow-up through 2016, by K. Ringen, J. Dement, S. Hines, et al (American Journal of Industrial Medicine, 2019).

The study

• Authors: K. Ringen, J. Dement, S. Hines, P. Quinn, A. Chen, S. Haas
• Journal: American Journal of Industrial Medicine
• Published: 2019;62(9):742-754
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: To determine if construction and trades workers employed at U.S. Department of Energy (DOE) nuclear sites facilities are at significant risk for diseases associated with occupational exposures, we compared the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed) to that of the US population.

Methods: The cohort includes 24,086 BTMed participants enrolled between 1998 and 2016 and 5203 deaths. Cause-specific standardized mortality ratios 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, chronic obstructive pulmonary disease, asbestosis, transportation injuries, and other injuries, particularly those caused by accidental poisoning, suggesting a possible effect of the opioid epidemic.

Conclusions: Apart from other injuries, mortality patterns were very similar to those reported in the past in this population. 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 possibly after 1990. The cancer risks closely match the cancers identified for DOE compensation from radiation exposures. The high risk of lung cancer supports the value of early lung cancer detection. Continued medical surveillance is important.

© 2019 Wiley Periodicals, Inc.

In plain English

The authors followed 24,086 construction and trade workers from 28 U.S. Department of Energy (DOE) nuclear sites who joined a voluntary medical screening program between 1998 and 2016. Using the National Death Index, they found 5203 deaths through 2016. They compared death rates with those of the U.S. population using standardized mortality ratios (SMRs), where a value above 1 means more deaths than expected. Deaths from all causes (SMR 1.09, 95% CI 1.06 to 1.12), all cancers (1.24, 1.18 to 1.30), lung cancer (1.40, 1.29 to 1.53) and COPD (1.46, 1.33 to 1.61) were higher than expected. There were 59 mesothelioma deaths where 9.25 were expected (SMR 6.38, 4.86 to 8.23), and 80 asbestosis deaths where 2.23 were expected (SMR 35.90, 28.47 to 44.68). Mesothelioma and asbestosis risks were highest among workers first employed at DOE sites before 1970. The authors stated that these excesses reflect significant past asbestos exposure. They concluded that these workers have a significantly increased risk for occupational illnesses. They noted that participants volunteered and that many also worked outside DOE sites.

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: Prospective cohort mortality study. Deaths in the cohort were compared with U.S. national death rates using standardized mortality ratios adjusted for age, race, sex and calendar year. This is the third mortality analysis of this cohort.
• Who was studied: 24,086 former construction and trade workers from 28 DOE sites in the Building Trades National Medical Screening Program (BTMed) who had a work history interview between January 1, 1998 and December 31, 2016. Follow-up totaled 252,903 years and recorded 5203 deaths. 93.0% were male, and the mean age at entry was 60.2 years.
• Exposure: Construction and trade work at DOE nuclear sites. Exposures included radiation, asbestos, silica, solvents, metals, and welding or cutting gases and fumes. No specific asbestos fiber types were named. The mean duration of DOE site work was 10.5 years.
• Main results:
  • All-cause mortality in the whole cohort was increased: SMR 1.09 (95% CI 1.06 to 1.12), based on 5203 deaths.
  • All-cancer mortality in the whole cohort: SMR 1.24 (95% CI 1.18 to 1.30).
  • Lung cancer (trachea, bronchus, lung) in the whole cohort: SMR 1.40 (95% CI 1.29 to 1.53), 532 deaths.
  • Mesothelioma in the whole cohort: 59 observed deaths against 9.25 expected, SMR 6.38 (95% CI 4.86 to 8.23).
  • Asbestosis in the whole cohort: 80 observed deaths against 2.23 expected, SMR 35.90 (95% CI 28.47 to 44.68).
  • COPD in the whole cohort: SMR 1.46 (95% CI 1.33 to 1.61), 429 deaths.
  • Kidney cancer in the whole cohort: SMR 1.39 (95% CI 1.03 to 1.84), 49 deaths. Lymphatic and hematopoietic cancers: SMR 1.25 (95% CI 1.07 to 1.46), 162 deaths.
  • Accidental poisoning in the whole cohort: SMR 1.62 (95% CI 1.16 to 2.19), 41 deaths. The authors suggested this was likely an early effect of the opioid epidemic.
  • Mesothelioma and asbestosis risk was highest among workers first employed at DOE sites before 1970, with evidence of a decreasing trend for later starters. Risks for those starting after 1990 were uncertain.
  • Smoking history was available for 20,685 cohort members: 18.5% were current smokers, 45.4% past smokers and 36.1% never smokers. The authors described this as lower than among most construction trades and U.S. males.
  • Deaths restricted to the cancers listed for radiation compensation under EEOICPA showed SMR 1.23 (95% CI 1.15 to 1.31).
• The authors' conclusion: The authors concluded that construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. They stated that the excess mesothelioma, lung cancer and asbestosis reflects significant past asbestos exposure, and that the high lung cancer risk supports early lung cancer detection.
• Limitations the authors state:
  • Participation was voluntary, so self-selection bias remains possible.
  • A healthy worker/survivor effect may lower some death rates, such as those for heart disease.
  • Many workers also worked outside DOE sites, so the results do not reflect DOE exposures alone.
  • Follow-up for workers who started DOE work after about 1990 is short, giving few deaths and low statistical power.
  • Radiation exposure is hard to capture in work history interviews.
  • Race was missing for 13.3% of cohort members, 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: Occupational Exposure, standardized mortality ratio (SMR), Bronchus, Mesothelioma, Lung Cancer.

Related studies

• 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)
• 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)
• USTUR Special Session Roundtable-US Transuranium and Uranium Registries (USTUR): A Five-decade Follow-up of Plutonium and Uranium Workers — S.Y. Tolmachev, M.J. Swint, et al. (2019)

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