Trends in mortality from occupational hazards among men in England and Wales during 1979-2010

Our plain-English summary of Trends in mortality from occupational hazards among men in England and Wales during 1979-2010, by E.C. Harris, K.T. Palmer, V. Cox, et al (Occupational and Environmental Medicine, 2016).

The study

• Authors: E.C. Harris, K.T. Palmer, V. Cox, A. Darnton, J. Osman, D. Coggon
• Journal: Occupational and Environmental Medicine
• Published: 2016;73(6):385-93
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To monitor the impact of health and safety provisions and inform future preventive strategies, we investigated trends in mortality from established occupational hazards in England and Wales.

Methods: We analysed data from death certificates on underlying cause of death and last full-time occupation for 3 688 916 deaths among men aged 20-74 years in England and Wales during 1979-2010 (excluding 1981 when records were incomplete). Proportional mortality ratios (PMRs), standardised for age and social class, were calculated for occupations at risk of specified hazards. Observed and expected numbers of deaths for each hazard were summed across occupations, and the differences summarised as average annual excesses.

Results: Excess mortality declined substantially for most hazards. For example, the annual excess of deaths from chronic bronchitis and emphysema fell from 170.7 during 1979-1990 to 36.0 in 2001-2010, and that for deaths from injury and poisoning from 237.0 to 87.5. In many cases, the improvements were associated with falling PMRs (suggesting safer working practices), but they also reflected reductions in the numbers of men employed in more hazardous jobs, and declining mortality from some diseases across the whole population. Notable exceptions to the general improvement were diseases caused by asbestos, especially in some construction trades and sinonasal cancer in woodworkers.

Conclusions: The highest priority for future prevention of work-related fatalities is the minority of occupational disorders for which excess mortality remains static or is increasing, in particular asbestos-related disease among certain occupations in the construction industry and sinonasal cancer in woodworkers.

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In plain English

This national study used death certificates for 3,688,916 deaths among men aged 20–74 in England and Wales in 1979–2010, excluding 1981 because records were incomplete. For jobs judged at risk of workplace hazards, the authors compared observed with expected deaths, adjusted for age and social class, as an average annual excess for three periods. Excess deaths fell for most hazards. For chronic bronchitis and emphysema the annual excess fell from 170.7 (1979–1990) to 36.0 (2001–2010). For injury and poisoning (men aged 20–64) it fell from 237.0 to 87.5. Asbestos diseases were an exception. The annual excess of asbestosis deaths rose from 25.5 to 40.7, mainly among carpenters and joiners, plumbers and platers. Excesses for cancer of the pleura (63.5, 65.8, 55.8) and peritoneum (7.6, 7.4, 7.3) stayed fairly constant. Mesothelioma at unspecified and other sites combined, recorded separately only in 2001–2010, accounted for 135.9 excess deaths a year. The authors noted that using the last recorded job probably missed many asbestos deaths. They concluded that asbestos disease in certain construction trades and sinonasal cancer in woodworkers should be the highest priorities for prevention.

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: National analysis of proportional mortality using death certificate data (underlying cause of death and last full-time occupation), comparing three time periods
• Who was studied: 3,688,916 deaths among men aged 20–74 in England and Wales during 1979–2010, excluding 1981. There were 1,564,981 deaths in 1979–1990, 1,199,234 in 1991–2000 and 924,701 in 2001–2010. Injury, poisoning and metal-fume pneumonia were analysed only for ages 20–64.
• Exposure: Established occupational hazards, assigned to job groups judged at risk. These included asbestos (for asbestosis, cancer of the pleura, cancer of the peritoneum, and mesothelioma at unspecified and other sites combined), coal mine dust, silica dust, wood and leather dust, metal fume, alcohol in bar work, and injury hazards. Fiber types were not specified.
• Main results:
  • Overall, excess mortality declined for most hazards. For chronic bronchitis and emphysema the annual excess fell from 170.7 to 36.0, and for coal workers' pneumoconiosis from 85.6 to 21.0.
  • For injury and poisoning in at-risk occupations (men aged 20–64), the annual excess of deaths fell from 237.0 in 1979–1990 to 137.4 in 1991–2000 and 87.5 in 2001–2010.
  • Excess mortality from sinonasal cancer and from asbestos diseases stayed fairly constant. Asbestosis was the exception and increased: its annual excess (deaths across all occupations) was 25.5, 33.1 and 40.7 in the three periods.
  • The main job groups contributing to the rise in asbestosis were carpenters and joiners (18.9 excess deaths in 2001–2010 against 3.8 in the earliest period), plumbers (23.1 against 9.8) and platers (13.4 against 1.9).
  • In asbestos-exposed job groups, the annual excess of deaths from cancer of the pleura was 63.5, 65.8 and 55.8 across the three periods. For cancer of the peritoneum it was 7.6, 7.4 and 7.3.
  • Mesothelioma at unspecified and other sites combined was analysed only for 2001–2010. In asbestos-exposed job groups there were 3149 deaths observed against 1790.3 expected, an annual excess of 135.9.
  • During 2001–2010, PMRs for mesothelioma at unspecified sites in the asbestos-exposed occupations correlated closely with those for cancer of the pleura (correlation coefficient 0.81).
  • Over the whole study period, calculated excess mortality in at-risk occupations accounted for 58% of 1019 asbestosis deaths and 52% of 9146 deaths from cancers of the peritoneum and pleura combined.
• The authors' conclusion: The authors concluded that excess mortality from most occupational hazards examined declined substantially between 1979 and 2010. They named disorders whose excess remains static or is increasing as the highest priority for prevention, in particular asbestos-related disease in certain construction occupations and sinonasal cancer in woodworkers.
• Limitations the authors state:
  • Cause of death came from death certificates, which are not always accurate.
  • Mesothelioma unspecified was grouped with other unspecified cancers under ICD-9, so its trend over time could not be analysed.
  • The death certificate records only the last full-time job, which may not be where the exposure happened. For mesothelioma this undercounting may have been even greater than for other diseases: at-risk occupations accounted for 52% of peritoneal and pleural cancer deaths, whereas the true attributable fraction is likely closer to 85%.
  • Confounding by smoking remains possible. Trends in lung cancer were not analysed for this reason.
  • The analysis was limited to men.
  • The authors judged that the net effect of the limitations was an undercount of mortality attributable to occupation.

Topics

Medical terms in this study, explained in our Lexicon: Death Certificate, Proportional mortality, Emphysema.

Related studies

• Work-related mortality in England and Wales, 1979-2000 — D. Coggon, E.C. Harris, et al. (2010)
• Mortality of asbestos workers in England and Wales 1971-81 — J.T. Hodgson, R.D. Jones (1986)
• Mortality from mesothelioma of the pleura during 1968-78 in England and Wales — M.J. Gardner, E.D. Acheson, et al. (1982)
• Women's occupation and cancer: preliminary analysis of cancer registrations in England and Wales, 1971-1990 — J. Simpson, E. Roman, et al. (1999)
• Mesothelioma of the peritoneum during 1967-82 in England and Wales — M.J. Gardner, R.D. Jones, et al. (1985)
• Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories — I.J. Selikoff (1992)

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