Swedish approaches to industry-wide studies: the construction industry

Our plain-English summary of Swedish approaches to industry-wide studies: the construction industry, by A. Englund (Annals of the New York Academy of Sciences, 1991).

The study

• Author: A. Englund
• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:313-5
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This short conference comment, not a full research report, was by the head of the Swedish construction trades' occupational health program. The author described following three groups through national death and cancer registries: workers identified in the 1960 and 1970 censuses; about 30,000 painters' union members, 20,000 plumbers and 1,500 insulation workers; and about 225,000 workers examined by the service up to 1979. Fewer than 1 per 1000 examinees were lost to follow-up. Among examinees, total and cardiovascular death rates seemed to level off after 10 years at about 75-80% of the expected rate. Concrete and wood workers had near-expected cancer incidence (standardized incidence ratio around 95). The painters' cohort showed about 30% more lung cancer than expected, mainly among those born before 1910. It also had a substantial number of pleural tumors, which the author said might be relevant to asbestos exposure. The author noted that examinees were young, so long-latency diseases might not yet show up. The author also described a laboratory testing about 5,000 asbestos samples a year, calling this service feasible and of great value.

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: Conference comment describing an occupational health surveillance program that followed construction-worker cohorts through national registries (record linkage), with a nested case-control analysis for lung cancer
• Who was studied: Swedish construction workers in three separate groups: (1) workers identified in the 1960 and 1970 population censuses; (2) three trade subcohorts of about 30,000 painters' union members from 1965, about 20,000 workers certified in plumbing in 1966 and about 1,500 certified in insulating in 1966; (3) about 225,000 men who attended the service from 1969/70 to 1979, with a focus on about 135,000 examined in 1971-74. Records were linked to the cause-of-death registry up to 1985 and the cancer registry up to 1984.
• Exposure: Work in construction trades, recorded mainly as job type (painters, plumbers, insulation workers, concrete workers, wood workers, sheet-metal workers). Asbestos exposure was mentioned for the most sensitive jobs. No fiber types or doses were given.
• Main results:
  • Fewer than 1 per 1000 of the roughly 225,000 examinees were lost to follow-up.
  • Among examinees, total mortality was very low in the first years after the first medical visit. After 10 years it seemed to level off at about 75-80% of the expected rate, compared with Swedish men in general. The cardiovascular mortality curve was almost identical to the total mortality curve.
  • Among examinees, cancer incidence was close to expected from the first year on. For concrete and wood workers the cancer SIR was around 95.
  • In a nested case-control analysis of lung cancer (five controls per case, adjusted for smoking and population density of home area), adjustment made little difference to relative risk in concrete workers. It played a much more significant role for insulation and sheet-metal workers. No figures were given.
  • The painters' union cohort showed about a 30% excess over expected lung cancer incidence and mortality.
  • In the painters' cohort, the lung cancer excess was mainly among those born before 1910.
  • There was a substantial number of pleural tumors among the painters. The author said this might be relevant to asbestos exposure. No count was given.
  • Among examinees aged 65-69 and 70-74, the lung cancer excess appeared to be in the oldest birth cohorts.
  • The author stated that asbestos use in Sweden peaked distinctly between 1955 and 1975.
  • The program's laboratory analyzed about 5,000 samples a year for asbestos for contractors. Results came the same day if the sample was delivered in the morning, or the next day for contractors outside Stockholm and Gothenburg.
• The authors' conclusion: The author concluded that a rapid asbestos sample-testing service for contractors is feasible and of great value in controlling asbestos exposure during demolition, rebuilding or repair.
• Limitations the authors state:
  • The examinee cohort was rather young, so an excess of long-latency diseases was less likely to show up yet.
  • The author said it was too early to draw firm conclusions from the birth-cohort pattern of lung cancer among examinees.

Related studies

• Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers — C. Jansson, A.L. Johansson, et al. (2005)
• Asbestos examinations for construction workers: a workable alternative — M.D. Whorton (1986)
• A labor-management occupational health service in a construction industry — I.R. Tabershaw, W.C. Cooper, et al. (1970)
• Respiratory cancer incidence in Swedish construction workers exposed to man-made mineral fibres and asbestos — G. Engholm, A. Englund, et al. (1987)
• Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers — M. Andersson, P.D. Blanc, et al. (2021)
• Multiple myeloma and diesel and other occupational exposures in swedish construction workers — W.J. Lee, D. Baris, et al. (2003)

Browse more research in Annals of the New York Academy of Sciences, or return to medical research.