Proportionate mortality among construction laborers

Our plain-English summary of Proportionate mortality among construction laborers, by F. Stern, P. Schulte, M.H. Sweeney, et al (American Journal of Industrial Medicine, 1995).

The study

• Authors: F. Stern, P. Schulte, M.H. Sweeney, M. Fingerhut, P. Vossenas, G. Burkhardt, M.F. Kornak
• Journal: American Journal of Industrial Medicine
• Published: 1995;27(4):485-509
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This report presents the results of proportionate mortality ratio (PMR) analyses and proportionate cancer mortality ratio (PCMR) analyses among the 11,685 members of the Laborers' International Union of North America (LIUNA), who died between 1985-1988, using U.S. proportionate mortality rates as the comparison population. Statistically significant elevated mortality risks were observed for all malignant neoplasms (N = 3285, PMR = 1.13, CI = 1.09-1.17), as well as for site-specific neoplasms of the lung (N = 1208, PCMR = 1.06, CI = 1.00-1.12), stomach (N = 170, PCMR = 1.44, CI = 1.23-1.68), and thyroid gland (N = 10, PCMR = 2.24, CI = 1.07-4.12). The PCMRs for these malignant neoplasms were elevated among both white and non-white males, regardless of length of union membership, in most 10-year categories of age at death above 40 and for the three largest LIUNA regions examined. The study also observed 20 mesothelioma deaths, which indicated that some LIUNA members had been previously exposed to asbestos. Statistically significant elevated risks were also observed for deaths from transportation injuries (N = 448, PMR = 1.37, CI = 1.25-1.51), falls (N = 85, PMR = 1.34, CI = 1.07-1.66), and other types of injuries (N = 245, PMR = 1.61, CI = 1.42-1.83). The deaths due to injuries were most often observed among those members who had the shortest amount of time within the union, were younger, and first entered the union after 1955. This is the first study that has examined the general mortality experience limited to construction laborers only (Bureau of Census code 869).

In plain English

This study looked at causes of death among 11,685 members of the Laborers' International Union of North America who died in the United States between 1985 and 1988. The authors used a proportionate mortality method, comparing the share of deaths from each cause with the share expected from U.S. death patterns. Deaths from all cancers combined were higher than expected (PMR 1.13, 95% CI 1.09-1.17). In the cancer-only analysis, deaths from lung cancer (1,208 deaths, PCMR 1.06, CI 1.00-1.12), stomach cancer (170 deaths, PCMR 1.44, CI 1.23-1.68) and thyroid cancer (10 deaths, PCMR 2.24, CI 1.07-4.12) were raised. Death certificates gave mesothelioma as the underlying cause for 20 members: 5 pleural, 1 peritoneal and 14 with no site stated. No expected figure was available for comparison. Deaths from transportation injuries, falls and other injuries were also raised, mostly among members with under 20 years in the union. Individual exposures were not measured, and smoking data were lacking. The authors suggested that asbestos exposure among some members contributed to the lung cancer excess. They also noted that part of that excess may have been tobacco-related.

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) and proportionate cancer mortality ratio (PCMR) study based on union death records and death certificates, compared with U.S. proportionate mortality
• Who was studied: 11,685 deceased members of the Laborers' International Union of North America (construction locals) who died in the United States from 1985 to 1988 and had at least 1 year of continuous union service. 124 deaths abroad and 106 deaths without a death certificate were excluded.
• Exposure: Work as construction laborers (Bureau of Census code 869). Exposures were not measured for individuals. Potential job-site exposures listed by the authors include asbestos, inorganic lead, solvents, carbon monoxide and noise. No asbestos fiber type was identified for this population.
• Main results:
  • All members: deaths from all malignant neoplasms were significantly elevated (PMR 1.13, 95% CI 1.09-1.17).
  • All members, cancer-only (PCMR) analysis: stomach cancer N = 170, PCMR 1.44 (CI 1.23-1.68); trachea, bronchus and lung cancer N = 1208, PCMR 1.06 (CI 1.00-1.12).
  • All members, PCMR analysis: thyroid cancer N = 10, PCMR 2.24 (CI 1.07-4.12).
  • Mesothelioma was the underlying cause of death for 20 members: 14 with no site specified, 5 pleural and 1 peritoneal. No expected rates were available for comparison.
  • All members: 1,208 lung cancer deaths were observed, against 1,137 expected in the PCMR analysis (71 excess) and 1,005 expected in the PMR analysis (203 excess).
  • Based on the mesothelioma deaths and the lung cancer excess, the authors suggested that some members had asbestos exposure that contributed to the lung cancer excess.
  • All members: nonmalignant respiratory disease deaths were 926 observed against 960.2 expected (PMR 0.96, CI 0.90-1.03), which the authors described as lower than expected.
  • All members: fatal injuries were elevated, with transportation injuries PMR 1.37 (CI 1.25-1.51), falls PMR 1.34 (CI 1.07-1.66) and other injuries PMR 1.61 (CI 1.42-1.83).
  • Fatal injury risks were significantly raised before 20 years of union membership and fell sharply after 20 years.
• The authors' conclusion: The authors concluded that their results seem to confirm and strengthen earlier findings of increased lung and stomach cancer risk among construction laborers, and of increased fatal injury risk in the earlier years of employment. They stated that the reason for the raised thyroid cancer risk is unclear.
• Limitations the authors state:
  • The types, intensity and length of individual exposures were unknown.
  • No information on smoking was available.
  • Some of the lung cancer excess, which was of borderline statistical significance, may have been tobacco-related.
  • Some stomach cancer deaths may have been misdiagnosed peritoneal mesothelioma.
  • Members who left the union before retirement or death were not included, so cancer deaths may have been underestimated.
  • If overall mortality in this group was higher than in the comparison population, the PMRs would tend to underestimate the true risk.
  • Multiple significance testing may have produced associations by chance alone.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Mesothelioma.

Related studies

• Assessment of mortality in the construction industry in the United States, 1984-1986 — C. Robinson, F. Stern, et al. (1995)
• Proportionate mortality among unionized construction ironworkers — F.B. Stern, M.H. Sweeney, et al. (1997)
• A proportionate mortality study of bricklayers and allied craftworkers — J. Salg, T. Alterman (2005)
• Proportionate mortality among unionized roofers and waterproofers — F.B. Stern, A.M. Ruder, et al. (2000)
• A cohort mortality study of construction workers — J. Sun, E. Shibata, et al. (1997)
• All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up — V. Arndt, D. Rothenbacher, et al. (2004)

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