Mortality Patterns among Commercial Painters in The Netherlands

Our plain-English summary of Mortality Patterns among Commercial Painters in The Netherlands, by C.W. Terstegge, G.M. Swaen, J.J. Slangen, et al (International Journal of Occupational and Environmental Health, 1995).

The study

• Authors: C.W. Terstegge, G.M. Swaen, J.J. Slangen, C. Van Vliet
• Journal: International Journal of Occupational and Environmental Health
• Published: 1995;1(4):303-310
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In an epidemiologic study, the mortality patterns of commercial painters in The Netherlands were investigated. The hypothesis that painters are at an increased risk of cancer, especially lung cancer, was tested in collaboration with the Dutch Social Fund for painters. This fund manages the pensions of Dutch painters. In the group of painters eligible for pensions, 9,812 deaths were observed between 1980 and 1992. Proportionate mortality ratios were calculated. The results support previous findings of an increased risk of lung cancer in painters. Although no statement can be made about the actual causal agent, the authors believe that the sanding down of old paint layers may expose painters to particulates that contain carcinogens such as lead chromates and asbestos. The decreased risks of mortality from some neoplasms and circulatory and digestive problems, pneumoconiosis, and "other causes" observed in the painters lack a plausible explanation. Chance or the known limitation of proportionate mortality ratio analysis might play a role.

In plain English

This study looked at causes of death among commercial painters in The Netherlands registered with the painters' pension fund. The authors compared causes of death among 9,812 painters who died between 1980 and 1992 with those in the total Dutch male population. They used proportionate mortality ratios (PMRs), which compare the share of deaths from each cause rather than death rates. Deaths from cancer overall were higher than expected (3,266 observed versus 3,050 expected; PMR 107, 95% CI 103-111). Among specific cancers, only lung cancer was statistically significantly increased (1,480 observed, 1,237 expected; PMR 120, 95% CI 114-126). This lung category also included cancers of the pleura and other chest sites. Deaths from pulmonary emphysema and other chronic obstructive lung disease were also raised, while deaths from pneumoconiosis and several other causes were lower than expected. No individual exposure or smoking information was available. The authors concluded that no causal agent could be identified, but believed that sanding old paint layers may expose painters to particles containing carcinogens such as lead chromates and asbestos.

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) study comparing deceased painters with the total Dutch male population
• Who was studied: 9,812 commercial painters registered in the Dutch painters' pension fund who died between 1980 and 1992; the reference group was the total Dutch male population over the same period
• Exposure: Work as a commercial (construction and maintenance) painter. No individual exposure data were available. The authors discussed asbestos and lead chromates as possible exposures during sanding, but these were not measured.
• Main results:
  • All cancers among the deceased painters: 3,266 deaths observed versus 3,050 expected (PMR 107, 95% CI 103-111). This was statistically significantly higher than expected.
  • Lung cancer among the painters: 1,480 observed versus 1,237 expected (PMR 120, 95% CI 114-126). This was the only specific cancer with a statistically significant increase.
  • In the results table, the 'lung' cancer category (ICD 162-165) combined trachea, bronchus and lung with pleura, thymus, heart, mediastinum and less defined parts of the respiratory tract
  • Pulmonary emphysema among the painters: PMR 130 (254 observed, 195 expected; 95% CI 115-147)
  • Other chronic obstructive pulmonary diseases among the painters: PMR 143 (200 observed, 139 expected; 95% CI 124-165)
  • Several causes of death were statistically significantly less frequent among the painters. These were cancers of the stomach/small intestine, large intestine and rectum/anus; multiple myeloma; circulatory and digestive diseases; pneumoconiosis; and 'other causes'.
  • Pneumoconiosis among the painters: 9 observed versus 27.8 expected (PMR 32.4, 95% CI 14.8-61.5). This was statistically significantly lower than expected.
• The authors' conclusion: The authors concluded that no statement could be made about the actual cause. They believed that sanding down old paint layers may expose painters to particles containing carcinogens such as lead chromates and asbestos.
• Limitations the authors state:
  • No individual exposure information was available, so no causal agent could be identified
  • No smoking histories were available
  • Some people in the pension fund were not painters (administrative and executive staff). The authors assumed this led to underestimated relative risks.
  • Cause-specific PMRs depend on one another, which is a recognized weakness of the method
  • Multiple statistical testing increases the chance of finding statistical significance
  • People who had left the trade before age 65 (group 4) were harder to trace

Topics

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

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