Work-related mortality in England and Wales, 1979-2000

Our plain-English summary of Work-related mortality in England and Wales, 1979-2000, by D. Coggon, E.C. Harris, T. Brown, et al (Occupational and Environmental Medicine, 2010).

The study

• Authors: D. Coggon, E.C. Harris, T. Brown, S. Rice, K.T. Palmer
• Journal: Occupational and Environmental Medicine
• Published: 2010;67(12):816-22
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: To explore time trends in deaths attributable to work in England and Wales, and identify priorities for prevention, we conducted a proportional analysis of mortality by occupation over a 22-year period.

Methods: Analysis was based on deaths in men aged 20-74 years during 1979-1980 and 1982-2000 with a recorded occupation. Proportional mortality ratios, standardised for age and social class, were calculated for pre-specified combinations of occupation and cause of death, for which excess mortality could reasonably be attributed to work. Differences between observed and expected numbers of deaths by cause and occupation were expressed as annual excess death rates.

Results: Mortality attributable to work declined substantially over the period of study, with total excess death rates of 733.2 per year during 1979-1990 and 471.7 per year during 1991-2000. The largest contributing hazards were chronic obstructive pulmonary disease and pneumoconiosis in coal miners, pleural cancer from asbestos, and motor vehicle accidents in lorry drivers. In contrast to most other hazards, there was no clear decline in excess mortality attributable to asbestos, or in deaths from sino-nasal cancer associated with exposure to wood dust.

Conclusions: The overall decline in mortality attributable to work is likely to reflect reduced employment in more hazardous occupations, as well as improvements in working conditions. It is imperative to ensure that occupational exposures to asbestos and wood dust are now adequately controlled. Further research is needed on accidents involving lorries with the aim of developing more effective strategies for the prevention of injury.

In plain English

This study estimated how many deaths among men in England and Wales were attributable to work. The authors analysed deaths of men aged 20 to 74 in 1979 to 1980 and 1982 to 2000 with a recorded occupation: 1,564,981 deaths in 1979 to 1990 and 1,199,234 in 1991 to 2000. For pre-selected job and cause-of-death combinations, they compared observed with expected deaths, adjusting for age and social class. Excess deaths attributed to work fell from 733.2 to 471.7 per year. The largest contributors were chronic obstructive pulmonary disease and pneumoconiosis in coal miners, pleural cancer from asbestos, and motor vehicle accidents in lorry drivers. There was no clear decline in excess deaths attributed to asbestos. Excess pleural cancer deaths were 64.1 per year, then 66.2. Asbestosis deaths, all counted as work-related, were 25.6 per year, then 33.1. The authors concluded that asbestos diseases remained a priority for prevention. They noted that only the last job was recorded, that satisfactory data on the numbers at risk in each job group were not available, and that smoking may have confounded some results.

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 proportional mortality analysis by occupation, using death certificate data
• Who was studied: Men aged 20 to 74 who died in England and Wales during 1979 to 1980 and 1982 to 2000 with a recorded occupation: 1,564,981 deaths from 1979 to 1990 and 1,199,234 from 1991 to 2000. Data for 1981 were omitted.
• Exposure: Occupations, taken as the last full-time job on the death certificate, linked to pre-specified occupational hazards. Asbestos was the exposure assigned to asbestosis, pleural cancer and peritoneal cancer; no fiber types were specified. Other hazards included coal mine dust, silica dust, metal fume, wood and leather dust, alcohol, and work-related injury.
• Main results:
  • Across all occupations studied, total excess deaths attributable to work were 8066 (733.2 per year) in 1979 to 1990 and 4717 (471.7 per year) in 1991 to 2000.
  • Pleural cancer attributed to asbestos: 1472 deaths observed versus 766.5 expected (64.1 excess deaths per year) in 1979 to 1990, and 1485 observed versus 822.6 expected (66.2 excess per year) in 1991 to 2000.
  • Asbestosis, counted entirely as work-related: 281 deaths (25.6 per year) in 1979 to 1990 and 331 deaths (33.1 per year) in 1991 to 2000.
  • Peritoneal cancer attributed to asbestos: 176 deaths observed versus 90.9 expected (7.7 excess per year) in 1979 to 1990, and 168 observed versus 92.2 expected (7.6 excess per year) in 1991 to 2000.
  • The decline in work-related mortality from dusts and fumes did not extend to sino-nasal cancer, asthma, or disorders caused by asbestos.
  • In 1991 to 2000, carpenters and joiners had 197 pleural cancer deaths versus 75.0 expected (12.2 excess per year).
  • In coal miners, the fall in excess deaths from chronic obstructive pulmonary disease came partly from a lower proportional mortality ratio (1.44 to 1.36), but mainly from fewer total deaths among coal miners (27 896 versus 47 249 per year).
  • Lorry drivers had proportional mortality ratios for motor vehicle traffic accidents of 1.60 (45.3 excess deaths per year) in 1979 to 1990 and 1.75 (38.0 excess per year) in 1991 to 2000.
• The authors' conclusion: The authors concluded that deaths attributable to work fell substantially after 1979, but that several hazards remained a priority for prevention: diseases caused by asbestos, sino-nasal cancer in woodworkers, and motor vehicle accidents in lorry drivers.
• Limitations the authors state:
  • No satisfactory data were available on the populations at risk in each job group, so the authors had to base their calculations on proportional mortality.
  • Results may have been confounded by non-occupational factors such as smoking, although adjustment for social class should have reduced this.
  • Only the last full-time job was recorded, which may cause risks to be underestimated for diseases with long induction periods, such as cancers.
  • Death certificates contain errors in both occupation and cause of death.
  • Selective recruitment into certain jobs could bias results, for example among publicans and bar staff.

Topics

Medical terms in this study, explained in our Lexicon: Proportional mortality, Pneumoconiosis, Occupational Exposure.

Related studies

• Trends in mortality from occupational hazards among men in England and Wales during 1979-2010 — E.C. Harris, K.T. Palmer, et al. (2016)
• 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)
• Mortality of welders and other craftsmen at a shipyard in NE England — M.L. Newhouse, D. Oakes, et al. (1985)

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