Carol A. Burnett

Suicide and occupation: a review of the literature.

Suicide is the eighth leading cause of death in the United States. Suicide rates have been reported to be particularly high in professional, managerial, and executive groups. We reviewed English language epidemiological studies on suicide and occupation published since 1982. Some studies suggest that workers in a number of occupations, including chemistry, farming, and law enforcement, may have elevated suicide rates. The weight of current evidence supports the conclusion that both male and female physicians have elevated rates of suicide, with females at particularly high risk. Elevated rates of suicide in a particular occupational group may result from a complex interaction between job factors such as work stress and access to means and other risk factors such as age and presence of a mental disorder.

Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

Occupational dermatitis causing days away from work in U.S. private industry, 1993

BACKGROUND Occupational skin disease is an important cause of disability in the workplace. The aim of this report is to estimate the incidence of occupational dermatitis cases that causes days away from work and to characterize the cases. METHODS The Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics collects employer reports on work-related dermatitis. Descriptive data are collected on a sample of the cases that result in days away from work. Estimates of the number of cases and days away from work were calculated by industry, occupation, and exposure source. RESULTS In 1993, there were an estimated 8,835 cases of occupational dermatitis, a rate of 1.12/10,000 workers. The largest number of cases was in health services, while the highest rate was in agricultural crops. The occupation with the largest number of cases was non-construction laborers. Cleaning/polishing agents caused the largest number of cases. Calcium hydroxide and oxides caused a median of nine days away from work. DISCUSSION/CONCLUSIONS The survey data show that the effect of occupational dermatitis is substantial in the lives of workers. These descriptive data should be used to target interventions.

Ischemic heart disease mortality and occupation among 16- to 60-year-old males.

Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.

Cancer mortality in health and science technicians

BACKGROUND Nearly one million U.S. women are employed as health or science technicians with various chemical and biological exposures, but few studies have looked at their health outcomes. METHODS Using 1984-1995 mortality data with coded occupation information, we calculated race- and age-adjusted proportionate cancer mortality ratios (PCMRs) and 95% confidence intervals for two age groups for black and white women with occupations of clinical laboratory (CLT), radiologic, and science technician. RESULTS For CLTs, the PCMRs for breast cancer were borderline significantly elevated. The PCMRs for leukemia were significantly elevated, particularly for myeloid leukemia. Radiologic technicians had no significantly elevated PCMRs. Science technicians had significantly elevated PCMRs for non-Hodgkins lymphoma and multiple myeloma in the younger age group. DISCUSSION The elevated risks for lymphatic and hematopoietic neoplasms in CLTs and science technicians may be associated with occupational exposures.

Hernia: is it a work-related condition?

BACKGROUND Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects. METHODS To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated. RESULTS In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14-2.80), machine operators (RR, 2.13; 95% CI, 1.81-2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43-2.00). CONCLUSIONS Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638-644, 1999. Published 1999 Wiley-Liss, Inc.

Ischemic heart disease and acute myocardial infarction mortality among police officers.

The relationship between the occupation of police officer and ischemic heart disease (IHD) mortality was examined through case-control studies using 1968/78 death certificate records from Rhode Island and Utah. IHD was divided into two subcategories--acute myocardial infarction (AMI) and other IHD. In both states, the odds ratio (OR) for AMI was significantly elevated (Rhode Island, OR = 1.3; Utah, OR = 1.8), and was higher than the OR for other IHD (Rhode Island, OR = 1.1; Utah, OR = 1.4). The odds ratio for AMI was higher in the less than 65 yr age group (Rhode Island, OR = 2.1; Utah, OR = 2.1) than in the greater than or equal to 65 yr age group (Rhode Island, OR = 0.9; Utah, OR = 1.6). These results suggest that the elevated risk for IHD among police officers observed in this and other studies is primarily due to an elevated risk for AMI. The pattern of diminishing risk with age suggests a risk factor, possibly stress, the effect of which diminishes when exposure ceases at retirement.

Cancer mortality among laundry and dry cleaning workers.

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.

Using occupational mortality data for surveillance of work-related diseases of women

A recently developed source of occupational mortality data from 28 states for the years 1979 through 1990 can be used to meet goals for the surveillance of womens work-related diseases. A proportionate cancer mortality ratio analysis is used to illustrate use of the data to address the goals of identifying previously unrecognized work-related disease and targeting consultation or health promotion programs to appropriate occupations. Strengths of the data include broad geographical coverage and coverage of all causes of death and numerous industries and occupations. The data set is current and very large, with annual additions. The data have certain limitations. Death certificate information collected regarding occupation and cause of death may not be accurate; furthermore, death certificates have little information on potential confounding factors, such as smoking.

Occupation and lung cancer mortality among women: using occupation to target smoking cessation programs for women.

Lung cancer mortality rates are increasing for women, despite the fact that 90% of these deaths could be prevented by smoking cessation. Targeted workplace smoking cessation programs may increase the effectiveness of lung cancer prevention for women. This study uses proportionate mortality ratio analysis of occupationally coded death certificates, from 28 states between 1979 and 1990, to identify occupations in which women are at high risk of lung cancer mortality. The study found gender and racial variation in the results for broad occupational groups. Blue-collar occupations associated with potentially carcinogenic workplace exposures also had elevated proportionate mortality ratios, probably reflecting both occupational and tobacco exposure. For women, specific occupations such as managers and financial officers revealed significant elevations in lung cancer mortality. Cessation programs targeting women in these occupational groups may increase the effectiveness of lung cancer prevention.